Objective We sought to review the literature on cerebrospinal fluid (CSF) testing in patients with COVID-19 for evidence of viral neuroinvasion by SARS-CoV-2. Methods We performed a systematic review of Medline and Embase between December 1, 2019 and November 18, 2020 to identify case reports or series of patients who had COVID-19 diagnosed based on positive SARS-CoV-2 polymerase chain reaction (PCR) or serologic testing and had CSF testing due to a neurologic symptom. Results We identified 242 relevant documents which included 430 patients with COVID-19 who had acute neurological symptoms prompting CSF testing. Of those, 321 (75%) patients had symptoms that localized to the central nervous system (CNS). Of 303 patients whose CSF was tested for SARS-CoV-2 PCR, there were 16 (5%) whose test was positive, all of whom had symptoms that localized to the central nervous system (CNS). The majority (12/16, 75%) of these patients were admitted to the hospital because of neurological symptoms. Of 58 patients whose CSF was tested for SARS-CoV-2 antibody, 7 (12%) had positive antibodies with evidence of intrathecal synthesis, all of whom had symptoms that localized to the CNS. Of 132 patients who had oligoclonal bands evaluated, 3 (2%) had evidence of intrathecal antibody synthesis. Of 72 patients tested for autoimmune antibodies in the CSF, 4 (6%) had positive findings. Conclusion Detection of SARS-CoV-2 in CSF via PCR or evaluation for intrathecal antibody synthesis appears to be rare. Most neurological complications associated with SARS- CoV-2 are unlikely to be related to direct viral neuroinvasion.

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COVID-19 中的脑脊液：文献的系统回顾

目的 我们试图回顾有关 COVID-19 患者脑脊液 (CSF) 检测的文献，以寻找 SARS-CoV-2 病毒神经侵袭的证据。方法 我们在 2019 年 12 月 1 日至 2020 年 11 月 18 日期间对 Medline 和 Embase 进行了系统回顾，以确定根据 SARS-CoV-2 聚合酶链反应 (PCR) 或血清学检测呈阳性诊断出 COVID-19 的病例报告或系列患者测试并因神经系统症状而进行脑脊液测试。结果 我们确定了 242 份相关文件，其中包括 430 名患有急性神经系统症状并需要进行脑脊液检测的 COVID-19 患者。其中 321 名 (75%) 患者出现局限于中枢神经系统 (CNS) 的症状。在 303 名患者的脑脊液中进行了 SARS-CoV-2 PCR 检测，其中 16 名（5%）患者检测结果呈阳性，所有患者均出现局限于中枢神经系统 (CNS) 的症状。这些患者中的大多数（12/16，75%）因神经系统症状入院。在 58 名患者的脑脊液中进行了 SARS-CoV-2 抗体检测，其中 7 名患者（12%）的抗体呈阳性，并有鞘内合成的证据，所有患者均出现局限于中枢神经系统的症状。在 132 名接受寡克隆带评估的患者中，3 名 (2%) 有鞘内抗体合成的证据。在 72 名接受脑脊液自身免疫抗体检测的患者中，4 名 (6%) 呈阳性结果。结论 通过 PCR 检测脑脊液中的 SARS-CoV-2 或评估鞘内抗体合成似乎很少。大多数与 SARS-CoV-2 相关的神经系统并发症不太可能与直接病毒神经侵袭有关。