COVID-19’s effects on the Egyptian population’s brain: Could MRI and specialized MR spectroscopic analysis be beneficial?

Abstract

Background The recent pandemic of COVID‐19 has thrown the world into chaos due to its high rate of transmissions. Recently viewed neurological manifestations among hospitalized Egyptian patients with COVID‐19 in quarantine centres. Ataxia, disturbed consciousness and convulsions should be further evaluated by MRI and MRS for CNS involvement by SARS‐CoV‐2. How COVID-19 targeting the CNS is still under study, as it is difficult to predict which diagnostic neurological tests will be used to identify high-risk COVID19 patients. MR spectroscopy represents a non-invasive in vivo diagnostic technique for evaluation of metabolic profile of the brain and can reveal important information about the underlying pathologies. Multiple recent reports in the medical literature had confirmed the neurological complications in COVID-19 infection, though few studies has reported the MR spectroscopic findings in these patients. This cross-sectional study aimed to use MRI and MR spectroscopic findings for evaluation of the neurological manifestation of Egyptian COVID‐19 patients. Results Ninety-one male and twenty-seven female met the inclusion criteria, with a mean age of 52 years ± 10 (SD) (age range; 12–78 years). The commonest neurological manifestations were disturbed conscious level (82.2%). The most common MRI findings were acute ischemic insult with/without haemorrhagic areas (42.3%), demyelinating patches of altered signal intensity (31.3%). Sixty cases who had haemorrhagic areas were excluded to perform MRS due to contamination of the spectra by blood component. However, the remaining 67 patients had NAA reduction, choline elevation, glutamate/glutamine and lactate elevation in short TE35, with mean of NAA/Cr ratio = 1.04 ± 0.14, Choline/Cr = 0.49 ± 0.04 and Glx/Cr = 1.56 ± 0.22. Conclusions During the current pandemic of COVID-19, radiologists should be aware of wide spectrum of MRI and MRS findings of COVID-19-related CNS involvement.

Molecular and metabolic changes in neurological manifestations of Post-COVID conditions with special consideration of spectroscopy MR analysis

“…According to Sun et al, MR spectroscopy in some conditions can detect neurochemical abnormalities, even when structural MR is inconclusive [44]. The technique of MR spectrosco-py consists of imaging protocols including sagittal and axial T1, proton spin density, and T2-weighted spin-echo with or without gadolinium contrast injection, and coronal and/or axial fluid-attenuated inversion recovery (FLAIR) images with or without axial diffusion-weighted imaging (DWI) [45][46][47].…”

“…This method is useful for distinguishing between various types of shifts in brain structures by comparing the ppm of each metabolite to the ppm of normal brain tissue. The main metabolites used to asses COVID patients are choline (Cho), creatine (Cr), N-acetyl-aspartate (NAA), myo-inositol (mI), glutamine (Glu)/glutamate (Gln), and GABA and lactates (Lac) [45,46,48,49]. Another metabolite, glutathione (GSH), was introduced into MR spectroscopy by Samkaria, Avantika et al as an immediate factor enhancing SARS-CoV-2-induced oxidative damage [50].…”

“…Therefore, these shifts may have been caused by mitochondrial dysfunction [49]. Elevated Lac was found to be increased in a study conducted by Reda et al [46], which could be the aftermath of oxidative stress in brain cells after a period of hypoxia.…”