Personalized Approach to Patient with MRI Brain Changes after SARS-CoV-2 Infection

Abstract

From the beginning of SARS-CoV-2 virus pandemic, it was clear that respiratory symptoms are often accompanied with neurological symptoms. Neurological manifestations can occur even after mild forms of respiratory disease, and neurological symptoms are very often associated with worsening of the patient’s condition. The aim of this study was to show abnormal brain neuroimaging findings evaluated by MRI in patients after SARS-CoV-2 infection and neurological symptoms. Methods: Sixteen patients after mild forms of SARS-CoV-2 infection, twenty-three patients after moderate forms of SARS-CoV-2 infection as well as sixteen healthy participants in the control group underwent MRI 3T brain scan. All subjects in the SARS-CoV-2 group had small, punctuate, strategically located and newly formed hyperintense lesions on T2 and FLAIR sequences. New lesions were formed more often in the bilateral frontal subcortical and bilateral periventricular, correlated with the severity of the clinical picture. These changes indicate an example of silent cerebrovascular disease related to SARS-CoV-2 and once again emphasize the neurotropism of the virus.

SARS-CoV-2 Infection Causes Relapse of Kleine-Levin Syndrome: Case Report and Review of Literature

“…Only moderate SARS-CoV-2 infection coincided with the new relapse of his symptoms. The SARS-CoV-2 virus is a single stranded RNA virus which primarily causes respiratory symptoms, but an increasing number of patients also have neurological symptoms or neurological consequences of overcoming infection [14]. There is almost no neurological symptom that has not been described in the literature as a possible consequence of SARS-CoV-2 infection.…”

“…The most common findings on MR brain images after COVID infection were hyperintensive nonconfluent white matter lesions in the FLAIR sequence with postcontrast imbibition (such lesions are seen on MRI of the brain in our patient), hemorrhagic lesions, and diffuse microbleeds within the white matter in the SWI sequence in the medial temporal lobe area. Laminar cortical lesions are also common, which may indicate a disorder of vasomotor reactivity, but also numerous periventricular and juxtacortical hypertensive lesions in the FLAIR sequence with in-creased signal intensity on the DWI map or in the area of the corpus callosum [14]. The symptoms of Kleine-Levin syndrome are characterized by their intermittent and periodic nature [16].…”

COVID-19-Impfung-assoziierte anhaltende Kopfschmerzen: Wie einordnen?

“…Pajo und Kollegen diskutieren einen direkten Befall des ZNS durch SARS-CoV‑2, einerseits hämatogen, alternativ durch retrograden Transport über den Nervus vagus aus Lunge und/oder Darm oder über den Nervus olfactorius [ 26 ]. Als Argument für eine hämatogene Verbreitung wurde das Neuauftreten von hyperdensen Läsionen im Marklager in T2-gewichteten MRT-Bildern gesehen, die mit der Schwere der Infektion korrelieren [ 23 ]. Für einen direkten Befall der Meningen und des Gehirns durch das COVID-19-Virus gibt es aber keine histologischen Hinweise [ 30 ].…”

Role of Demyelination in the Persistence of Neurological and Mental Impairments after COVID-19

“…The study of Marcic et al [ 160 ] conducted in 40–60 days after recovery from mild ( n = 16) or moderate ( n = 23) SARS-CoV-2 infection showed multiple punctate hyperintensities on brain T2 and FLAIR MRI. Those changes were not present on pre-COVID MRI brain scans of the same patients and correlated with the severity of the clinical symptoms.…”