Evolution of Neuroimaging Findings in Severe COVID-19 Patients with Initial Neurological Impairment: An Observational Study

Abstract

Background and Objectives: Cerebral complications related to the COVID-19 were documented by brain MRIs during the acute phase. The purpose of the present study was to describe the evolution of these neuroimaging findings (MRI and FDG-PET/CT) and describe the neurocognitive outcomes of these patients. Methods: During the first wave of the COVID-19 outbreak between March 1 and May 31, 2020, 112 consecutive COVID-19 patients with neurologic manifestations underwent a brain MRI at Strasbourg University hospitals. After recovery, during follow-up, of these 112 patients, 31 (initially hospitalized in intensive care units) underwent additional imaging studies (at least one brain MRI). Results: Twenty-three men (74%) and eight women (26%) with a mean age of 61 years (range: 18–79) were included. Leptomeningeal enhancement, diffuse brain microhemorrhages, acute ischemic strokes, suspicion of cerebral vasculitis, and acute inflammatory demyelinating lesions were described on the initial brain MRIs. During follow-up, the evolution of the leptomeningeal enhancement was discordant, and the cerebral microhemorrhages were stable. We observed normalization of the vessel walls in all patients suspected of cerebral vasculitis. Four patients (13%) demonstrated new complications during follow-up (ischemic strokes, hypoglossal neuritis, marked increase in the white matter FLAIR hyperintensities with presumed vascular origin, and one suspected case of cerebral vasculitis). Concerning the grey matter volumetry, we observed a loss of volume of 3.2% during an average period of approximately five months. During follow-up, the more frequent FDG-PET/CT findings were hypometabolism in temporal and insular regions. Conclusion: A minority of initially severe COVID-19 patients demonstrated new complications on their brain MRIs during follow-up after recovery.

Cerebral perfusion using ASL in patients with COVID-19 and neurological manifestations: A retrospective multicenter observational study

“…The short- and long-term functional outcome of patients with severe COVID-19 and brain perfusion abnormalities needs to be further investigated. However, a recently published follow-up of patients with COVID-19 and initial neurological symptoms 42 , of whom 68% had MRI abnormalities (including perfusion abnormalities), shows that nearly half of them had persistent slightly diminished results in working memory and executive functions testing. Alteration of such frontal neurocognitive functions might have a link with the fronto-temporal pattern of hypoperfusion that we report.…”

Gray Matter Changes Following Mild COVID‐19: An MR Morphometric Study in Healthy Young People

“…10,11 Others have found that after severe COVID, gray matter volume decreases. 8 After mild COVID infection, some authors found no gray matter abnormalities at all. 12 Most quantitative MRI studies investigating the period following COVID-19 infection have found abnormalities in structures associated with the olfactory system.…”

“…Therefore, it is particularly important to detect or refute the central nervous system effects of the SARS-CoV-2 virus in people who have experienced mild COVID-19.In patients with severe COVID-19 requiring intensive care unit treatment, conventional MRI techniques sometimes detect brain abnormalities during and after acute infection: microbleeds, ischemic lesions, and white matter abnormalities have been reported. 8 However, no clear central nervous system abnormalities underlying long COVID have yet been detected by conventional MRI. 9 The results of quantitative MRI studies looking for subtle differences-not visible by direct visual analysis-are surprisingly contradictory.…”

“…However, there is also a possibility that the direct or indirect consequences of viral infection may affect the nervous system, leading to long COVID. Therefore, it is particularly important to detect or refute the central nervous system effects of the SARS‐CoV‐2 virus in people who have experienced mild COVID‐19.In patients with severe COVID‐19 requiring intensive care unit treatment, conventional MRI techniques sometimes detect brain abnormalities during and after acute infection: microbleeds, ischemic lesions, and white matter abnormalities have been reported 8 . However, no clear central nervous system abnormalities underlying long COVID have yet been detected by conventional MRI 9 .…”

Editorial for “Gray Matter Changes Following Mild COVID‐19: An MR Morphometric Study in Healthy Young People”

“…These alterations are a result of ischemic strokes and changes in structural white matter integrity. 1,3 Nonetheless, these sequences cannot detect biomarkers associated with the neurological symptoms observed in mild COVID patients. 4 Previous studies have performed morphometric gray matter approaches.…”