Inflammation-Triggered Enlargement of Choroid Plexus in Subacute COVID-19 Patients with Neurological Symptoms

Ann Neurol. 2024 Oct;96(4):715-725. doi: 10.1002/ana.27016. Epub 2024 Jun 27.

Abstract

Objective: To investigate whether choroid plexus volumes in subacute coronavirus disease 2019 (COVID-19) patients with neurological symptoms could indicate inflammatory activation or barrier dysfunction and assess their association with clinical data.

Methods: Choroid plexus volumes were measured in 28 subacute COVID-19 patients via cerebral magnetic resonance imaging (MRI), compared with those in infection-triggered non-COVID-19 encephalopathy patients (n = 25), asymptomatic individuals after COVID-19 (n = 21), and healthy controls (n = 21). Associations with inflammatory serum markers (peak counts of leukocytes, C-reactive protein [CRP], interleukin 6), an MRI-based marker of barrier dysfunction (CSF volume fraction [V-CSF]), and clinical parameters like olfactory performance and cognitive scores (Montreal Cognitive Assessment) were investigated.

Results: COVID-19 patients showed significantly larger choroid plexus volumes than control groups (p < 0.001, η2 = 0.172). These volumes correlated significantly with peak leukocyte levels (p = 0.001, Pearson's r = 0.621) and V-CSF (p = 0.009, Spearman's rho = 0.534), but neither with CRP nor interleukin 6. No significant correlations were found with clinical parameters.

Interpretation: In patients with subacute COVID-19, choroid plexus volume is a marker of central nervous system inflammation and barrier dysfunction in the presence of neurologic symptoms. The absence of plexus enlargement in infection-triggered non-COVID-19 encephalopathy suggests a specific severe acute respiratory syndrome coronavirus 2 effect. This study also documents an increase in choroid plexus volume for the first time as a parainfectious event. ANN NEUROL 2024;96:715-725.

MeSH terms

  • Adult
  • Aged
  • C-Reactive Protein / analysis
  • C-Reactive Protein / metabolism
  • COVID-19* / complications
  • COVID-19* / diagnostic imaging
  • Choroid Plexus* / diagnostic imaging
  • Choroid Plexus* / pathology
  • Female
  • Humans
  • Inflammation / pathology
  • Magnetic Resonance Imaging*
  • Male
  • Middle Aged
  • Organ Size
  • Post-Acute COVID-19 Syndrome
  • SARS-CoV-2

Substances

  • C-Reactive Protein