Three-tier stratification for CNS COVID-19 to help decide which patients should undergo lumbar puncture with CSF analysis: a case report and literature review

• Main Authors: Ramakrishna Jahanavi M., Libertin Claudia R., Siegel Jason, Binnicker Matthew J., Harris Dana, Matcha Gautam V., Caulfield Thomas, Freeman W. D.
• Format: Article
• Language: English
• Published: Sciendo 2021-03-01
• Series: Romanian Journal of Internal Medicine
• Subjects: covid-19; sars-cov-2; encephalitis; lumbar puncture; cerebral spinal fluid
• Online Access: https://doi.org/10.2478/rjim-2020-0031
• ISSN: 2501-062X

The COVID-19 pandemic continues to overwhelm global healthcare systems. While the disease primarily causes pulmonary complications, reports of central nervous system (CNS) involvement have recently emerged ranging from encephalopathy to stroke. This raises a practical dilemma for clinicians as to when to pursue neuroimaging and lumbar tap with cerebrospinal fluid (CSF) analysis in COVID-19 patients with neurological symptoms. We present a case of an encephalopathic patient infected with SARS-CoV-2 with no pulmonary symptoms. We propose a three-tier risk stratification for CNS COVID-19 aiming to help clinicians to decide which patients should undergo CSF analysis. The neurological examination remains an integral component of screening and evaluating patients for COVID-19 considering the range of emerging CNS complications.