Neuroimaging features of COVID-19, the authors of a research letter published online in Radiology have noted, are variable among patients with acute neurological symptoms but are dominated by acute ischemic infarcts.
Using a retrospective, multicenter study design, Abdelkader Mahammedi, M.D., from the University of Cincinnati Medical Center, and colleagues describe neurological symptoms and neuroimaging features observed in hospitalized COVID-19 patients in Italy.
A total of 108 hospitalized COVID-19 patients met the eligibility criteria; of these patients, 107 underwent noncontrast brain computed tomography (CT), 17 underwent head and neck CT angiography, and 20 had brain magnetic resonance imaging (MRI). The researchers found that the most common neurological symptoms were altered mental status and ischemic stroke (59 and 31 percent, respectively). Twenty-nine percent of patients had no known past medical history and 71 percent had at least one chronic disorder.
Of the patients without known past medical history, 10 and two had acute ischemic infarcts and intracranial hemorrhage, respectively. Sixty-six percent of the 108 patients had no acute findings on brain CT; acute abnormalities were seen on seven brain MRIs. Acute ischemic infarcts were the main neuroimaging hallmark; of the 34 infarcts, 19 were large, 11 were small, three were cardioembolic, and one was hypoxic-ischemic encephalopathy pattern. Of six intracranial hemorrhages, three were subarachnoid.
“Currently,” the authors concluded, “we have a poor mechanistic understanding of the neurological symptoms in COVID-19 patients, whether these are arising from critical illness or from direct central nervous system invasion of severe acute respiratory syndrome coronavirus 2.”
REFERENCE: Mahammedi et al: Imaging in Neurological Disease of Hospitalized COVID-19 Patients; https://pubs.rsna.org/doi/10.1148/radiol.2020201933