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January 12, 2021; 96 (2) Article

CSF Biomarkers in Patients With COVID-19 and Neurologic Symptoms

A Case Series

Arvid Edén, Nelly Kanberg, View ORCID ProfileJohanna Gostner, Dietmar Fuchs, Lars Hagberg, Lars-Magnus Andersson, Magnus Lindh, Richard W. Price, Henrik Zetterberg, Magnus Gisslén
First published October 1, 2020, DOI: https://doi.org/10.1212/WNL.0000000000010977
Arvid Edén
From the Department of Infectious Diseases (A.E., N.K., L.H., L.-M.A., M.L., M.G.), Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg; Region Västra Götaland (A.E., N.K., L.H., L.-M.A., M.G.), Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden; Institutes of Medical Biochemistry (J.G.) and Biological Chemistry (D.F.), Medical University of Innsbruck, Biocenter, Austria; Department of Neurology (R.W.P.), University of California San Francisco; Department of Psychiatry and Neurochemistry (H.Z.), Institute of Neuroscience & Physiology, Sahlgrenska Academy at the University of Gothenburg; Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z.), UCL Institute of Neurology; and UK Dementia Research Institute at UCL (H.Z.), London.
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Nelly Kanberg
From the Department of Infectious Diseases (A.E., N.K., L.H., L.-M.A., M.L., M.G.), Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg; Region Västra Götaland (A.E., N.K., L.H., L.-M.A., M.G.), Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden; Institutes of Medical Biochemistry (J.G.) and Biological Chemistry (D.F.), Medical University of Innsbruck, Biocenter, Austria; Department of Neurology (R.W.P.), University of California San Francisco; Department of Psychiatry and Neurochemistry (H.Z.), Institute of Neuroscience & Physiology, Sahlgrenska Academy at the University of Gothenburg; Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z.), UCL Institute of Neurology; and UK Dementia Research Institute at UCL (H.Z.), London.
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Johanna Gostner
From the Department of Infectious Diseases (A.E., N.K., L.H., L.-M.A., M.L., M.G.), Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg; Region Västra Götaland (A.E., N.K., L.H., L.-M.A., M.G.), Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden; Institutes of Medical Biochemistry (J.G.) and Biological Chemistry (D.F.), Medical University of Innsbruck, Biocenter, Austria; Department of Neurology (R.W.P.), University of California San Francisco; Department of Psychiatry and Neurochemistry (H.Z.), Institute of Neuroscience & Physiology, Sahlgrenska Academy at the University of Gothenburg; Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z.), UCL Institute of Neurology; and UK Dementia Research Institute at UCL (H.Z.), London.
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  • ORCID record for Johanna Gostner
Dietmar Fuchs
From the Department of Infectious Diseases (A.E., N.K., L.H., L.-M.A., M.L., M.G.), Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg; Region Västra Götaland (A.E., N.K., L.H., L.-M.A., M.G.), Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden; Institutes of Medical Biochemistry (J.G.) and Biological Chemistry (D.F.), Medical University of Innsbruck, Biocenter, Austria; Department of Neurology (R.W.P.), University of California San Francisco; Department of Psychiatry and Neurochemistry (H.Z.), Institute of Neuroscience & Physiology, Sahlgrenska Academy at the University of Gothenburg; Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z.), UCL Institute of Neurology; and UK Dementia Research Institute at UCL (H.Z.), London.
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Lars Hagberg
From the Department of Infectious Diseases (A.E., N.K., L.H., L.-M.A., M.L., M.G.), Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg; Region Västra Götaland (A.E., N.K., L.H., L.-M.A., M.G.), Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden; Institutes of Medical Biochemistry (J.G.) and Biological Chemistry (D.F.), Medical University of Innsbruck, Biocenter, Austria; Department of Neurology (R.W.P.), University of California San Francisco; Department of Psychiatry and Neurochemistry (H.Z.), Institute of Neuroscience & Physiology, Sahlgrenska Academy at the University of Gothenburg; Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z.), UCL Institute of Neurology; and UK Dementia Research Institute at UCL (H.Z.), London.
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Lars-Magnus Andersson
From the Department of Infectious Diseases (A.E., N.K., L.H., L.-M.A., M.L., M.G.), Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg; Region Västra Götaland (A.E., N.K., L.H., L.-M.A., M.G.), Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden; Institutes of Medical Biochemistry (J.G.) and Biological Chemistry (D.F.), Medical University of Innsbruck, Biocenter, Austria; Department of Neurology (R.W.P.), University of California San Francisco; Department of Psychiatry and Neurochemistry (H.Z.), Institute of Neuroscience & Physiology, Sahlgrenska Academy at the University of Gothenburg; Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z.), UCL Institute of Neurology; and UK Dementia Research Institute at UCL (H.Z.), London.
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Magnus Lindh
From the Department of Infectious Diseases (A.E., N.K., L.H., L.-M.A., M.L., M.G.), Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg; Region Västra Götaland (A.E., N.K., L.H., L.-M.A., M.G.), Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden; Institutes of Medical Biochemistry (J.G.) and Biological Chemistry (D.F.), Medical University of Innsbruck, Biocenter, Austria; Department of Neurology (R.W.P.), University of California San Francisco; Department of Psychiatry and Neurochemistry (H.Z.), Institute of Neuroscience & Physiology, Sahlgrenska Academy at the University of Gothenburg; Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z.), UCL Institute of Neurology; and UK Dementia Research Institute at UCL (H.Z.), London.
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Richard W. Price
From the Department of Infectious Diseases (A.E., N.K., L.H., L.-M.A., M.L., M.G.), Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg; Region Västra Götaland (A.E., N.K., L.H., L.-M.A., M.G.), Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden; Institutes of Medical Biochemistry (J.G.) and Biological Chemistry (D.F.), Medical University of Innsbruck, Biocenter, Austria; Department of Neurology (R.W.P.), University of California San Francisco; Department of Psychiatry and Neurochemistry (H.Z.), Institute of Neuroscience & Physiology, Sahlgrenska Academy at the University of Gothenburg; Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z.), UCL Institute of Neurology; and UK Dementia Research Institute at UCL (H.Z.), London.
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Henrik Zetterberg
From the Department of Infectious Diseases (A.E., N.K., L.H., L.-M.A., M.L., M.G.), Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg; Region Västra Götaland (A.E., N.K., L.H., L.-M.A., M.G.), Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden; Institutes of Medical Biochemistry (J.G.) and Biological Chemistry (D.F.), Medical University of Innsbruck, Biocenter, Austria; Department of Neurology (R.W.P.), University of California San Francisco; Department of Psychiatry and Neurochemistry (H.Z.), Institute of Neuroscience & Physiology, Sahlgrenska Academy at the University of Gothenburg; Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z.), UCL Institute of Neurology; and UK Dementia Research Institute at UCL (H.Z.), London.
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Magnus Gisslén
From the Department of Infectious Diseases (A.E., N.K., L.H., L.-M.A., M.L., M.G.), Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg; Region Västra Götaland (A.E., N.K., L.H., L.-M.A., M.G.), Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden; Institutes of Medical Biochemistry (J.G.) and Biological Chemistry (D.F.), Medical University of Innsbruck, Biocenter, Austria; Department of Neurology (R.W.P.), University of California San Francisco; Department of Psychiatry and Neurochemistry (H.Z.), Institute of Neuroscience & Physiology, Sahlgrenska Academy at the University of Gothenburg; Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease (H.Z.), UCL Institute of Neurology; and UK Dementia Research Institute at UCL (H.Z.), London.
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Citation
CSF Biomarkers in Patients With COVID-19 and Neurologic Symptoms
A Case Series
Arvid Edén, Nelly Kanberg, Johanna Gostner, Dietmar Fuchs, Lars Hagberg, Lars-Magnus Andersson, Magnus Lindh, Richard W. Price, Henrik Zetterberg, Magnus Gisslén
Neurology Jan 2021, 96 (2) e294-e300; DOI: 10.1212/WNL.0000000000010977

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    Figure 1 Disease Course in the 6 Patients

    Details of the disease courses in individual patients, including viral load in nasopharyngeal swabs as index. Vertical arrow indicates time of lumbar puncture. Geometric symbols on dashed line are individual as also seen in figure 2. Patient 1 died during the study period. Patient 2 was still admitted at the time of manuscript submission. Patients 3 through 6 were discharged. Patients 1 and 2 were treated with chloroquine phosphate; patient 5 was treated with remdesivir. ICU = intensive care unit; NPH = nasopharynx.

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    Figure 2 Viral and Biomarker Measurements

    (A) CSF white blood cell was <3 cells/µL in all patients; symbol shape and colors apply to the patient number and are used in all panels. (B) Albumin ratios and immunoglobulin G (IgG) index values were all in the normal range. The median (range) albumin ratio was 5.35 (4.3–9.7) with a reference value of <10.2, and median (range) IgG index was 0.39 (0.32–0.43) with a reference value of <0.63. (C) CSF neopterin concentrations were elevated in all patients. Median (range) CSF neopterin concentrations were 43.0 (26.7–50.0) nmol/L with an upper normal reference value of 5.8 nmol/L (CSF). CSF β2-microglobulin (β2M) was elevated in 5 of 5 measured CSF samples. Median (range) CSF β2M concentration was 3.1 (1.6–7.2) mg/L with an upper normal reference value of 1.8 mg/L. Both normal reference values are indicated by dashed lines. (D) CSF neurofilament light chain protein (NfL) was increased in 2 patients. The median (range) age-adjusted CSF NfL (65 years of age) was 974 (669–1998) ng/L with an upper normal reference value of 1,577 ng/L.

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  • Reader response: CSF biomarkers in patients with COVID-19 and neurological symptoms: A case series
    • Anand Kumar, Assistant Professor, Neurology, Banaras Hindu University, Institute of Medical Sciences (Varanasi, India)
    • Neha Lall, Junior Resident, Radiotherapy & Radiation Medicine, Banaras Hindu University, Institute of Medical Sciences (Varanasi, India)
    Submitted October 02, 2020
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