Acute encephalopathy with elevated CSF inflammatory markers as the initial presentation of COVID-19

BMC Neurol. 2020 Jun 18;20(1):248. doi: 10.1186/s12883-020-01812-2.


Background: COVID-19 is caused by the severe acute respiratory syndrome virus SARS-CoV-2. It is widely recognized as a respiratory pathogen, but neurologic complications can be the presenting manifestation in a subset of infected patients.

Case presentation: We describe a 78-year old immunocompromised woman who presented with altered mental status after witnessed seizure-like activity at home. She was found to have SARS-CoV-2 infection and associated neuroinflammation. In this case, we undertake the first detailed analysis of cerebrospinal fluid (CSF) cytokines during COVID-19 infection and find a unique pattern of inflammation in CSF, but no evidence of viral neuroinvasion.

Conclusion: Our findings suggest that neurologic symptoms such as encephalopathy and seizures may be the initial presentation of COVID-19. Central nervous system inflammation may associate with neurologic manifestations of disease.

Keywords: COVID-19; Neuroinflammation; SARS-CoV-2.

Publication types

  • Case Reports

MeSH terms

  • Acute Disease
  • Aged
  • Betacoronavirus*
  • Biomarkers / cerebrospinal fluid
  • COVID-19
  • Coronavirus Infections*
  • Cytokines / cerebrospinal fluid*
  • Encephalitis, Viral*
  • Female
  • Humans
  • Pandemics*
  • Pneumonia, Viral*
  • SARS-CoV-2
  • Seizures


  • Biomarkers
  • Cytokines