Changes in the profile of Coronavirus disease (COVID-19) and related neuroimaging findings during the first and second waves: a South Indian perspective

Abstract

Background The spectrum of COVID-19 infection-related neurological imaging findings in East Asian and Western populations has been well documented. In the Indian subcontinent, certain extracranial neurological imaging manifestations such as acute invasive fungal sinusitis were noted to occur with increasing frequency when compared to that reported in literature. This anomaly was more evident during the second wave of infection and since there is a paucity of literature documenting this change, we undertook this retrospective observational study. Results Patients with COVID-19 who underwent brain or spine imaging between 1st March 2020 and 31st May 2021 were assessed for inclusion. We considered cases with imaging done in 2020 as the 1st wave, and cases with imaging done in 2021 as the 2nd wave. In the first wave, the most common neuroimaging findings were ischemic stroke (82, 26.5%), acute invasive fungal sinusitis (34, 11%), dural venous sinus thrombosis (15, 4.9%), and brain hemorrhages (15, 4.9%). In the second wave, the most common were acute invasive fungal sinusitis (44, 21.9%), ischemic stroke (39, 19.4%), and noninvasive sinusitis (30, 14.9%). The second wave had significantly more cases of acute invasive fungal sinusitis (44, 21.9% vs. 34, 11%; p-value .001), noninvasive sinusitis, and orbital cellulitis when compared to the first wave. Conclusions While we had ischemic stroke, followed by acute invasive fungal sinusitis, dural venous sinus thrombosis, and brain hemorrhages as the most common neuroimaging findings in the first wave, the second wave was dominated by the extracranial complications of Mucormycosis, namely acute invasive fungal sinusitis.