Encephalopathy and Encephalitis Associated with Cerebrospinal Fluid Cytokine Alterations and Coronavirus Disease, Atlanta, Georgia, USA, 2020

• Main Authors: Karima Benameur, Ankita Agarwal, Sara C. Auld, Matthew P. Butters, Andrew S. Webster, Tugba Ozturk, J. Christina Howell, Leda C. Bassit, Alvaro Velasquez, Raymond F. Schinazi, Mark E. Mullins, William T. Hu
• Format: Article
• Language: English
• Published: Centers for Disease Control and Prevention 2020-09-01
• Series: Emerging Infectious Diseases
• Subjects: coronavirus disease; COVID-19; severe acute respiratory syndrome coronavirus 2; SARA-CoV-2; coronaviruses; viruses
• Online Access: https://wwwnc.cdc.gov/eid/article/26/9/20-2122_article
• ISSN: 1080-6040; 1080-6059

There are few detailed investigations of neurologic complications in severe acute respiratory syndrome coronavirus 2 infection. We describe 3 patients with laboratory-confirmed coronavirus disease who had encephalopathy and encephalitis develop. Neuroimaging showed nonenhancing unilateral, bilateral, and midline changes not readily attributable to vascular causes. All 3 patients had increased cerebrospinal fluid (CSF) levels of anti-S1 IgM. One patient who died also had increased levels of anti-envelope protein IgM. CSF analysis also showed markedly increased levels of interleukin (IL)-6, IL-8, and IL-10, but severe acute respiratory syndrome coronavirus 2 was not identified in any CSF sample. These changes provide evidence of CSF periinfectious/postinfectious inflammatory changes during coronavirus disease with neurologic complications.