scholarly journals Cerebrospinal fluid findings and hypernatremia in COVID-19 patients with altered mental status

2020 ◽  
Vol 13 (1) ◽  
Author(s):  
Hale Toklu ◽  
Latha Ganti ◽  
Ettore Crimi ◽  
Cristobal Cintron ◽  
Joshua Hagan ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Cell Count ◽  
Mental Status ◽  
Total Protein ◽  
Neuron Specific Enolase ◽  
Altered Mental Status ◽  
Hospital Length Of Stay ◽  
Hospital Death ◽  
Csf Analysis ◽  
Normal White Blood Cell

Abstract Background The objective of the study was to assess the cerebrospinal fluid (CSF) findings in COVID-19 patients. Aims This was an observational retrospective cohort from electronic medical records of hospitalized patients (n = 2655) with confirmed COVID-19 between February 15, 2020, and April 15, 2020, in 182 hospitals from a large health system in the USA. The review of data yielded to a total of 79 patients in 20 hospitals who had CSF analysis. Methods Outcomes during hospitalization, including hospital length of stay, disease severity, ventilator time, and in-hospital death were recorded. Independent variables collected included patient demographics, diagnoses, laboratory values, and procedures. Results A total of 79 patients underwent CSF analysis. Of these, antigen testing was performed in 73 patients. Ten patients had CSF analysis for general markers such as total protein, cell count, glucose, clarity, and color. Seven of the 10 cases (70%) had normal total cell count and normal white blood cell count in CSF. Sixty-three percent (5/8) had elevated total protein. Two patients had normal levels of lactate dehydrogenase (LDH) and 1 patient had significantly elevated (fourfold) neuron-specific enolase (NSE) level in CSF. Conclusion Unlike bacterial infections, viral infections are less likely to cause remarkable changes in CSF glucose, cell count, or protein. Our observations showed no pleocytosis, but mild increase in protein in the CSF of the COVID-19 patients. The fourfold elevation of NSE may have diagnostic/prognostic value as a biomarker in CSF for COVID-19 patients who have altered mental status. Graphical abstract

scholarly journals Acute childhood encephalopathy with prolonged fever, pleocytosis and elevated inflammatory cytokines in the cerebrospinal fluid and transient splenial lesion

2019 ◽  
Author(s):  
Rena Okada ◽  
Yuri Sakaguchi ◽  
Takeshi Matsushige ◽  
Isamu Kamimaki ◽  
Toshiki Takenouchi ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Mental Status ◽  
Nationwide Survey ◽  
Altered Mental Status ◽  
Acute Encephalopathy ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Prolonged Fever ◽  
Splenial Lesion ◽  
Male Patients

Background: Acute encephalopathy during childhood represents a highly heterogeneous group of infectious and non-infectious pathologies. According to a recent nationwide survey on acute childhood encephalopathy in Japan, the combination of clinical and radiographic features left approximately half of the affected children unclassified, mainly because of the lack of disease-specific biomarkers. Case: Herein, we document a school-aged boy who manifested with acute encephalopathy that was characterized by a prolonged fever, altered mental status, urinary retention, and intention tremor lasting for more than a month. Accompanying features included syndrome of inappropriate secretion of antidiuretic hormone, pleocytosis with elevated interleukin-6 and interferon-gamma levels in the cerebrospinal fluid, and a transient splenial lesion on neuroimaging. No pathogens were identified, and C-reactive protein was negative throughout his clinical course. This constellation of clinical features was not compatible with any of the existing entities of acute pediatric encephalopathy. Discussion: Our retrospective literature review identified two additional school-aged male patients who exhibited highly similar clinical courses. The prolonged altered mental status with pleocytosis in the cerebrospinal fluid and a transient splenial lesion in the absence of serum inflammatory markers suggest a primary central nervous system pathology. Conclusion: This combination of features defines this presumably new group of acute childhood febrile encephalopathy with prolonged fever and ataxia in school-aged boys.

scholarly journals Inflammatory cerebrospinal fluid analysis in cats: Clinical diagnosis and outcome

2005 ◽  
Vol 7 (2) ◽  
pp. 77-93 ◽  
Author(s):  
M. Singh ◽  
D.J. Foster ◽  
G. Child ◽  
W.A. Lamb
Keyword(s):  
Central Nervous System ◽  
Cerebrospinal Fluid ◽  
Nervous System ◽  
Cell Count ◽  
Clinical Signs ◽  
Central Nervous System Disease ◽  
Nervous System Disease ◽  
Differential Count ◽  
System Disease ◽  
Csf Analysis

The medical records of 62 cats with clinical signs of central nervous system disease and accompanying inflammatory cerebrospinal fluid (CSF) analysis were examined retrospectively to determine if signalment, clinical signs, CSF analysis and ancillary testing could accurately predict the type of central nervous system disease that was present. An inflammatory CSF was defined as one in which a total nucleated cell count was greater than 5 cells/μl or one in which the total nucleated cell count was normal but the nucleated cell differential count was abnormal. Sex, degree of CSF inflammation, neuroanatomical location and systemic signs provided little contributory information to the final diagnosis. In 63% of the cases a presumptive diagnosis could be made based on a combination of clinical signs, clinicopathological data and ancillary diagnostic tests. CSF analysis alone was useful only in the diagnosis of cats with feline infectious peritonitis, Cryptococcus species infection, lymphoma and trauma. Overall, despite extensive diagnostic evaluation, a specific diagnosis could not be made in 37% of cats. The prognosis for cats with inflammatory CSF was poor with 77% of cats surviving less than 1 year.

Distinguishing neurosarcoidosis from multiple sclerosis based on CSF analysis

Neurology ◽  
2020 ◽  
Vol 94 (24) ◽  
pp. e2545-e2554
Author(s):  
Tarunya Arun ◽  
Laura Pattison ◽  
Jacqueline Palace
Keyword(s):  
Multiple Sclerosis ◽  
Cell Count ◽  
Total Protein ◽  
White Cell Count ◽  
Binary Logistic Regression ◽  
White Cell ◽  
Oligoclonal Bands ◽  
Csf Analysis ◽  
Elevated Protein ◽  
Oligoclonal Igg

ObjectiveTo characterize a cohort of patients with neurosarcoidosis with particular focus on CSF analysis and to investigate whether CSF values could help in distinguishing it from multiple sclerosis (MS).MethodsThis retrospective cohort study enrolled 85 patients with a diagnosis of neurosarcoidosis (possible, probable, or definite). CSF total protein, white cell count, and angiotensin-converting enzyme levels were measured. CSF and serum oligoclonal immunoglobulin G (IgG) patterns were analyzed with the use of odds ratios and binary logistic regression.ResultsEighty patients had a probable (nonneural positive histology) or definite (neural positive histology) diagnosis of neurosarcoidosis. Most frequent findings on MRI were leptomeningeal enhancement (35%) and white matter and spinal cord involvement (30% and 23%). PET scan showed avid areas in 74% of cases. CSF analysis frequently showed lymphocytosis (63%) and elevated protein (62%), but CSF-selective oligoclonal bands were rare (3%). Serum ACE levels were elevated in 51% of patients but in only 14% of those with isolated neurosarcoidosis. Elevated CSF ACE was not found in any patient.ConclusionsLarge elevations in total protein, white cell count, and serum ACE occur in neurosarcoidosis but are rare in MS. The diagnostic use of these tests is, however, limited because minimal changes may occur in both. MS clinical mimics in neurosarcoidosis are not common, and intrathecal synthesis of oligoclonal IgG is a powerful discriminator because it is rare in neurosarcoidosis but occurs in 95% to 98% cases of MS. We suggest caution in making a diagnosis of neurosarcoidosis when intrathecal oligoclonal IgG synthesis is found.

scholarly journals Confusional State in HaNDL Syndrome: Case Report and Literature Review

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Sarah Nelson
Keyword(s):  
Cerebrospinal Fluid ◽  
Case Report ◽  
Literature Review ◽  
Mental Status ◽  
Clinical Manifestation ◽  
English Language ◽  
Altered Mental Status ◽  
Confusional State ◽  
Limited Condition ◽  
Confusional States

The syndrome of transient headache and neurologic deficits with cerebrospinal fluid lymphocytosis (HaNDL syndrome) is a self-limited condition. Confusional states are uncommonly reported as a clinical manifestation of this syndrome. Here, I report a 76-year-old female who presented with headache, confusion, and agitation with a mild CSF lymphocytosis. Other workup to determine the cause of her altered mental status was otherwise negative. The literature available in the English language on HaNDL syndrome is reviewed, including its history, pathophysiology, possible associations with migraine and stroke, and previously reported cases of confusional states in this syndrome. While HaNDL syndrome has been a described entity since the 1980s, its pathophysiology has yet to be clearly defined.

Altered Mental Status During the COVID-19 Pandemic

2021 ◽  
pp. 254-256
Author(s):  
Sara Mariotto ◽  
Silvia Bozzetti ◽  
Maria Elena De Rui ◽  
Fulvia Mazzaferri ◽  
Andrew McKeon ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cerebrospinal Fluid ◽  
Magnetic Resonance ◽  
Mental Status ◽  
Central Nervous System Infection ◽  
Brain Magnetic Resonance Imaging ◽  
Altered Mental Status ◽  
High Dose ◽  
Resonance Imaging ◽  
Vein Thrombosis

In March 2020, a 68-year-old man with a history of pulmonary thromboembolism sought care at the emergency department for fever, cough, headache, and confusion. Because of severe respiratory failure, orotracheal intubation was required, and the patient was admitted to the intensive care unit, where bilateral deep vein thrombosis and hematemesis occurred. After 2 weeks, owing to respiratory improvement, the patient was weaned from ventilator support and sedation. However, persistent fluctuations in confusion, anxiety, agitation, and cognitive-motor slowing were noted. One week later, he was referred to the infectious diseases unit, where altered mental status persisted in the absence of fever, seizures, or episodes of impaired consciousness. Chest radiography showed small, bilateral, ground-glass opacities. Brain magnetic resonance imaging showed bilateral involvement of mesial temporal lobes and hippocampus on fluid-attenuated inversion recovery sequences, in the absence of contrast enhancement or restricted diffusion. Nasopharyngeal samples were positive for SARS-CoV-2 on reverse transcriptase–polymerase chain reaction testing. Cerebrospinal fluid examination showed a slight increase in protein concentration, 1 white blood cell/µL, and no evidence of central nervous system infection. In particular, SARS-CoV-2 RNA was not detected. The patient was diagnosed with postinfectious inflammatory (limbic) encephalitis in the course of SARS-CoV-2 infection. The patient was treated with lopinavir/ritonavir and hydroxychloroquine. His recent thromboembolism prevented the administration of intravenous immunoglobulins, and high-dose corticosteroids were not administered because of the recent episode of hematemesis. Improvement in cognitive symptoms was noted 6 weeks after onset. At the time of this writing, May 2020, a few cases of encephalitis after COVID-19 had already been described. These have generally been characterized by fever, cognitive dysfunction, epileptic seizures, coma, and cerebrospinal fluid inflammatory findings. It appears that a common magnetic resonance imaging appearance in these patients is that of diffuse inflammatory encephalitis.

scholarly journals Clinical and Laboratory Findings That Differentiate Herpes Simplex Virus Central Nervous System Disease from Enteroviral Meningitis

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Layli Sanaee ◽  
Monica Taljaard ◽  
Tim Karnauchow ◽  
Jeffrey J. Perry
Keyword(s):  
Central Nervous System ◽  
Cerebrospinal Fluid ◽  
Nervous System ◽  
Herpes Simplex Virus ◽  
Herpes Simplex ◽  
Mental Status ◽  
Altered Mental Status ◽  
Neurological Deficits ◽  
Simplex Virus ◽  
Csf Findings

Background. It can be difficult for clinicians to distinguish between the relatively benign enteroviral (EnV) meningitis and potentially lethal herpes simplex virus (HSV) central nervous system (CNS) disease. Very limited evidence currently exists to guide them.Objective. This study sought to identify clinical features and cerebrospinal fluid (CSF) findings associated with HSV CNS disease.Methods. Given that PCR testing often is not immediately available, this chart review study sought to identify clinical and cerebrospinal fluid (CSF) findings associated with HSV meningitis over a 6-year period. In cases where PCR was not performed, HSV and EnV were assigned based on clinical criteria.Results. We enrolled 166 consecutive patients: 40 HSV and 126 EnV patients. HSV patients had a mean 40.4 versus 31.3 years for EnV,p=0.005, seizures 21.1% versus 1.6% for EnV,p<0.001, altered mental status 46.2% versus 3.2% for EnV,p<0.001, or neurological deficits 44.7% versus 3.9% for EnV,p<0.001. CSF neutrophils were lower in HSV (median 3.0% versus 9.5%,p=0.0002); median lymphocytes (87.0% versus 67.0%,p=0.0004) and protein (0.9 g/L versus 0.6 g/L,p=0.0005) were elevated.Conclusion. Our study found that HSV patients were older and more likely to have seizure, altered mental status, or neurological deficits than patients with benign EnV meningitis. HSV cases had lower CSF neutrophils, higher lymphocytes, and higher protein levels.

Pragmatic and evidence-based approach to paediatric cerebrospinal fluid reference limits for white cell count and concentrations of total protein and glucose

2018 ◽  
Vol 71 (10) ◽  
pp. 932-935 ◽  
Author(s):  
Nicky Josman ◽  
Nancy W S Tee ◽  
Matthias Maiwald ◽  
Liat Hui Loo ◽  
Clement K M Ho
Keyword(s):  
Cerebrospinal Fluid ◽  
Cell Count ◽  
Total Protein ◽  
Clinical Laboratory ◽  
White Cell Count ◽  
Reference Intervals ◽  
White Cell ◽  
Invasive Procedures ◽  
Paediatric Hospital ◽  
Reference Limits

BackgroundIt is often impractical for each laboratory to establish its own paediatric reference intervals. This is particularly true for specimen types collected using invasive procedures, for example, cerebrospinal fluid (CSF).MethodsPublished CSF reference intervals for white cell count, and concentrations of total protein and glucose were reviewed by stakeholders in a paediatric hospital. Consensus reference intervals for the three CSF parameters were then subjected to verification using guidelines from the Clinical Laboratory Standards Institute and residual CSF specimens.ResultsConsensus paediatric reference intervals adapted from published studies with minor modifications were locally verified as follows. White cell count (x106 cells/L): 0–20 (<1 month); 0–10 (1–2 months); 0–5 (>2 months). Total protein (g/L): 0.3–1.2 (<1 month); 0.2–0.6 (1–3 months); 0.1–0.4 (>3 months). Glucose (mmol/L): 2.0–5.6 (<6 months); 2.4–4.3 (6 months or older).

scholarly journals Cerebrospinal Fluid Lactate as a Prognostic Marker of Disease Severity and Mortality in Cryptococcal Meningitis

2020 ◽  
Author(s):  
Mahsa Abassi ◽  
Ananta S Bangdiwala ◽  
Edwin Nuwagira ◽  
Kiiza Kandole Tadeo ◽  
Michael Okirwoth ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Disease Severity ◽  
Prognostic Marker ◽  
Mental Status ◽  
Cryptococcal Meningitis ◽  
Clinical Characteristics ◽  
Point Of Care ◽  
Altered Mental Status ◽  
Csf Lactate ◽  
Lactate Levels

Abstract Background Cerebrospinal fluid (CSF) lactate levels can differentiate between bacterial and viral meningitis. We measured CSF lactate in individuals with cryptococcal meningitis to determine its clinical significance. Methods We measured point-of-care CSF lactate at the bedside of 319 HIV-infected Ugandan adults at diagnosis of cryptococcal meningitis. We summarized demographic variables and clinical characteristics by CSF lactate tertiles. We evaluated the association of CSF lactate with clinical characteristics and survival. Results Individuals with high CSF lactate &gt;5 mmol/L at cryptococcal diagnosis more likely presented with altered mental status (p&lt;.0001), seizures (p=.0005), elevated intracranial opening pressure (p=.03), higher CSF white cells (p=.007), and lower CSF glucose (p=.0003) compared to those with mid-range (3.1 to 5 mmol/L) or low (≤3 mmol/L) CSF lactate levels. Two-week mortality was higher among individuals with high baseline CSF lactate &gt;5 mmol/L (35%; 38/109) as compared to individuals with mid-range (22%; 25/112) or low CSF lactate (9%; 9/97; p=&lt;.0001). After multivariate adjustment, CSF lactate &gt;5mmol/L remained independently associated with excess mortality (adjusted Hazard Ratio = 3.41; 95%CI, 1.55-7.51; p=.002). We found no correlation between baseline CSF lactate levels and blood capillary lactate levels (p=.72). Conclusions Baseline point-of-care CSF lactate levels may be utilized as a prognostic marker of disease severity and mortality in cryptococcal meningitis. Individuals with an elevated baseline CSF lactate are more likely to present with altered mental status, seizures, elevated CSF opening pressures, and are at a greater risk of death. Future studies are needed to determine targeted therapeutic management strategy in persons with high CSF lactate.

scholarly journals Varicella Zoster Virus Meningitis in a Young Immunocompetent Adult without Rash: A Misleading Clinical Presentation

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Thomas Pasedag ◽  
Karin Weissenborn ◽  
Ulrich Wurster ◽  
Tina Ganzenmueller ◽  
Martin Stangel ◽  
...  
Keyword(s):  
Bacterial Infection ◽  
Cell Count ◽  
Varicella Zoster Virus ◽  
Total Protein ◽  
Antiviral Treatment ◽  
Neurological Deficits ◽  
Healthy Population ◽  
Varicella Zoster ◽  
Csf Analysis ◽  
Acute Headache

Meningitis caused by varicella zoster virus (VZV) is rare in healthy population. Predominantly immunocompromised patients are affected by reactivation of this virus with primary clinical features of rash and neurological symptoms. Here we report a young otherwise healthy man diagnosed with a VZV meningitis without rash. He complained of acute headache, nausea, and vomiting. The clinical examination did not show any neurological deficits or rash. Cerebrospinal fluid (CSF) analysis revealed a high leukocyte cell count of 1720 cells/µL and an elevated total protein of 1460 mg/L misleadingly indicating a bacterial infection. Further CSF analyses, including polymerase chain reaction (PCR) and detection of intrathecal synthesis of antibodies, showed a VZV infection. Clinical and CSF follow-up examinations proved the successful antiviral treatment. In conclusion, even young immunocompetent patients without rash might present with VZV meningitis. CSF examination is a key procedure in the diagnosis of CNS infections but in rare cases the standard values cell count and total protein might misleadingly indicate a bacterial infection. Thus, virological analyses should be considered even when a bacterial infection is suspected.

scholarly journals Cerebrospinal Fluid Lactate as a Prognostic Marker of Disease Severity and Mortality in Cryptococcal Meningitis

2020 ◽  
Author(s):  
Mahsa Abassi ◽  
Ananta S Bangdiwala ◽  
Edwin Nuwagira ◽  
Kiiza Kandole Tadeo ◽  
Michael Okirwoth ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Disease Severity ◽  
Prognostic Marker ◽  
Mental Status ◽  
Cryptococcal Meningitis ◽  
Clinical Characteristics ◽  
Point Of Care ◽  
Altered Mental Status ◽  
Csf Lactate ◽  
Lactate Levels

Background: Cerebrospinal fluid (CSF) lactate levels can differentiate between bacterial and viral meningitis. We measured CSF lactate in individuals with cryptococcal meningitis to determine its clinical significance. Methods: We measured point-of-care CSF lactate at the bedside of 319 HIV-infected Ugandan adults at diagnosis of cryptococcal meningitis. We summarized demographic variables and clinical characteristics by CSF lactate tertiles. We evaluated the association of CSF lactate with clinical characteristics and survival. Results: Individuals with high CSF lactate >5 mmol/L at cryptococcal diagnosis more likely presented with altered mental status (p<.0001), seizures (p=.0005), elevated intracranial opening pressure (p=.03), higher CSF white cells (p=0.007), and lower CSF glucose (p=.0003) compared to those with mid-range (3.1 to 5 mmol/L) or low (≤3 mmol/L) CSF lactate levels. Two-week mortality was higher among individuals with high baseline CSF lactate >5 mmol/L (35%; 38/109) as compared to individuals with mid-range (22%; 25/112) or low CSF lactate (9%; 9/97; p=<.0001). After multivariate adjustment, CSF lactate >5mmol/L remained independently associated with excess mortality (adjusted Hazard Ratio = 3.41; 95%CI, 1.55-7.51; p=.002). We found no correlation between baseline CSF lactate levels and blood capillary lactate levels (p=.72). Conclusions: Baseline point-of-care CSF lactate levels may be utilized as a prognostic marker of disease severity and mortality in cryptococcal meningitis. Individuals with an elevated baseline CSF lactate are more likely to present with altered mental status, seizures, elevated CSF opening pressures, and are at a greater risk of death. Future studies are needed to determine targeted therapeutic management strategy in persons with high CSF lactate.

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