Neurologic and neuroimaging findings in patients with COVID-19

Abstract

ObjectiveTo describe neuroimaging findings and to report the epidemiological and clinical characteristics of COVID-19 patients with neurological manifestations.MethodsIn this retrospective multicenter study (10 Hospitals), we included 64 confirmed COVID-19 patients with neurologic manifestations who underwent a brain MRI.ResultsThe cohort included 43 men (67%), 21 women (33%), and the median age was 66 years (range: 20-92). 36 (56%) brain MRIs were considered abnormal, possibly related to SARS-CoV-2. Ischemic strokes (27%), leptomeningeal enhancement (17%), and encephalitis (13%) were the most frequent neuroimaging findings. Confusion (53%) was the most common neurological manifestation, following by impaired consciousness (39%), presence of clinical signs of corticospinal tract involvement (31%), agitation (31%), and headache (16%). The profile of patients experiencing ischemic stroke was different from the other patients with abnormal brain imaging since the former had less frequently acute respiratory distress syndrome (p=0·006) and more frequently corticospinal tract signs (p=0·02). Patients with encephalitis were younger (p=0·007), whereas agitation was more frequent for patients with leptomeningeal enhancement (p=0·009).ConclusionsCOVID-19 patients may develop a wide range of neurological symptoms, which can be associated with severe and fatal complications, such as ischemic stroke or encephalitis. Concerning the meningoencephalitis involvement, even if a direct effect of the virus cannot be excluded, the pathophysiology rather seems to involve an immune and/or inflammatory process given the presence of signs of inflammation in both cerebrospinal fluid and neuroimaging but the lack of virus in cerebrospinal fluid.

Possible Autoimmune Encephalitis with Claustrum Sign in case of Acute SARS-CoV-2 Infection

“…neuropathogenesis is autoimmune, which would align with steroid responsiveness. The finding of the claustrum sign on brain MRI, not previously reported in a COVID-19 patient, [4][5][6][7][8] provides further support for the idea that acute SARS-CoV-2 infection may present as an autoimmune encephalitis.…”

“…CoV-2 5,8. Instead, negative CSF PCR for SARS-CoV-2 may reflect that the underlying https://doi.org/10.1017/cjn.2020.209Downloaded from https://www.cambridge.org/core.…”

Multisystem Imaging Manifestations of COVID-19, Part 2: From Cardiac Complications to Pediatric Manifestations

“…About one-third of patients with acute or subacute COVID-19 referred for neuroimaging may show brain abnormalities (25). The results of a large multi-institutional study in France showed ischemic strokes depicted in 27% of patients, leptomeningeal enhancement in 17%, and encephalitis in 13% (26). Large infarcts have been reported in 45% of patients, with lacunar infarcts in 24% and hemorrhagic stroke in another 24% of 38 patients with COVID-19 from a large cohort within the New York health system (27).…”

Severe Acute Respiratory Syndrome Coronavirus 2 Impact on the Central Nervous System: Are Astrocytes and Microglia Main Players or Merely Bystanders?

“…Neurological manifestations of SARS-CoV-2 infection are starting to be systematically recorded and reported, with several initiatives to consolidate and record clinical findings (Ferrarese et al, 2020;Roma´n et al, 2020;Romero-Sa´nchez et al, 2020). Between 30% and 40% of the SARS-CoV-2 patients present neurological symptoms; these can go from mild symptoms including olfactory and gustatory disorders, dizziness, headache, confusion, to a more severe cerebrovascular disease, encephalitis, seizures, or the Guillain-Barr e syndrome (Asadi-Pooya and Simani, 2020; Kremer et al, 2020;Mao et al, 2020). The presence of SARS-CoV-2 viral particles in the CNS has been evidenced in some cases (Benameur et al, 2020;Moriguchi et al, 2020;Wu et al, 2020), with reports showing SARS-CoV-2 presence in CSF (Finsterer and Stollberger, 2020).…”

“…A mounting body of reports from SARS-CoV-2affected patients is showing that about 30% to 40% of patients develop serious central nervous system (CNS) symptoms, with neurological and neuroradiological alterations confirmed in a large number of cases (Alam et al, 2020;Helms et al, 2020;Jasti et al, 2020;Kremer et al, 2020;Mao et al, 2020;Najjar et al, 2020;Pryce-Roberts et al, 2020;Roma´n et al, 2020;Romero-Sa´nchez et al, 2020;Xiong et al, 2020; and several others). Plasma biomarkers of CNS injury have been shown to be increased in a group of patients with moderate and severe COVID-19 disease (Kanberg et al, 2020).…”