June 17, 2020

Imaging Study Identifies the Most Frequent Neuroimaging Features of Patients With COVID-19

Patients with severe coronavirus disease 2019 (COVID-19) without ischaemic infarcts had a wide range of neurologic manifestations that were associated with abnormal brain MRIs, according to a study published in Radiology.

The findings come from a study of 37 consecutive patients (mean age, 61 years; 81% male) with COVID-19 infection and neurologic manifestations who underwent brain MRI between March 23 and April 27, 2020, at 16 French centers, including 11 university hospitals and 5 general hospitals.

The most frequent neuroimaging features of patients with COVID-19 were involvement of the medial temporal lobe (43%), non-confluent multifocal white matter hyperintense lesions on FLAIR with variable enhancement and haemorrhagic lesions (30%), and extensive and isolated white matter microhemorrhages (24%).

The most common neurologic manifestations were alteration of consciousness (73%), pathological wakefulness when sedation was stopped (41%), confusion (32%), and agitation (19%).

Of the patients, 28 (76%) showed 1 neuroimaging pattern, 7 (19%) 2 patterns, and 2 (5%) showed 3 patterns.

The majority (54%) of the patients in the study presented with intracerebral haemorrhagic lesions, which were associated with worse clinical status.

“Three main neuroradiological patterns could be distinguished [in patients with COVI-19], and the presence of haemorrhage was associated with worse clinical status.” the authors wrote.

They noted that severe acute respiratory syndrome coronavirus 2 RNA was detected in the cerebrospinal fluid of only 1 patient, and the underlying mechanisms of brain involvement remain unclear.

“Imaging and neurological follow-up has to be undertaken in order to evaluate the prognosis of these patients,” the authors wrote.

Reference: https://pubs.rsna.org/doi/10.1148/radiol.2020202222

SOURCE: Radiological Society of North America
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