ArticleNeurology2020
Acute necrotizing encephalopathy with SARS-CoV-2 RNA confirmed in cerebrospinal fluid.
Registry-linked trialOpen access · hybridAbstract readCase Reports
In one paragraph
Article in Neurology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04775784 (Determination of SARS-Cov-2 Virus in Central Nervous System), which is not on this map. Cited by 156 papers, 15 of them syntheses that pooled it.
0numbers the graph read from it
0cells of the map it votes in
156citing papers in PubMed, 15 pooled it
20.5field-weighted citation impact, top 1% of its field
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Determination of SARS-Cov-2 Virus in Central Nervous System
Who cites it
156 citing papers in PubMed, 15 syntheses or guidelines pooled it, 253 citations in OpenAlex.
- Defining the Clinicoradiologic Syndrome of SARS-CoV-2 Acute Necrotizing Encephalopathy: A Systematic Review and 3 New Pediatric CasesNeurology(R) neuroimmunology & neuroinflammation · 2024Pooled it
- Acute necrotizing encephalopathy associated with COVID-19: case series and systematic review.Journal of neurology · 2023Pooled it
- Cerebrospinal fluid cytokines in COVID-19: a review and meta-analysis.Journal of neurology · 2023Pooled it
- Pooled it
- Neurological and Head/Eyes/Ears/Nose/Throat Manifestations of COVID-19: A Systematic Review and Meta-Analysis.The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques · 2022Pooled it
- Clinical symptoms, diagnosis, treatment, and outcome of COVID-19-associated encephalitis: A systematic review of case reports and case series.Journal of clinical laboratory analysis · 2022Pooled it
- Association of CNS demyelination and COVID-19 infection: an updated systematic review.Journal of neurology · 2022Pooled it
- Systematic review of cases of acute myelitis in individuals with COVID-19.European journal of neurology · 2021Pooled it
- COVID-19 associated brain/spinal cord lesions and leptomeningeal enhancement: A meta-analysis of the relationship to CSF SARS-CoV-2.Journal of neuroimaging : official journal of the American Society of Neuroimaging · 2021Pooled it
- Central and peripheral nervous system involvement by COVID-19: a systematic review of the pathophysiology, clinical manifestations, neuropathology, neuroimaging, electrophysiology, and cerebrospinal fluid findings.BMC infectious diseases · 2021Pooled it
- A Comprehensive Systematic Review of CSF analysis that defines Neurological Manifestations of COVID-19.International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2021Pooled it
- Cerebrospinal fluid in COVID-19: A systematic review of the literature.Journal of the neurological sciences · 2021Pooled it
- Neuroradiological Features of Mild and Severe SARS-CoV-2 Infection.Academic radiology · 2020Pooled it
- Brain abnormalities in COVID-19 acute/subacute phase: A rapid systematic review.Brain, behavior, and immunity · 2020Pooled it
- Neurological manifestations of coronavirus infections - a systematic review.Annals of clinical and translational neurology · 2020Pooled it
- Differences in Neurofilament Light Chain, Glial Fibrillary Acidic Protein, and Tau Protein Levels in Patients with Temporal Lobe Epilepsy and Comorbid Depression.Molecular neurobiology · 2026Article
- Acute necrotizing encephalopathy associated with COVID-19 in a pediatric patient and a systematic review.Journal of human immunity · 2026Article
- Acute Hemorrhagic Necrotizing Encephalopathy in a COVID-19 Patient With a Response to Intravenous Immunoglobulin Therapy.The American journal of case reports · 2026Article
- SARS-CoV-2-induced damage to rat cortical neuronal networks ex vivo is mediated by the pro-inflammatory activation of the cGAS-STING pathway.Journal of neurovirology · 2025Article
- Expression of SARS-CoV-2 entry receptor ACE2 in human brain and its association with Alzheimer's disease and COVID-19.Molecular psychiatry · 2025Review
96 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
18 authors at 1 institution in 1 country.
Johan VirhammarFrom the Department of Neuroscience (J.V., E.K., S.J.), Neurology, Uppsala University, Uppsala, Sweden; Department of Surgical Sciences (D.F., J.W., A.G.), Radiology, Uppsala University, Uppsala, Sweden; Department of Surgical Sciences (R.F., H.D.P.D.O.-R.), Anaesthesia and Intensive Care, Uppsala University, Uppsala, Sweden; Department of Neuroscience (M.K.S., H.D.P.D.O.-R., E.R.), Neurosurgery, Uppsala University, Uppsala, Sweden; Department of Internal Medicine (M.K., J.L.), Nyköping Hospital, Nyköping, Sweden; Department of Radiology (J.F.), Nyköping Hospital, Nyköping, Sweden; Department of Neuroscience (J.L.C.), Psychiatry, Uppsala University, Uppsala, Sweden; Department of Medical Sciences (K.B.), Uppsala University, Uppsala, Sweden; Department of Chemistry-BMC (J.B.), Analytical Chemistry and Neurochemistry, Uppsala University, Uppsala, Sweden; Department of Psychiatry and Neurochemistry (H.Z.), Institute of Neuroscience & Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal; and Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden.
Eva KumlienFrom the Department of Neuroscience (J.V., E.K., S.J.), Neurology, Uppsala University, Uppsala, Sweden; Department of Surgical Sciences (D.F., J.W., A.G.), Radiology, Uppsala University, Uppsala, Sweden; Department of Surgical Sciences (R.F., H.D.P.D.O.-R.), Anaesthesia and Intensive Care, Uppsala University, Uppsala, Sweden; Department of Neuroscience (M.K.S., H.D.P.D.O.-R., E.R.), Neurosurgery, Uppsala University, Uppsala, Sweden; Department of Internal Medicine (M.K., J.L.), Nyköping Hospital, Nyköping, Sweden; Department of Radiology (J.F.), Nyköping Hospital, Nyköping, Sweden; Department of Neuroscience (J.L.C.), Psychiatry, Uppsala University, Uppsala, Sweden; Department of Medical Sciences (K.B.), Uppsala University, Uppsala, Sweden; Department of Chemistry-BMC (J.B.), Analytical Chemistry and Neurochemistry, Uppsala University, Uppsala, Sweden; Department of Psychiatry and Neurochemistry (H.Z.), Institute of Neuroscience & Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal; and Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden.
David FällmarFrom the Department of Neuroscience (J.V., E.K., S.J.), Neurology, Uppsala University, Uppsala, Sweden; Department of Surgical Sciences (D.F., J.W., A.G.), Radiology, Uppsala University, Uppsala, Sweden; Department of Surgical Sciences (R.F., H.D.P.D.O.-R.), Anaesthesia and Intensive Care, Uppsala University, Uppsala, Sweden; Department of Neuroscience (M.K.S., H.D.P.D.O.-R., E.R.), Neurosurgery, Uppsala University, Uppsala, Sweden; Department of Internal Medicine (M.K., J.L.), Nyköping Hospital, Nyköping, Sweden; Department of Radiology (J.F.), Nyköping Hospital, Nyköping, Sweden; Department of Neuroscience (J.L.C.), Psychiatry, Uppsala University, Uppsala, Sweden; Department of Medical Sciences (K.B.), Uppsala University, Uppsala, Sweden; Department of Chemistry-BMC (J.B.), Analytical Chemistry and Neurochemistry, Uppsala University, Uppsala, Sweden; Department of Psychiatry and Neurochemistry (H.Z.), Institute of Neuroscience & Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal; and Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden.ORCID 0000-0001-5615-2036
Robert FrithiofFrom the Department of Neuroscience (J.V., E.K., S.J.), Neurology, Uppsala University, Uppsala, Sweden; Department of Surgical Sciences (D.F., J.W., A.G.), Radiology, Uppsala University, Uppsala, Sweden; Department of Surgical Sciences (R.F., H.D.P.D.O.-R.), Anaesthesia and Intensive Care, Uppsala University, Uppsala, Sweden; Department of Neuroscience (M.K.S., H.D.P.D.O.-R., E.R.), Neurosurgery, Uppsala University, Uppsala, Sweden; Department of Internal Medicine (M.K., J.L.), Nyköping Hospital, Nyköping, Sweden; Department of Radiology (J.F.), Nyköping Hospital, Nyköping, Sweden; Department of Neuroscience (J.L.C.), Psychiatry, Uppsala University, Uppsala, Sweden; Department of Medical Sciences (K.B.), Uppsala University, Uppsala, Sweden; Department of Chemistry-BMC (J.B.), Analytical Chemistry and Neurochemistry, Uppsala University, Uppsala, Sweden; Department of Psychiatry and Neurochemistry (H.Z.), Institute of Neuroscience & Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal; and Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden.
Sven JackmannFrom the Department of Neuroscience (J.V., E.K., S.J.), Neurology, Uppsala University, Uppsala, Sweden; Department of Surgical Sciences (D.F., J.W., A.G.), Radiology, Uppsala University, Uppsala, Sweden; Department of Surgical Sciences (R.F., H.D.P.D.O.-R.), Anaesthesia and Intensive Care, Uppsala University, Uppsala, Sweden; Department of Neuroscience (M.K.S., H.D.P.D.O.-R., E.R.), Neurosurgery, Uppsala University, Uppsala, Sweden; Department of Internal Medicine (M.K., J.L.), Nyköping Hospital, Nyköping, Sweden; Department of Radiology (J.F.), Nyköping Hospital, Nyköping, Sweden; Department of Neuroscience (J.L.C.), Psychiatry, Uppsala University, Uppsala, Sweden; Department of Medical Sciences (K.B.), Uppsala University, Uppsala, Sweden; Department of Chemistry-BMC (J.B.), Analytical Chemistry and Neurochemistry, Uppsala University, Uppsala, Sweden; Department of Psychiatry and Neurochemistry (H.Z.), Institute of Neuroscience & Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal; and Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden.
Mattias K SköldFrom the Department of Neuroscience (J.V., E.K., S.J.), Neurology, Uppsala University, Uppsala, Sweden; Department of Surgical Sciences (D.F., J.W., A.G.), Radiology, Uppsala University, Uppsala, Sweden; Department of Surgical Sciences (R.F., H.D.P.D.O.-R.), Anaesthesia and Intensive Care, Uppsala University, Uppsala, Sweden; Department of Neuroscience (M.K.S., H.D.P.D.O.-R., E.R.), Neurosurgery, Uppsala University, Uppsala, Sweden; Department of Internal Medicine (M.K., J.L.), Nyköping Hospital, Nyköping, Sweden; Department of Radiology (J.F.), Nyköping Hospital, Nyköping, Sweden; Department of Neuroscience (J.L.C.), Psychiatry, Uppsala University, Uppsala, Sweden; Department of Medical Sciences (K.B.), Uppsala University, Uppsala, Sweden; Department of Chemistry-BMC (J.B.), Analytical Chemistry and Neurochemistry, Uppsala University, Uppsala, Sweden; Department of Psychiatry and Neurochemistry (H.Z.), Institute of Neuroscience & Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal; and Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden.
Mohamed KadirFrom the Department of Neuroscience (J.V., E.K., S.J.), Neurology, Uppsala University, Uppsala, Sweden; Department of Surgical Sciences (D.F., J.W., A.G.), Radiology, Uppsala University, Uppsala, Sweden; Department of Surgical Sciences (R.F., H.D.P.D.O.-R.), Anaesthesia and Intensive Care, Uppsala University, Uppsala, Sweden; Department of Neuroscience (M.K.S., H.D.P.D.O.-R., E.R.), Neurosurgery, Uppsala University, Uppsala, Sweden; Department of Internal Medicine (M.K., J.L.), Nyköping Hospital, Nyköping, Sweden; Department of Radiology (J.F.), Nyköping Hospital, Nyköping, Sweden; Department of Neuroscience (J.L.C.), Psychiatry, Uppsala University, Uppsala, Sweden; Department of Medical Sciences (K.B.), Uppsala University, Uppsala, Sweden; Department of Chemistry-BMC (J.B.), Analytical Chemistry and Neurochemistry, Uppsala University, Uppsala, Sweden; Department of Psychiatry and Neurochemistry (H.Z.), Institute of Neuroscience & Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal; and Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden.
Jens FrickFrom the Department of Neuroscience (J.V., E.K., S.J.), Neurology, Uppsala University, Uppsala, Sweden; Department of Surgical Sciences (D.F., J.W., A.G.), Radiology, Uppsala University, Uppsala, Sweden; Department of Surgical Sciences (R.F., H.D.P.D.O.-R.), Anaesthesia and Intensive Care, Uppsala University, Uppsala, Sweden; Department of Neuroscience (M.K.S., H.D.P.D.O.-R., E.R.), Neurosurgery, Uppsala University, Uppsala, Sweden; Department of Internal Medicine (M.K., J.L.), Nyköping Hospital, Nyköping, Sweden; Department of Radiology (J.F.), Nyköping Hospital, Nyköping, Sweden; Department of Neuroscience (J.L.C.), Psychiatry, Uppsala University, Uppsala, Sweden; Department of Medical Sciences (K.B.), Uppsala University, Uppsala, Sweden; Department of Chemistry-BMC (J.B.), Analytical Chemistry and Neurochemistry, Uppsala University, Uppsala, Sweden; Department of Psychiatry and Neurochemistry (H.Z.), Institute of Neuroscience & Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal; and Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden.
Jonas LindebergFrom the Department of Neuroscience (J.V., E.K., S.J.), Neurology, Uppsala University, Uppsala, Sweden; Department of Surgical Sciences (D.F., J.W., A.G.), Radiology, Uppsala University, Uppsala, Sweden; Department of Surgical Sciences (R.F., H.D.P.D.O.-R.), Anaesthesia and Intensive Care, Uppsala University, Uppsala, Sweden; Department of Neuroscience (M.K.S., H.D.P.D.O.-R., E.R.), Neurosurgery, Uppsala University, Uppsala, Sweden; Department of Internal Medicine (M.K., J.L.), Nyköping Hospital, Nyköping, Sweden; Department of Radiology (J.F.), Nyköping Hospital, Nyköping, Sweden; Department of Neuroscience (J.L.C.), Psychiatry, Uppsala University, Uppsala, Sweden; Department of Medical Sciences (K.B.), Uppsala University, Uppsala, Sweden; Department of Chemistry-BMC (J.B.), Analytical Chemistry and Neurochemistry, Uppsala University, Uppsala, Sweden; Department of Psychiatry and Neurochemistry (H.Z.), Institute of Neuroscience & Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal; and Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden.
Henrik Olivero-ReiniusFrom the Department of Neuroscience (J.V., E.K., S.J.), Neurology, Uppsala University, Uppsala, Sweden; Department of Surgical Sciences (D.F., J.W., A.G.), Radiology, Uppsala University, Uppsala, Sweden; Department of Surgical Sciences (R.F., H.D.P.D.O.-R.), Anaesthesia and Intensive Care, Uppsala University, Uppsala, Sweden; Department of Neuroscience (M.K.S., H.D.P.D.O.-R., E.R.), Neurosurgery, Uppsala University, Uppsala, Sweden; Department of Internal Medicine (M.K., J.L.), Nyköping Hospital, Nyköping, Sweden; Department of Radiology (J.F.), Nyköping Hospital, Nyköping, Sweden; Department of Neuroscience (J.L.C.), Psychiatry, Uppsala University, Uppsala, Sweden; Department of Medical Sciences (K.B.), Uppsala University, Uppsala, Sweden; Department of Chemistry-BMC (J.B.), Analytical Chemistry and Neurochemistry, Uppsala University, Uppsala, Sweden; Department of Psychiatry and Neurochemistry (H.Z.), Institute of Neuroscience & Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal; and Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden.
Mats RyttleforsFrom the Department of Neuroscience (J.V., E.K., S.J.), Neurology, Uppsala University, Uppsala, Sweden; Department of Surgical Sciences (D.F., J.W., A.G.), Radiology, Uppsala University, Uppsala, Sweden; Department of Surgical Sciences (R.F., H.D.P.D.O.-R.), Anaesthesia and Intensive Care, Uppsala University, Uppsala, Sweden; Department of Neuroscience (M.K.S., H.D.P.D.O.-R., E.R.), Neurosurgery, Uppsala University, Uppsala, Sweden; Department of Internal Medicine (M.K., J.L.), Nyköping Hospital, Nyköping, Sweden; Department of Radiology (J.F.), Nyköping Hospital, Nyköping, Sweden; Department of Neuroscience (J.L.C.), Psychiatry, Uppsala University, Uppsala, Sweden; Department of Medical Sciences (K.B.), Uppsala University, Uppsala, Sweden; Department of Chemistry-BMC (J.B.), Analytical Chemistry and Neurochemistry, Uppsala University, Uppsala, Sweden; Department of Psychiatry and Neurochemistry (H.Z.), Institute of Neuroscience & Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal; and Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden.
Janet L CunninghamFrom the Department of Neuroscience (J.V., E.K., S.J.), Neurology, Uppsala University, Uppsala, Sweden; Department of Surgical Sciences (D.F., J.W., A.G.), Radiology, Uppsala University, Uppsala, Sweden; Department of Surgical Sciences (R.F., H.D.P.D.O.-R.), Anaesthesia and Intensive Care, Uppsala University, Uppsala, Sweden; Department of Neuroscience (M.K.S., H.D.P.D.O.-R., E.R.), Neurosurgery, Uppsala University, Uppsala, Sweden; Department of Internal Medicine (M.K., J.L.), Nyköping Hospital, Nyköping, Sweden; Department of Radiology (J.F.), Nyköping Hospital, Nyköping, Sweden; Department of Neuroscience (J.L.C.), Psychiatry, Uppsala University, Uppsala, Sweden; Department of Medical Sciences (K.B.), Uppsala University, Uppsala, Sweden; Department of Chemistry-BMC (J.B.), Analytical Chemistry and Neurochemistry, Uppsala University, Uppsala, Sweden; Department of Psychiatry and Neurochemistry (H.Z.), Institute of Neuroscience & Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal; and Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden.
Johan WikströmFrom the Department of Neuroscience (J.V., E.K., S.J.), Neurology, Uppsala University, Uppsala, Sweden; Department of Surgical Sciences (D.F., J.W., A.G.), Radiology, Uppsala University, Uppsala, Sweden; Department of Surgical Sciences (R.F., H.D.P.D.O.-R.), Anaesthesia and Intensive Care, Uppsala University, Uppsala, Sweden; Department of Neuroscience (M.K.S., H.D.P.D.O.-R., E.R.), Neurosurgery, Uppsala University, Uppsala, Sweden; Department of Internal Medicine (M.K., J.L.), Nyköping Hospital, Nyköping, Sweden; Department of Radiology (J.F.), Nyköping Hospital, Nyköping, Sweden; Department of Neuroscience (J.L.C.), Psychiatry, Uppsala University, Uppsala, Sweden; Department of Medical Sciences (K.B.), Uppsala University, Uppsala, Sweden; Department of Chemistry-BMC (J.B.), Analytical Chemistry and Neurochemistry, Uppsala University, Uppsala, Sweden; Department of Psychiatry and Neurochemistry (H.Z.), Institute of Neuroscience & Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal; and Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden.
Anna GrabowskaFrom the Department of Neuroscience (J.V., E.K., S.J.), Neurology, Uppsala University, Uppsala, Sweden; Department of Surgical Sciences (D.F., J.W., A.G.), Radiology, Uppsala University, Uppsala, Sweden; Department of Surgical Sciences (R.F., H.D.P.D.O.-R.), Anaesthesia and Intensive Care, Uppsala University, Uppsala, Sweden; Department of Neuroscience (M.K.S., H.D.P.D.O.-R., E.R.), Neurosurgery, Uppsala University, Uppsala, Sweden; Department of Internal Medicine (M.K., J.L.), Nyköping Hospital, Nyköping, Sweden; Department of Radiology (J.F.), Nyköping Hospital, Nyköping, Sweden; Department of Neuroscience (J.L.C.), Psychiatry, Uppsala University, Uppsala, Sweden; Department of Medical Sciences (K.B.), Uppsala University, Uppsala, Sweden; Department of Chemistry-BMC (J.B.), Analytical Chemistry and Neurochemistry, Uppsala University, Uppsala, Sweden; Department of Psychiatry and Neurochemistry (H.Z.), Institute of Neuroscience & Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal; and Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden.
Kåre BondesonFrom the Department of Neuroscience (J.V., E.K., S.J.), Neurology, Uppsala University, Uppsala, Sweden; Department of Surgical Sciences (D.F., J.W., A.G.), Radiology, Uppsala University, Uppsala, Sweden; Department of Surgical Sciences (R.F., H.D.P.D.O.-R.), Anaesthesia and Intensive Care, Uppsala University, Uppsala, Sweden; Department of Neuroscience (M.K.S., H.D.P.D.O.-R., E.R.), Neurosurgery, Uppsala University, Uppsala, Sweden; Department of Internal Medicine (M.K., J.L.), Nyköping Hospital, Nyköping, Sweden; Department of Radiology (J.F.), Nyköping Hospital, Nyköping, Sweden; Department of Neuroscience (J.L.C.), Psychiatry, Uppsala University, Uppsala, Sweden; Department of Medical Sciences (K.B.), Uppsala University, Uppsala, Sweden; Department of Chemistry-BMC (J.B.), Analytical Chemistry and Neurochemistry, Uppsala University, Uppsala, Sweden; Department of Psychiatry and Neurochemistry (H.Z.), Institute of Neuroscience & Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal; and Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden.
Jonas BergquistFrom the Department of Neuroscience (J.V., E.K., S.J.), Neurology, Uppsala University, Uppsala, Sweden; Department of Surgical Sciences (D.F., J.W., A.G.), Radiology, Uppsala University, Uppsala, Sweden; Department of Surgical Sciences (R.F., H.D.P.D.O.-R.), Anaesthesia and Intensive Care, Uppsala University, Uppsala, Sweden; Department of Neuroscience (M.K.S., H.D.P.D.O.-R., E.R.), Neurosurgery, Uppsala University, Uppsala, Sweden; Department of Internal Medicine (M.K., J.L.), Nyköping Hospital, Nyköping, Sweden; Department of Radiology (J.F.), Nyköping Hospital, Nyköping, Sweden; Department of Neuroscience (J.L.C.), Psychiatry, Uppsala University, Uppsala, Sweden; Department of Medical Sciences (K.B.), Uppsala University, Uppsala, Sweden; Department of Chemistry-BMC (J.B.), Analytical Chemistry and Neurochemistry, Uppsala University, Uppsala, Sweden; Department of Psychiatry and Neurochemistry (H.Z.), Institute of Neuroscience & Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal; and Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden.
Henrik ZetterbergFrom the Department of Neuroscience (J.V., E.K., S.J.), Neurology, Uppsala University, Uppsala, Sweden; Department of Surgical Sciences (D.F., J.W., A.G.), Radiology, Uppsala University, Uppsala, Sweden; Department of Surgical Sciences (R.F., H.D.P.D.O.-R.), Anaesthesia and Intensive Care, Uppsala University, Uppsala, Sweden; Department of Neuroscience (M.K.S., H.D.P.D.O.-R., E.R.), Neurosurgery, Uppsala University, Uppsala, Sweden; Department of Internal Medicine (M.K., J.L.), Nyköping Hospital, Nyköping, Sweden; Department of Radiology (J.F.), Nyköping Hospital, Nyköping, Sweden; Department of Neuroscience (J.L.C.), Psychiatry, Uppsala University, Uppsala, Sweden; Department of Medical Sciences (K.B.), Uppsala University, Uppsala, Sweden; Department of Chemistry-BMC (J.B.), Analytical Chemistry and Neurochemistry, Uppsala University, Uppsala, Sweden; Department of Psychiatry and Neurochemistry (H.Z.), Institute of Neuroscience & Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal; and Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden.
Elham RostamiFrom the Department of Neuroscience (J.V., E.K., S.J.), Neurology, Uppsala University, Uppsala, Sweden; Department of Surgical Sciences (D.F., J.W., A.G.), Radiology, Uppsala University, Uppsala, Sweden; Department of Surgical Sciences (R.F., H.D.P.D.O.-R.), Anaesthesia and Intensive Care, Uppsala University, Uppsala, Sweden; Department of Neuroscience (M.K.S., H.D.P.D.O.-R., E.R.), Neurosurgery, Uppsala University, Uppsala, Sweden; Department of Internal Medicine (M.K., J.L.), Nyköping Hospital, Nyköping, Sweden; Department of Radiology (J.F.), Nyköping Hospital, Nyköping, Sweden; Department of Neuroscience (J.L.C.), Psychiatry, Uppsala University, Uppsala, Sweden; Department of Medical Sciences (K.B.), Uppsala University, Uppsala, Sweden; Department of Chemistry-BMC (J.B.), Analytical Chemistry and Neurochemistry, Uppsala University, Uppsala, Sweden; Department of Psychiatry and Neurochemistry (H.Z.), Institute of Neuroscience & Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal; and Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden. Elham.rostami@neuro.uu.se.
Uppsala University · SE
Funding
No grant is acknowledged in the PubMed record.
Abstract
Here, we report a case of COVID-19-related acute necrotizing encephalopathy where SARS-CoV-2 RNA was found in CSF 19 days after symptom onset after testing negative twice. Although monocytes and protein levels in CSF were only marginally increased, and our patient never experienced a hyperinflammatory state, her neurologic function deteriorated into coma. MRI of the brain showed pathologic signal symmetrically in central thalami, subinsular regions, medial temporal lobes, and brain stem. Extremely high concentrations of the neuronal injury markers neurofilament light and tau, as well as an astrocytic activation marker, glial fibrillary acidic protein, were measured in CSF. Neuronal rescue proteins and other pathways were elevated in the in-depth proteomics analysis. The patient received IV immunoglobulins and plasma exchange. Her neurologic status improved, and she was extubated 4 weeks after symptom onset. This case report highlights the neurotropism of SARS-CoV-2 in selected patients and emphasizes the importance of repeated lumbar punctures and CSF analyses in patients with suspected COVID-19 and neurologic symptoms.
Indexed as
AcyclovirAntiviral AgentsBetacoronavirusBrainCoronavirus InfectionsCOVID-19FemaleGlial Fibrillary Acidic ProteinHumansImmunoglobulins, IntravenousImmunologic FactorsInterleukin-6Leukoencephalitis, Acute HemorrhagicMagnetic Resonance ImagingMiddle AgedNeurofilament ProteinsAcyclovirAntiviral AgentsGlial Fibrillary Acidic ProteinImmunoglobulins, IntravenousImmunologic FactorsInterleukin-6neurofilament protein LNeurofilament ProteinsRNA, Viraltau Proteins
Identifiers
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LicenceCC BY-NC-ND
Read underepoch 390
Registered trials
NCT04775784ClinicalTrials.gov
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.