Anti-SARS-CoV-2 antibodies in the CSF, blood-brain barrier dysfunction, and neurological outcome: Studies in 8 stuporous and comatose patients.
Identifieur interne : 000079 ( Main/Corpus ); précédent : 000078; suivant : 000080Anti-SARS-CoV-2 antibodies in the CSF, blood-brain barrier dysfunction, and neurological outcome: Studies in 8 stuporous and comatose patients.
Auteurs : Harry Alexopoulos ; Eleni Magira ; Kleopatra Bitzogli ; Nikolitsa Kafasi ; Panayiotis Vlachoyiannopoulos ; Athanasios Tzioufas ; Anastasia Kotanidou ; Marinos C. DalakasSource :
- Neurology(R) neuroimmunology & neuroinflammation [ 2332-7812 ] ; 2020.
English descriptors
- KwdEn :
- Aged (MeSH), Aged, 80 and over (MeSH), Autoantibodies (cerebrospinal fluid), Betacoronavirus (isolation & purification), Biomarkers (cerebrospinal fluid), Blood-Brain Barrier (metabolism), Coma (cerebrospinal fluid), Coma (diagnosis), Coronavirus Infections (cerebrospinal fluid), Coronavirus Infections (diagnosis), Female (MeSH), Humans (MeSH), Male (MeSH), Middle Aged (MeSH), Nervous System Diseases (cerebrospinal fluid), Nervous System Diseases (diagnosis), Pandemics (MeSH), Pneumonia, Viral (cerebrospinal fluid), Pneumonia, Viral (diagnosis), Stupor (cerebrospinal fluid), Stupor (diagnosis), Treatment Outcome (MeSH).
- MESH :
- chemical , cerebrospinal fluid : Autoantibodies, Biomarkers.
- cerebrospinal fluid : Coma, Coronavirus Infections, Nervous System Diseases, Pneumonia, Viral, Stupor.
- diagnosis : Coma, Coronavirus Infections, Nervous System Diseases, Pneumonia, Viral, Stupor.
- isolation & purification : Betacoronavirus.
- metabolism : Blood-Brain Barrier.
- Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Pandemics, Treatment Outcome.
Abstract
OBJECTIVE
To investigate the pathophysiologic mechanism of encephalopathy and prolonged comatose or stuporous state in severally ill patients with coronavirus disease 2019 (COVID-19).
METHODS
Eight COVID-19 patients with signs of encephalopathy were tested for antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the serum and CSF using a Food and Drug Administration-approved and independently validated ELISA. Blood-brain barrier (BBB) integrity and immunoglobulin G (IgG) intrathecal synthesis were further tested using albumin and IgG indices. The CSF was also tested for autoimmune encephalitis antibodies and 14-3-3, a marker of ongoing neurodegeneration.
RESULTS
All patients had anti-SARS-CoV-2 antibodies in their CSF, and 4 of 8 patients had high titers, comparable to high serum values. One patient had anti-SARS-CoV-2 IgG intrathecal synthesis, and 3 others had disruption of the blood-brain barrier. The CSF in 4 patients was positive for 14-3-3-protein suggesting ongoing neurodegeneration. In all patients, the CSF was negative for autoimmune encephalitis antibodies and SARS-CoV-2 by PCR. None of the patients, apart from persistent encephalopathic signs, had any focal neurologic signs or history or specific neurologic disease.
CONCLUSIONS
High-titer anti-SARS-CoV-2 antibodies were detected in the CSF of comatose or encephalopathic patients demonstrating intrathecal IgG synthesis or BBB disruption. A disrupted BBB may facilitate the entry of cytokines and inflammatory mediators into the CNS enhancing neuroinflammation and neurodegeneration. The observations highlight the need for prospective CSF studies to determine the pathogenic role of anti-SARS-CoV-2 antibodies and identify early therapeutic interventions.
DOI: 10.1212/NXI.0000000000000893
PubMed: 32978291
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pubmed:32978291Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Anti-SARS-CoV-2 antibodies in the CSF, blood-brain barrier dysfunction, and neurological outcome: Studies in 8 stuporous and comatose patients.</title><author><name sortKey="Alexopoulos, Harry" sort="Alexopoulos, Harry" uniqKey="Alexopoulos H" first="Harry" last="Alexopoulos">Harry Alexopoulos</name><affiliation><nlm:affiliation>From the Neuroimmunology Unit (H.A., K.B., M.C.D.), Department of Pathophysiology (P.V., A.T.), and 1st Department of Intensive Care Medicine (E.M., A.K.), Evangelismos Hospital, Faculty of Medicine, National and Kapodistrian University of Athens; and Department of Immunology and Histocompatibility (N.K.), Laikon University Hospital, Athens, Greece.</nlm:affiliation></affiliation></author><author><name sortKey="Magira, Eleni" sort="Magira, Eleni" uniqKey="Magira E" first="Eleni" last="Magira">Eleni Magira</name><affiliation><nlm:affiliation>From the Neuroimmunology Unit (H.A., K.B., M.C.D.), Department of Pathophysiology (P.V., A.T.), and 1st Department of Intensive Care Medicine (E.M., A.K.), Evangelismos Hospital, Faculty of Medicine, National and Kapodistrian University of Athens; and Department of Immunology and Histocompatibility (N.K.), Laikon University Hospital, Athens, Greece.</nlm:affiliation></affiliation></author><author><name sortKey="Bitzogli, Kleopatra" sort="Bitzogli, Kleopatra" uniqKey="Bitzogli K" first="Kleopatra" last="Bitzogli">Kleopatra Bitzogli</name><affiliation><nlm:affiliation>From the Neuroimmunology Unit (H.A., K.B., M.C.D.), Department of Pathophysiology (P.V., A.T.), and 1st Department of Intensive Care Medicine (E.M., A.K.), Evangelismos Hospital, Faculty of Medicine, National and Kapodistrian University of Athens; and Department of Immunology and Histocompatibility (N.K.), Laikon University Hospital, Athens, Greece.</nlm:affiliation></affiliation></author><author><name sortKey="Kafasi, Nikolitsa" sort="Kafasi, Nikolitsa" uniqKey="Kafasi N" first="Nikolitsa" last="Kafasi">Nikolitsa Kafasi</name><affiliation><nlm:affiliation>From the Neuroimmunology Unit (H.A., K.B., M.C.D.), Department of Pathophysiology (P.V., A.T.), and 1st Department of Intensive Care Medicine (E.M., A.K.), Evangelismos Hospital, Faculty of Medicine, National and Kapodistrian University of Athens; and Department of Immunology and Histocompatibility (N.K.), Laikon University Hospital, Athens, Greece.</nlm:affiliation></affiliation></author><author><name sortKey="Vlachoyiannopoulos, Panayiotis" sort="Vlachoyiannopoulos, Panayiotis" uniqKey="Vlachoyiannopoulos P" first="Panayiotis" last="Vlachoyiannopoulos">Panayiotis Vlachoyiannopoulos</name><affiliation><nlm:affiliation>From the Neuroimmunology Unit (H.A., K.B., M.C.D.), Department of Pathophysiology (P.V., A.T.), and 1st Department of Intensive Care Medicine (E.M., A.K.), Evangelismos Hospital, Faculty of Medicine, National and Kapodistrian University of Athens; and Department of Immunology and Histocompatibility (N.K.), Laikon University Hospital, Athens, Greece.</nlm:affiliation></affiliation></author><author><name sortKey="Tzioufas, Athanasios" sort="Tzioufas, Athanasios" uniqKey="Tzioufas A" first="Athanasios" last="Tzioufas">Athanasios Tzioufas</name><affiliation><nlm:affiliation>From the Neuroimmunology Unit (H.A., K.B., M.C.D.), Department of Pathophysiology (P.V., A.T.), and 1st Department of Intensive Care Medicine (E.M., A.K.), Evangelismos Hospital, Faculty of Medicine, National and Kapodistrian University of Athens; and Department of Immunology and Histocompatibility (N.K.), Laikon University Hospital, Athens, Greece.</nlm:affiliation></affiliation></author><author><name sortKey="Kotanidou, Anastasia" sort="Kotanidou, Anastasia" uniqKey="Kotanidou A" first="Anastasia" last="Kotanidou">Anastasia Kotanidou</name><affiliation><nlm:affiliation>From the Neuroimmunology Unit (H.A., K.B., M.C.D.), Department of Pathophysiology (P.V., A.T.), and 1st Department of Intensive Care Medicine (E.M., A.K.), Evangelismos Hospital, Faculty of Medicine, National and Kapodistrian University of Athens; and Department of Immunology and Histocompatibility (N.K.), Laikon University Hospital, Athens, Greece.</nlm:affiliation></affiliation></author><author><name sortKey="Dalakas, Marinos C" sort="Dalakas, Marinos C" uniqKey="Dalakas M" first="Marinos C" last="Dalakas">Marinos C. Dalakas</name><affiliation><nlm:affiliation>From the Neuroimmunology Unit (H.A., K.B., M.C.D.), Department of Pathophysiology (P.V., A.T.), and 1st Department of Intensive Care Medicine (E.M., A.K.), Evangelismos Hospital, Faculty of Medicine, National and Kapodistrian University of Athens; and Department of Immunology and Histocompatibility (N.K.), Laikon University Hospital, Athens, Greece. mdalakas@med.uoa.gr.</nlm:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2020">2020</date><idno type="RBID">pubmed:32978291</idno><idno type="pmid">32978291</idno><idno type="doi">10.1212/NXI.0000000000000893</idno><idno type="wicri:Area/Main/Corpus">000079</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">000079</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Anti-SARS-CoV-2 antibodies in the CSF, blood-brain barrier dysfunction, and neurological outcome: Studies in 8 stuporous and comatose patients.</title><author><name sortKey="Alexopoulos, Harry" sort="Alexopoulos, Harry" uniqKey="Alexopoulos H" first="Harry" last="Alexopoulos">Harry Alexopoulos</name><affiliation><nlm:affiliation>From the Neuroimmunology Unit (H.A., K.B., M.C.D.), Department of Pathophysiology (P.V., A.T.), and 1st Department of Intensive Care Medicine (E.M., A.K.), Evangelismos Hospital, Faculty of Medicine, National and Kapodistrian University of Athens; and Department of Immunology and Histocompatibility (N.K.), Laikon University Hospital, Athens, Greece.</nlm:affiliation></affiliation></author><author><name sortKey="Magira, Eleni" sort="Magira, Eleni" uniqKey="Magira E" first="Eleni" last="Magira">Eleni Magira</name><affiliation><nlm:affiliation>From the Neuroimmunology Unit (H.A., K.B., M.C.D.), Department of Pathophysiology (P.V., A.T.), and 1st Department of Intensive Care Medicine (E.M., A.K.), Evangelismos Hospital, Faculty of Medicine, National and Kapodistrian University of Athens; and Department of Immunology and Histocompatibility (N.K.), Laikon University Hospital, Athens, Greece.</nlm:affiliation></affiliation></author><author><name sortKey="Bitzogli, Kleopatra" sort="Bitzogli, Kleopatra" uniqKey="Bitzogli K" first="Kleopatra" last="Bitzogli">Kleopatra Bitzogli</name><affiliation><nlm:affiliation>From the Neuroimmunology Unit (H.A., K.B., M.C.D.), Department of Pathophysiology (P.V., A.T.), and 1st Department of Intensive Care Medicine (E.M., A.K.), Evangelismos Hospital, Faculty of Medicine, National and Kapodistrian University of Athens; and Department of Immunology and Histocompatibility (N.K.), Laikon University Hospital, Athens, Greece.</nlm:affiliation></affiliation></author><author><name sortKey="Kafasi, Nikolitsa" sort="Kafasi, Nikolitsa" uniqKey="Kafasi N" first="Nikolitsa" last="Kafasi">Nikolitsa Kafasi</name><affiliation><nlm:affiliation>From the Neuroimmunology Unit (H.A., K.B., M.C.D.), Department of Pathophysiology (P.V., A.T.), and 1st Department of Intensive Care Medicine (E.M., A.K.), Evangelismos Hospital, Faculty of Medicine, National and Kapodistrian University of Athens; and Department of Immunology and Histocompatibility (N.K.), Laikon University Hospital, Athens, Greece.</nlm:affiliation></affiliation></author><author><name sortKey="Vlachoyiannopoulos, Panayiotis" sort="Vlachoyiannopoulos, Panayiotis" uniqKey="Vlachoyiannopoulos P" first="Panayiotis" last="Vlachoyiannopoulos">Panayiotis Vlachoyiannopoulos</name><affiliation><nlm:affiliation>From the Neuroimmunology Unit (H.A., K.B., M.C.D.), Department of Pathophysiology (P.V., A.T.), and 1st Department of Intensive Care Medicine (E.M., A.K.), Evangelismos Hospital, Faculty of Medicine, National and Kapodistrian University of Athens; and Department of Immunology and Histocompatibility (N.K.), Laikon University Hospital, Athens, Greece.</nlm:affiliation></affiliation></author><author><name sortKey="Tzioufas, Athanasios" sort="Tzioufas, Athanasios" uniqKey="Tzioufas A" first="Athanasios" last="Tzioufas">Athanasios Tzioufas</name><affiliation><nlm:affiliation>From the Neuroimmunology Unit (H.A., K.B., M.C.D.), Department of Pathophysiology (P.V., A.T.), and 1st Department of Intensive Care Medicine (E.M., A.K.), Evangelismos Hospital, Faculty of Medicine, National and Kapodistrian University of Athens; and Department of Immunology and Histocompatibility (N.K.), Laikon University Hospital, Athens, Greece.</nlm:affiliation></affiliation></author><author><name sortKey="Kotanidou, Anastasia" sort="Kotanidou, Anastasia" uniqKey="Kotanidou A" first="Anastasia" last="Kotanidou">Anastasia Kotanidou</name><affiliation><nlm:affiliation>From the Neuroimmunology Unit (H.A., K.B., M.C.D.), Department of Pathophysiology (P.V., A.T.), and 1st Department of Intensive Care Medicine (E.M., A.K.), Evangelismos Hospital, Faculty of Medicine, National and Kapodistrian University of Athens; and Department of Immunology and Histocompatibility (N.K.), Laikon University Hospital, Athens, Greece.</nlm:affiliation></affiliation></author><author><name sortKey="Dalakas, Marinos C" sort="Dalakas, Marinos C" uniqKey="Dalakas M" first="Marinos C" last="Dalakas">Marinos C. Dalakas</name><affiliation><nlm:affiliation>From the Neuroimmunology Unit (H.A., K.B., M.C.D.), Department of Pathophysiology (P.V., A.T.), and 1st Department of Intensive Care Medicine (E.M., A.K.), Evangelismos Hospital, Faculty of Medicine, National and Kapodistrian University of Athens; and Department of Immunology and Histocompatibility (N.K.), Laikon University Hospital, Athens, Greece. mdalakas@med.uoa.gr.</nlm:affiliation></affiliation></author></analytic><series><title level="j">Neurology(R) neuroimmunology & neuroinflammation</title><idno type="eISSN">2332-7812</idno><imprint><date when="2020" type="published">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged (MeSH)</term><term>Aged, 80 and over (MeSH)</term><term>Autoantibodies (cerebrospinal fluid)</term><term>Betacoronavirus (isolation & purification)</term><term>Biomarkers (cerebrospinal fluid)</term><term>Blood-Brain Barrier (metabolism)</term><term>Coma (cerebrospinal fluid)</term><term>Coma (diagnosis)</term><term>Coronavirus Infections (cerebrospinal fluid)</term><term>Coronavirus Infections (diagnosis)</term><term>Female (MeSH)</term><term>Humans (MeSH)</term><term>Male (MeSH)</term><term>Middle Aged (MeSH)</term><term>Nervous System Diseases (cerebrospinal fluid)</term><term>Nervous System Diseases (diagnosis)</term><term>Pandemics (MeSH)</term><term>Pneumonia, Viral (cerebrospinal fluid)</term><term>Pneumonia, Viral (diagnosis)</term><term>Stupor (cerebrospinal fluid)</term><term>Stupor (diagnosis)</term><term>Treatment Outcome (MeSH)</term></keywords><keywords scheme="MESH" type="chemical" qualifier="cerebrospinal fluid" xml:lang="en"><term>Autoantibodies</term><term>Biomarkers</term></keywords><keywords scheme="MESH" qualifier="cerebrospinal fluid" xml:lang="en"><term>Coma</term><term>Coronavirus Infections</term><term>Nervous System Diseases</term><term>Pneumonia, Viral</term><term>Stupor</term></keywords><keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Coma</term><term>Coronavirus Infections</term><term>Nervous System Diseases</term><term>Pneumonia, Viral</term><term>Stupor</term></keywords><keywords scheme="MESH" qualifier="isolation & purification" xml:lang="en"><term>Betacoronavirus</term></keywords><keywords scheme="MESH" qualifier="metabolism" xml:lang="en"><term>Blood-Brain Barrier</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Aged</term><term>Aged, 80 and over</term><term>Female</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Pandemics</term><term>Treatment Outcome</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>OBJECTIVE</b></p><p>To investigate the pathophysiologic mechanism of encephalopathy and prolonged comatose or stuporous state in severally ill patients with coronavirus disease 2019 (COVID-19).</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>Eight COVID-19 patients with signs of encephalopathy were tested for antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the serum and CSF using a Food and Drug Administration-approved and independently validated ELISA. Blood-brain barrier (BBB) integrity and immunoglobulin G (IgG) intrathecal synthesis were further tested using albumin and IgG indices. The CSF was also tested for autoimmune encephalitis antibodies and 14-3-3, a marker of ongoing neurodegeneration.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>All patients had anti-SARS-CoV-2 antibodies in their CSF, and 4 of 8 patients had high titers, comparable to high serum values. One patient had anti-SARS-CoV-2 IgG intrathecal synthesis, and 3 others had disruption of the blood-brain barrier. The CSF in 4 patients was positive for 14-3-3-protein suggesting ongoing neurodegeneration. In all patients, the CSF was negative for autoimmune encephalitis antibodies and SARS-CoV-2 by PCR. None of the patients, apart from persistent encephalopathic signs, had any focal neurologic signs or history or specific neurologic disease.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>High-titer anti-SARS-CoV-2 antibodies were detected in the CSF of comatose or encephalopathic patients demonstrating intrathecal IgG synthesis or BBB disruption. A disrupted BBB may facilitate the entry of cytokines and inflammatory mediators into the CNS enhancing neuroinflammation and neurodegeneration. The observations highlight the need for prospective CSF studies to determine the pathogenic role of anti-SARS-CoV-2 antibodies and identify early therapeutic interventions.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">32978291</PMID><DateCompleted><Year>2020</Year><Month>10</Month><Day>07</Day></DateCompleted><DateRevised><Year>2020</Year><Month>10</Month><Day>07</Day></DateRevised><Article PubModel="Electronic-Print"><Journal><ISSN IssnType="Electronic">2332-7812</ISSN><JournalIssue CitedMedium="Internet"><Volume>7</Volume><Issue>6</Issue><PubDate><Year>2020</Year><Month>11</Month></PubDate></JournalIssue><Title>Neurology(R) neuroimmunology & neuroinflammation</Title><ISOAbbreviation>Neurol Neuroimmunol Neuroinflamm</ISOAbbreviation></Journal><ArticleTitle>Anti-SARS-CoV-2 antibodies in the CSF, blood-brain barrier dysfunction, and neurological outcome: Studies in 8 stuporous and comatose patients.</ArticleTitle><ELocationID EIdType="pii" ValidYN="Y">e893</ELocationID><ELocationID EIdType="doi" ValidYN="Y">10.1212/NXI.0000000000000893</ELocationID><Abstract><AbstractText Label="OBJECTIVE">To investigate the pathophysiologic mechanism of encephalopathy and prolonged comatose or stuporous state in severally ill patients with coronavirus disease 2019 (COVID-19).</AbstractText><AbstractText Label="METHODS">Eight COVID-19 patients with signs of encephalopathy were tested for antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the serum and CSF using a Food and Drug Administration-approved and independently validated ELISA. Blood-brain barrier (BBB) integrity and immunoglobulin G (IgG) intrathecal synthesis were further tested using albumin and IgG indices. The CSF was also tested for autoimmune encephalitis antibodies and 14-3-3, a marker of ongoing neurodegeneration.</AbstractText><AbstractText Label="RESULTS">All patients had anti-SARS-CoV-2 antibodies in their CSF, and 4 of 8 patients had high titers, comparable to high serum values. One patient had anti-SARS-CoV-2 IgG intrathecal synthesis, and 3 others had disruption of the blood-brain barrier. The CSF in 4 patients was positive for 14-3-3-protein suggesting ongoing neurodegeneration. In all patients, the CSF was negative for autoimmune encephalitis antibodies and SARS-CoV-2 by PCR. None of the patients, apart from persistent encephalopathic signs, had any focal neurologic signs or history or specific neurologic disease.</AbstractText><AbstractText Label="CONCLUSIONS">High-titer anti-SARS-CoV-2 antibodies were detected in the CSF of comatose or encephalopathic patients demonstrating intrathecal IgG synthesis or BBB disruption. A disrupted BBB may facilitate the entry of cytokines and inflammatory mediators into the CNS enhancing neuroinflammation and neurodegeneration. The observations highlight the need for prospective CSF studies to determine the pathogenic role of anti-SARS-CoV-2 antibodies and identify early therapeutic interventions.</AbstractText><CopyrightInformation>Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Alexopoulos</LastName><ForeName>Harry</ForeName><Initials>H</Initials><AffiliationInfo><Affiliation>From the Neuroimmunology Unit (H.A., K.B., M.C.D.), Department of Pathophysiology (P.V., A.T.), and 1st Department of Intensive Care Medicine (E.M., A.K.), Evangelismos Hospital, Faculty of Medicine, National and Kapodistrian University of Athens; and Department of Immunology and Histocompatibility (N.K.), Laikon University Hospital, Athens, Greece.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Magira</LastName><ForeName>Eleni</ForeName><Initials>E</Initials><AffiliationInfo><Affiliation>From the Neuroimmunology Unit (H.A., K.B., M.C.D.), Department of Pathophysiology (P.V., A.T.), and 1st Department of Intensive Care Medicine (E.M., A.K.), Evangelismos Hospital, Faculty of Medicine, National and Kapodistrian University of Athens; and Department of Immunology and Histocompatibility (N.K.), Laikon University Hospital, Athens, Greece.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Bitzogli</LastName><ForeName>Kleopatra</ForeName><Initials>K</Initials><AffiliationInfo><Affiliation>From the Neuroimmunology Unit (H.A., K.B., M.C.D.), Department of Pathophysiology (P.V., A.T.), and 1st Department of Intensive Care Medicine (E.M., A.K.), Evangelismos Hospital, Faculty of Medicine, National and Kapodistrian University of Athens; and Department of Immunology and Histocompatibility (N.K.), Laikon University Hospital, Athens, Greece.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kafasi</LastName><ForeName>Nikolitsa</ForeName><Initials>N</Initials><AffiliationInfo><Affiliation>From the Neuroimmunology Unit (H.A., K.B., M.C.D.), Department of Pathophysiology (P.V., A.T.), and 1st Department of Intensive Care Medicine (E.M., A.K.), Evangelismos Hospital, Faculty of Medicine, National and Kapodistrian University of Athens; and Department of Immunology and Histocompatibility (N.K.), Laikon University Hospital, Athens, Greece.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Vlachoyiannopoulos</LastName><ForeName>Panayiotis</ForeName><Initials>P</Initials><AffiliationInfo><Affiliation>From the Neuroimmunology Unit (H.A., K.B., M.C.D.), Department of Pathophysiology (P.V., A.T.), and 1st Department of Intensive Care Medicine (E.M., A.K.), Evangelismos Hospital, Faculty of Medicine, National and Kapodistrian University of Athens; and Department of Immunology and Histocompatibility (N.K.), Laikon University Hospital, Athens, Greece.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Tzioufas</LastName><ForeName>Athanasios</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>From the Neuroimmunology Unit (H.A., K.B., M.C.D.), Department of Pathophysiology (P.V., A.T.), and 1st Department of Intensive Care Medicine (E.M., A.K.), Evangelismos Hospital, Faculty of Medicine, National and Kapodistrian University of Athens; and Department of Immunology and Histocompatibility (N.K.), Laikon University Hospital, Athens, Greece.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kotanidou</LastName><ForeName>Anastasia</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>From the Neuroimmunology Unit (H.A., K.B., M.C.D.), Department of Pathophysiology (P.V., A.T.), and 1st Department of Intensive Care Medicine (E.M., A.K.), Evangelismos Hospital, Faculty of Medicine, National and Kapodistrian University of Athens; and Department of Immunology and Histocompatibility (N.K.), Laikon University Hospital, Athens, Greece.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Dalakas</LastName><ForeName>Marinos C</ForeName><Initials>MC</Initials><AffiliationInfo><Affiliation>From the Neuroimmunology Unit (H.A., K.B., M.C.D.), Department of Pathophysiology (P.V., A.T.), and 1st Department of Intensive Care Medicine (E.M., A.K.), Evangelismos Hospital, Faculty of Medicine, National and Kapodistrian University of Athens; and Department of Immunology and Histocompatibility (N.K.), Laikon University Hospital, Athens, Greece. mdalakas@med.uoa.gr.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2020</Year><Month>09</Month><Day>25</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>Neurol Neuroimmunol Neuroinflamm</MedlineTA><NlmUniqueID>101636388</NlmUniqueID><ISSNLinking>2332-7812</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D001323">Autoantibodies</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D015415">Biomarkers</NameOfSubstance></Chemical></ChemicalList><SupplMeshList><SupplMeshName Type="Disease" UI="C000657245">COVID-19</SupplMeshName><SupplMeshName Type="Organism" UI="C000656484">severe acute respiratory syndrome coronavirus 2</SupplMeshName></SupplMeshList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000369" MajorTopicYN="N">Aged, 80 and over</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D001323" MajorTopicYN="N">Autoantibodies</DescriptorName><QualifierName UI="Q000134" MajorTopicYN="Y">cerebrospinal fluid</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000073640" MajorTopicYN="N">Betacoronavirus</DescriptorName><QualifierName UI="Q000302" MajorTopicYN="Y">isolation & purification</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D015415" MajorTopicYN="N">Biomarkers</DescriptorName><QualifierName UI="Q000134" MajorTopicYN="N">cerebrospinal fluid</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D001812" MajorTopicYN="N">Blood-Brain Barrier</DescriptorName><QualifierName UI="Q000378" MajorTopicYN="Y">metabolism</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D003128" MajorTopicYN="N">Coma</DescriptorName><QualifierName UI="Q000134" MajorTopicYN="Y">cerebrospinal fluid</QualifierName><QualifierName UI="Q000175" MajorTopicYN="N">diagnosis</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D018352" MajorTopicYN="N">Coronavirus Infections</DescriptorName><QualifierName UI="Q000134" MajorTopicYN="Y">cerebrospinal fluid</QualifierName><QualifierName UI="Q000175" MajorTopicYN="N">diagnosis</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D009422" MajorTopicYN="N">Nervous System Diseases</DescriptorName><QualifierName UI="Q000134" MajorTopicYN="Y">cerebrospinal fluid</QualifierName><QualifierName UI="Q000175" MajorTopicYN="N">diagnosis</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D058873" MajorTopicYN="N">Pandemics</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011024" MajorTopicYN="N">Pneumonia, Viral</DescriptorName><QualifierName UI="Q000134" MajorTopicYN="Y">cerebrospinal fluid</QualifierName><QualifierName UI="Q000175" MajorTopicYN="N">diagnosis</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D053608" MajorTopicYN="N">Stupor</DescriptorName><QualifierName UI="Q000134" MajorTopicYN="Y">cerebrospinal fluid</QualifierName><QualifierName UI="Q000175" MajorTopicYN="N">diagnosis</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D016896" MajorTopicYN="N">Treatment Outcome</DescriptorName></MeshHeading></MeshHeadingList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2020</Year><Month>07</Month><Day>22</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2020</Year><Month>08</Month><Day>25</Day></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2020</Year><Month>9</Month><Day>26</Day><Hour>5</Hour><Minute>25</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2020</Year><Month>9</Month><Day>27</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2020</Year><Month>10</Month><Day>8</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>epublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">32978291</ArticleId><ArticleId IdType="pii">7/6/e893</ArticleId><ArticleId IdType="doi">10.1212/NXI.0000000000000893</ArticleId></ArticleIdList></PubmedData></pubmed></record>Pour manipuler ce document sous Unix (Dilib)
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