Multiple Microbleeds: A Serious Neurological Manifestation in a Critically Ill COVID-19 Patient

Abstract

Coronavirus disease 2019 (COVID-19) is a viral illness caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). There is worldwide emerging evidence of multisystem involvement including different neurological manifestations in COVID-19 patients. As a result, healthcare systems worldwide are not only experiencing diagnostic but also therapeutic and prognostic challenges with COVID-19-related complications. Cerebral microbleeds and leukoencephalopathy have been described in COVID-19 patients; although the mechanism remains unknown, possibilities include endotheliitis with thrombotic microangiopathy, excessive inflammation, prolonged respiratory failure, and hypoxemia. We describe here the clinical, radiological, and laboratory findings as well as the 90-day outcome of a 72-year-old gentleman who presented with severe SARS-CoV-2 infection, leading to diffuse cerebral microhemorrhages and ischemic infarct causing severe morbidity. He was tested positive for COVID-19 confirmed by reverse transcriptase polymerase chain reaction.

Modeling SARS-CoV-2: Comparative Pathology in Rhesus Macaque and Golden Syrian Hamster Models

“… 37 - 39 In humans, COVID-19-associated brain pathologies, such as encephalitis, cerebral microbleeds, stroke, and diffuse leukoencephalopathy are described, and it is hypothesized that inflammation of blood vessels secondary to virus binding of endothelium (rich in ACE2) results in subsequent breaks and leaks. 37 , 38 Another potential route for viral entry into the brain following intranasal inoculation could be through the olfactory nerve that provides a pathway between the olfactory bulb, located near the nasal cavity, and the brain; however, a recent review suggests a weak case for infection through this route. 40 There are little data on SARS-CoV-2-related encephalitis in nonhuman primates.…”