SARS-CoV-2 Detected in One-Third of Cerebrospinal Fluid Samples of Those Exposed to COVID-19!
Nikhil Prasad Fact checked by:Thailand Medical News Team Mar 22, 2025 9 hours, 45 minutes ago
Medical News: In a groundbreaking clinical study from Brazil, researchers have found that SARS-CoV-2 - the virus responsible for COVID-19 - was detected in one-third of CSF samples, regardless of time interval between COVID-19 diagnosis and the onset of neurological signs. This startling discovery adds new evidence to the growing body of research suggesting that the virus can directly invade the central nervous system, raising serious concerns about the long-term neurological impacts of COVID-19.
SARS-CoV-2 Detected in One-Third of Cerebrospinal Fluid Samples of Those Exposed to COVID-19!
The study was conducted by scientists from the Virology Research Center, Department of Internal Medicine, Medical School, University of São Paulo and the Advanced Molecular Biology Laboratory at the Blood Center of Ribeirão Preto, also under the University of São Paulo. The team evaluated 27 patients who were admitted to a tertiary medical center between December 2020 and December 2022, all of whom had confirmed nasal swab tests for SARS-CoV-2 and displayed neurological abnormalities.
This
Medical News report covers one of the first few studies to explore the direct detection of SARS-CoV-2 in cerebrospinal fluid - a clear sign of viral neuroinvasion. Most prior studies have focused primarily on immune-mediated pathways as the cause of neurological symptoms, often due to the absence of virus detection in CSF. However, this new research suggests that direct CNS involvement may be more common than previously believed.
Study Design and Major Findings
The researchers performed RT-PCR tests on CSF samples to detect the presence of viral RNA. Out of the 27 patients tested, 9 - or 33.3% - had positive results, an unusually high detection rate compared to earlier studies which reported much lower figures ranging between 4% and 9%.
Interestingly, the presence of the virus in CSF did not appear to correlate with the timing of neurological symptoms. Some patients experienced these issues during active respiratory infection, while others developed symptoms up to 60 days later. In fact, the study found that the virus could still be detected in the spinal fluid even when respiratory symptoms had resolved, indicating the possibility of prolonged CNS involvement.
Range of Neurological Symptoms Observed
The affected patients exhibited a wide spectrum of neurological problems. These included seizures (44.4%), muscle weakness or paresis (40.7%), gait abnormalities (29.6%), headaches (25.9%), memory loss or cognitive difficulties (22.2%), and altered consciousness (25.9%). In some rare cases, patients experienced visual disturbances, neck stiffness, and vomiting.
CSF analysis revealed mostly normal white cell counts in both positive and negative cases, although three patients did show elevated white blood cell levels. Protein levels in the CSF were slightly elevated in 44% of the positive cases, which could suggest inflammation or breakdown of the blood-brain barrier.
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Imaging studies using MRI and CT scans also did not yield consistent findings. While 14 patients had normal brain imaging, 11 showed abnormalities such as demyelination, inflammation, or signs of cerebral atrophy. However, these changes were not specific enough to reliably differentiate patients with positive CSF from those without.
Comorbidities and Outcomes
The study also noted a higher incidence of comorbidities - like hypertension, obesity, and diabetes - among those who tested positive for the virus in their CSF. Of the 27 patients, 19 had poor clinical outcomes, with two deaths and 17 developing chronic conditions or neurological sequelae such as stroke, meningoencephalitis, epilepsy, or Guillain-Barré syndrome.
Despite the range of clinical manifestations, the researchers concluded that the presence of SARS-CoV-2 in the CSF was not directly tied to any specific symptom or disease pattern. Instead, it reinforces the idea that multiple mechanisms - such as direct viral invasion, immune responses, cytokine storms, and vascular injury - might all be at play in causing neurological damage.
What This Means for COVID-19 Survivors
This study delivers important insights into why so many individuals recovering from COVID-19 experience long-term neurological symptoms. It also provides evidence supporting routine testing of CSF in cases with unexplained neurological changes post-infection, especially in those with no prior neurological disorders.
Importantly, the researchers emphasized that viral detection in CSF could occur at any point - during acute infection or long after respiratory symptoms have faded. Thus, dismissing neurological complaints as unrelated to COVID-19 just because the infection appears to be resolved could lead to underdiagnosis and inadequate treatment.
Conclusion
The detection of SARS-CoV-2 in one-third of cerebrospinal fluid samples from COVID-19 patients with neurological issues provides direct evidence that the virus can invade the central nervous system. This challenges the commonly held belief that neurological symptoms are only due to immune responses or inflammation.
The study underscores the need for further investigation into the mechanisms of neuroinvasion, viral persistence, and their link to both acute and long-term brain-related complications. Routine CSF testing in patients with neurological symptoms could offer critical insights and improve outcomes through earlier diagnosis and targeted interventions.
The study findings were published in the peer-reviewed journal: PLOS ONE.
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0312621
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