Available studies offer only limited guidance on neuroimaging of non-acute headache patients. The aim of this study was to estimate the frequency of significant intracranial lesions in patients with headache and to determine the clinical variables helpful in identifying patients with intracranial lesions. All patients aged >or= 15 years attending the Neurology Clinic with non-acute headache were included in the study and followed prospectively. Every patient was investigated by neuroimaging studies, either computed tomography or magnetic resonance imaging. Neuroimaging results were classified as 'significant abnormalities', 'non-significant abnormalities' or 'normal'. Significant abnormalities included neoplastic disease, hydrocephalus, vascular malformations, Chiari malformation, large arachnoid cysts, intracranial haemorrhage, and acute cerebral infarcts. Consecutive patients (n=1876; 1243 women and 633 men) were included. Their mean age was 38 years (range 15-95 years). Neuroimaging studies detected significant lesions in 22 patients [1.2%, 95% confidence interval (CI) 0.7, 1.8]. The rate of significant intracranial abnormalities in patients with headache and normal neurological examination was 0.9% (95% CI 0.5, 1.4). The only clinical variable associated with a higher probability of intracranial abnormalities was neurological examination. The proportion of patients with headache and intracranial lesions is relatively small, but neither neurological examination nor the features in the clinical history permit us to rule out such abnormalities.

PURPOSE: Our aim was to study the association between abnormal findings on chest and brain imaging in patients with coronavirus disease 2019 (COVID-19) and neurologic symptoms. MATERIALS AND METHODS: In this retrospective, international multicenter study, we reviewed the electronic medical records and imaging of hospitalized patients with COVID-19 from March 3, 2020, to June 25, 2020. Our inclusion criteria were patients diagnosed with Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) infection with acute neurologic manifestations and available chest CT and brain imaging. The 5 lobes of the lungs were individually scored on a scale of 0-5 (0 corresponded to no involvement and 5 corresponded to .75% involvement). A CT lung severity score was determined as the sum of lung involvement, ranging from 0 (no involvement) to 25 (maximum involvement). RESULTS: A total of 135 patients met the inclusion criteria with 132 brain CT, 36 brain MR imaging, 7 MRA of the head and neck, and 135 chest CT studies. Compared with 86 (64%) patients without acute abnormal findings on neuroimaging, 49 (36%) patients with these findings had a significantly higher mean CT lung severity score (9.9 versus 5.8, P , .001). These patients were more likely to present with ischemic stroke (40 [82%] versus 11 [13%], P , .0001) and were more likely to have either ground-glass opacities or consolidation (46 [94%] versus 73 [84%], P ¼ .01) in the lungs. A threshold of the CT lung severity score of .8 was found to be 74% sensitive and 65% specific for acute abnormal findings on neuroimaging. The neuroimaging hallmarks of these patients were acute ischemic infarct (28%), intracranial hemorrhage (10%) including microhemorrhages (19%), and leukoencephalopathy with and/or without restricted diffusion (11%). The predominant CT chest findings were peripheral ground-glass opacities with or without consolidation. CONCLUSIONS: The CT lung disease severity score may be predictive of acute abnormalities on neuroimaging in patients with COVID-19 with neurologic manifestations. This can be used as a predictive tool in patient management to improve clinical outcome. ABBREVIATIONS: COVID-19 ¼ coronavirus disease 2019; GGOs ¼ ground-glass opacities; PRES ¼ posterior reversible encephalopathy syndrome; SARS-CoV-2 ¼ Severe Acute Respiratory Syndrome coronavirus 2; TIPIC ¼ Transient Perivascular Inflammation of the Carotid artery syndrome S evere Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) began in Wuhan, China, in December 2019 and has rapidly spread around the world to become a pandemic. 1 Extensive studies have described chest and brain imaging characteristics associated with coronavirus disease 2019 (COVID-19). 2-13 The hallmarks of COVID-19 infection on chest imaging

Neurological and neuroradiological manifestations in patients with COVID-19 have been extensively reported. Available imaging data are, however, very heterogeneous. Hence, there is a growing need to standardise clinical indications for neuroimaging, MRI acquisition protocols, and necessity of follow-up examinations. A NeuroCovid working group with experts in the field of neuroimaging in COVID-19 has been constituted under the aegis of the Subspecialty Committee on Diagnostic Neuroradiology of the European Society of Neuroradiology (ESNR). The initial objectives of this NeuroCovid working group are to address the standardisation of the imaging in patients with neurological manifestations of COVID-19 and to give advice based on expert opinion with the aim of improving the quality of patient care and ensure high quality of any future clinical studies. Key Points • In patients with COVID-19 and neurological manifestations, neuroimaging should be performed in order to detect underlying causal pathology. • The basic MRI recommended protocol includes T2-weighted, FLAIR (preferably 3D), and diffusion-weighted images, as well as haemorrhage-sensitive sequence (preferably SWI), and at least for the initial investigation pre and post-contrast T1 weighted-images. • 3D FLAIR should be acquired after gadolinium administration in order to optimise the detection of leptomeningeal contrast enhancement.

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Introdução: A Coronaviridae é uma grande família de vírus de RNA causadores de síndromes respiratórias comuns em animais e humanos(1). Em dezembro de 2019 foi detectado em Wuhan, China, um novo subgênero coronavírus, o SARS-COV-2(2). A COVID-19, assim denominada a doença causada pelo novo coronavírus, é responsável por desencadear desde sintomas gripais leves a síndrome respiratória aguda grave(1). Além de anosmia (perda de olfato) e disgeusia (diminuição do paladar) os quais são sintomas relatados entre os infectados durante o curso da doença. Objetivo: Considerando a situação atual mundial, marcada por importantes crises na saúde pública, sendo a pandemia da Covid-19 uma delas, o presente artigo buscou reunir evidencias cientificas a respeito dos distúrbios gustativos e olfativos na COVID-19. Metodologia: Foi realizada uma busca no portal científico PubMed com os descritores Anosmia; Dysgeusia; COVID-19, com filtros sem restrição linguística para o período de 2 anos (2020-2021) em modelos humanos, o retorno foi de 100 artigos, dos quais 20 foram selecionados para revisão bibliográfica. Resultados: Os resultados alcançados mostram que na maioria dos pacientes a recuperação da anosmia e disgeusia é rápida e geralmente reversível, em virtude da capacidade do epitélio olfativo de se regenerar e da recuperação das células epiteliais da língua que em alguns casos depende da recuperação do olfato primeiramente, quando este também estiver alterado(3). Diversos estudos mostram uma correlação entre a perda ou alteração do olfato e do paladar e a infecção pelo SARS-CoV-2.(4),(5) Atualmente não se sabe quanto tempo esses sintomas podem permanecer e determinar se haverá uma recuperação completa das funções olfativa e gustativa. Os mecanismos fisiopatológicos das alterações do olfato e paladar ainda não foram totalmente elucidados(3). Quanto ao tratamento para esses distúrbios ainda não se tem conhecimento na medicina de medicamentos ou tratamentos que sejam eficazes na recuperação das funções olfativa/gustatória. Conclusão: Nos casos estudados, anosmia e disgeusia foram os principais sintomas que acometeram os pacientes com a COVID-19 leve, os quais podem ou não persistir após a cura clínica da doença. Portanto, é desejável que futuros estudos de longa duração sejam realizados para se ter uma ideia mais abrangente para elucidação de mecanismos, duração dos sintomas após a cura clínica e desenvolvimento de terapias para o retorno dessas funções sensoriais.