Cerebral microhaemorrhage in COVID-19: a critical illness related phenomenon?

Dixon, Luke; McNamara, Cillian; Gaur, Pritika; Mallon, Dermot; Coughlan, Christopher; Tona, Francesca; Jan, Wajanat; Wilson, Mark; Jones, Brynmor

doi:10.1136/svn-2020-000652

Cited by 46 publications

(47 citation statements)

References 41 publications

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“…Cerebral microbleeds are reported in the majority of patients with COVID-19 encephalopathy, exceeding the prevalence of microbleeds reported in COVID-19 patients [2,6,16] including those hospitalized in the intensive care unit [17]. This increased prevalence of microbleeds reported in the current series can be explained by the strict inclusion of patients with COVID-19 encephalopathy.…”

Section: Discussioncontrasting

confidence: 80%

Cerebrovascular Complications and Vessel Wall Imaging in COVID-19 Encephalopathy—A Pilot Study

et al. 2021

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Background and Purpose Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with several complications of the central nervous system (CNS), including acute encephalopathy. Methods In this pilot study, we report a series of 39 patients (66.5 ± 9.2 years; 10.3% female) with acute encephalopathy, who underwent a standard brain magnetic resonance imaging (MRI) at 1.5 T during the acute symptomatic phase. In addition to diffusion-weighted imaging, MR angiography and susceptibility-weighted images, high-resolution vascular black blood sequences (in 34 cases) were used to investigate the vasculature of the brain. Results In 29 out of 34 patients with COVID-19 encephalopathy (85%) with high-resolution vessel wall imaging, we found a circular enhancement and thickening of the basilar and vertebral arteries, without any correlation with ischemia or microbleeds (reported in 21% and 59%, respectively). Conclusion We report a high prevalence of vascular changes suggestive of endotheliitis as reported in other organs. This could suggest an inflammatory mechanism underlying this encephalopathy.

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Section: Discussioncontrasting

confidence: 80%

Cerebrovascular Complications and Vessel Wall Imaging in COVID-19 Encephalopathy—A Pilot Study

et al. 2021

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“…As in previous studies, the most frequent neuroimaging finding was single or multiple T2* punctiform hypointense lesions (microbleeding) 8, 16-19 (frequently associated with white matter lesions on T2 8, 19 which sometimes have restricted diffusion 8 ) located mainly at the subcortical white matter junction and sometimes at the splenium of the corpus callosum 16-19 .…”

Section: Discussionsupporting

confidence: 64%

“…Several mechanisms for the SARS-CoV-2-related neurological complications are being considered: (a) a direct viral invasion of the haematogenic or retrograde axonal route by olfactory mucosa to olfactory bulbs and to the brain which can lead to intracellular virus accumulation in endothelial cells (endothelitis with thrombotic microangiopathy 16 20 ), neurons, 21 glial cells, macrophages and etc; (b), an indirect process resulting from hypercoagulability-related 22 ; (c) an exaggerated cytokine/ 19 immune-mediated response to viral infection causing damage to blood vessel walls or cells in the brain 23 with (d) ischemia and hypoxic, 16 23 and (e) treatment complications 24 or (f) a combination of them 16 .…”

Section: Discussionmentioning

confidence: 99%

Comparative Study - The Impact and Profile of COVID-19 Patients Who Are Indicated for Neuroimaging: Vascular Phenomena Are Been Found in the Brain and Olfactory Bulbs

Aragão

Leal

Filho

et al. 2021

Preprint

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ObjectiveTo verify the impact and findings of the COVID-19 patients’ group that underwent brain scans in comparison to the group which only chest CT was performed.Method876 suspected COVID-19 patients and a subsample of 232 cases with confirmed COVID-19 who underwent brain CT/MRI scan (n=35) or only chest CT (n=197) in two radiology departments, were evaluated.Results5.59% of all suspected COVID-19 patients found had brain scans and 98.74% chest CT. There was a statistically significant difference with associations regarding the COVID-19 brain scan group for: admission to ICU, greater severity of lung injuries, the use of mechanical ventilator, seizure, sepsis, and stroke and statistical tendency for chronic renal failure and systemic arterial hypertension. 40.0% of COVID-19 patients from the brain scan group were abnormal on brain CT and/or brain MRI. 22.9% cases with any kind of bleeding or microbleeding, 8.6% with restricted diffusion lesions. One ischemic stroke case was associated with irregularity at M1 segment of the right middle cerebral artery. There was a case of left facial nerve palsy with enhancement of left geniculate ganglia. An analyse of the olfactory bulbs was possible in 12 brain MRIs and 100% had enhancement and/or microbleeding. There was no statistical difference regarding death (9.1% versus 5.2%).In conclusionthe COVID-19 patients group on which brain CT and/or MRI needed to be performed was statically associated with the more severe COVID-19 disease, an indication to ICU, a more severe form of lung disease, use of mechanical ventilator, seizure, sepsis and stroke. Less than half of patients had abnormal brain imaging scans with all of them showing vascular brain injury lesion, being more frequently microbleeding or bleeding, followed by restricted diffusion lesions. All the olfactory bulbs evaluated showed injury by vascular phenomenon, probably methahemoglobine by microbleeding or microthrombus and/or abnormal enhancement

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“…As in previous studies, the most frequent neuroimaging finding was single or multiple T2* punctiform hypointense lesions (microbleeding) [ 8 , 17 , 18 , 19 , 20 ] (frequently associated with white matter lesions on T2 [ 8 , 20 ], which sometimes have restricted diffusion) [ 8 ] located mainly at the subcortical white matter junction and sometimes at the splenium of the corpus callosum [ 17 , 18 , 19 , 20 ].…”

Section: Discussionmentioning

confidence: 72%

Clinical and Radiological Profiles of COVID-19 Patients with Neurological Symptomatology: A Comparative Study

Aragão

Gouveia

Andrade

et al. 2021

Viruses

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Patients with COVID-19 can require radiological examination, with chest CT being more frequent than neuro-imaging. The objective is to identify epidemiological, clinical and radiological factors considered as predictors of neurological involvement in patients with COVID-19 assessed by neuroimaging and to describe the neuroimaging findings. This retrospective study was performed with 232 consecutive confirmed COVID-19 patients, from two radiological units, which were divided into two groups: (1) those who underwent a brain CT/MRI scan (n = 35) versus (2) those who did not undergo the brain CT/MRI scan, but underwent only chest CT (n = 197). There was a statistically significant difference with associations regarding the COVID-19 brain scan group for: admission to ICU, greater severity of lung injuries, the use of a mechanical ventilator and sepsis. Statistical tendency was found for chronic renal failure and systemic arterial hypertension. Forty-percent of COVID-19 patients from the brain scan group were abnormal on brain CT and/or brain MRI (22.9% of the cases with bleeding or microbleeding, 8.6% with restricted diffusion lesions). One ischemic stroke case was associated with irregularity at the M1 segment of the right middle cerebral artery. There was a case of left facial nerve palsy with enhancement of the left geniculate ganglia. An analysis of the olfactory bulbs was possible in 12 brain MRIs and 100% had enhancement and/or microbleeding. In conclusion, a more severe COVID-19 disease from ICU, a more severe form of lung disease, the use of mechanical ventilator and sepsis were associated to the COVID-19 patients with neurological involvement who had undergone brain scans. Microvascular phenomenon was a frequent finding in the brain and olfactory bulbs evaluated by neuroimaging.

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Cerebral microhaemorrhage in COVID-19: a critical illness related phenomenon?

Cited by 46 publications

References 41 publications

Cerebrovascular Complications and Vessel Wall Imaging in COVID-19 Encephalopathy—A Pilot Study

Cerebrovascular Complications and Vessel Wall Imaging in COVID-19 Encephalopathy—A Pilot Study

Comparative Study - The Impact and Profile of COVID-19 Patients Who Are Indicated for Neuroimaging: Vascular Phenomena Are Been Found in the Brain and Olfactory Bulbs

Clinical and Radiological Profiles of COVID-19 Patients with Neurological Symptomatology: A Comparative Study

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