Unusual Brain MRI Pattern in 2 Patients with COVID-19 Acute Respiratory Distress Syndrome

Toledano-Massiah, S.; Badat, Neesmah; Leberre, A.; Bruel, Cédric; Ray, Aritra; Gerber, Sophie; Zins, Marc; Hodel, Jérôme

doi:10.3174/ajnr.a6817

Cited by 9 publications

(8 citation statements)

References 7 publications

(7 reference statements)

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“…Both our cases depicted lesions showing ring-shaped diffusion restriction, previously described in two cases (Toledano-Massiah et al 2020 ). This feature is reminiscent of cytotoxic edema at the leading edge of demyelination.…”

Section: Discussionsupporting

confidence: 73%

COVID-19 leukoencephalopathy with subacute magnetic resonance imaging findings of vasculitis and demyelination

et al. 2021

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) commonly results in a respiratory illness in symptomatic patients; however, those critically ill can develop a leukoencephalopathy. We describe two patients who had novel subacute MRI findings in the context of coronavirus disease 2019 (COVID-19) leukoencephalopathy, which we hypothesize could implicate a potent small-vessel vasculitis, ischemic demyelination and the presence of prolonged ischemia. Recent evidence of the direct neuroinvasiness of SARS-CoV-2 leading to ischemia and vascular damage supports this hypothesis.

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Section: Discussionsupporting

confidence: 73%

COVID-19 leukoencephalopathy with subacute magnetic resonance imaging findings of vasculitis and demyelination

et al. 2021

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“…Several mechanisms for the SARS-CoV-2-related neurological complications are being considered: (a) a direct viral invasion (haematogenic or retrograde axonal by olfactory mucosa to olfactory bulbs) to the brain, which can lead to intracellular virus accumulation in endothelial cells (endothelitis with thrombotic microangiopathy) [ 17 , 18 , 19 , 20 , 21 ], neurons, Reference [ 22 ] glial cells, macrophages; (b) an indirect process resulting from hypercoagulability-related [ 23 ]; (c) an exaggerated cytokine [ 20 ]/immune-mediated response to viral infection causing damage to blood vessel wall or cells in the brain [ 24 ] with (d) ischemia, hypoxic, References [ 17 , 24 ] and (e) treatment complications [ 25 ] or (f) a combination of some or all of them [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical and Radiological Profiles of COVID-19 Patients with Neurological Symptomatology: A Comparative Study

Aragão

Gouveia

Andrade

et al. 2021

Viruses

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Patients with COVID-19 can require radiological examination, with chest CT being more frequent than neuro-imaging. The objective is to identify epidemiological, clinical and radiological factors considered as predictors of neurological involvement in patients with COVID-19 assessed by neuroimaging and to describe the neuroimaging findings. This retrospective study was performed with 232 consecutive confirmed COVID-19 patients, from two radiological units, which were divided into two groups: (1) those who underwent a brain CT/MRI scan (n = 35) versus (2) those who did not undergo the brain CT/MRI scan, but underwent only chest CT (n = 197). There was a statistically significant difference with associations regarding the COVID-19 brain scan group for: admission to ICU, greater severity of lung injuries, the use of a mechanical ventilator and sepsis. Statistical tendency was found for chronic renal failure and systemic arterial hypertension. Forty-percent of COVID-19 patients from the brain scan group were abnormal on brain CT and/or brain MRI (22.9% of the cases with bleeding or microbleeding, 8.6% with restricted diffusion lesions). One ischemic stroke case was associated with irregularity at the M1 segment of the right middle cerebral artery. There was a case of left facial nerve palsy with enhancement of the left geniculate ganglia. An analysis of the olfactory bulbs was possible in 12 brain MRIs and 100% had enhancement and/or microbleeding. In conclusion, a more severe COVID-19 disease from ICU, a more severe form of lung disease, the use of mechanical ventilator and sepsis were associated to the COVID-19 patients with neurological involvement who had undergone brain scans. Microvascular phenomenon was a frequent finding in the brain and olfactory bulbs evaluated by neuroimaging.

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“…They also showed radiological–pathological correlates of these microlesions, which included red blood cell extravasation, ischemia, deficiency, but not loss of axons and myelin, and microglial response [ 19 ]. Our patients did not have lesions in the corpus callosum, which may be a sign of a bad clinical picture and a worse clinical outcome [ 16 , 19 ]. Significant consequences and pathological changes after infection remained on all organs, especially on the lung parenchyma [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

“…Toledano-Massiah et al showed two patients with a severe SARS-CoV-2 infection who had an MRI of the brain with unusual nodular and annular lesions periventricularly, and within the white matter, it was hyperintensive on the FLAIR sequence. The corpus callosum was also affected [ 16 ]. Flores et al showed extensive pontine and midbrain hemorrhage with penetration into the 3rd and 4th ventricles [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

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

Marčić

Kojundžić

et al. 2021

JPM

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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.

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Unusual Brain MRI Pattern in 2 Patients with COVID-19 Acute Respiratory Distress Syndrome

Cited by 9 publications

References 7 publications

COVID-19 leukoencephalopathy with subacute magnetic resonance imaging findings of vasculitis and demyelination

COVID-19 leukoencephalopathy with subacute magnetic resonance imaging findings of vasculitis and demyelination

Clinical and Radiological Profiles of COVID-19 Patients with Neurological Symptomatology: A Comparative Study

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

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