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COVID-19–associated Acute Hemorrhagic Necrotizing Encephalopathy: CT and MRI Features
Neo Poyiadji, Gassan Shahin, Daniel Noujaim, Michael Stone, Suresh Patel, and Brent Griffith
Radiology 0 0:0
COVID-19–associated Acute Hemorrhagic Necrotizing Encephalopathy: CT and MRI Features
Neo Poyiadji, Gassan Shahin, Daniel Noujaim, Michael Stone, Suresh Patel, and Brent Griffith
Radiology 0 0:0
...Acute necrotizing encephalopathy (ANE) is a rare complication of influenza and other viral infections and has been related to intracranial cytokine storms, which result in blood-brain-barrier breakdown, but without direct viral invasion or parainfectious demyelination (3). Accumulating evidence suggests that a subgroup of patients with severe COVID-19 might have a cytokine storm syndrome (4). While predominantly described in the pediatric population, ANE is known to occur in adults as well. The most characteristic imaging feature includes symmetric, multifocal lesions with invariable thalamic involvement (5). Other commonly involved locations include the brain stem, cerebral white matter, and cerebellum (5). Lesions appear hypoattenuating on CT images and MRI demonstrates T2 FLAIR hyperintense signal with internal hemorrhage. Postcontrast images may demonstrate a ring of contrast enhancement (5).
This is the first reported case of COVID-19–associated acute necrotizing hemorrhagic encephalopathy. As the number of patients with COVID-19 increases worldwide, clinicians and radiologists should be watching for this presentation among patients presenting with COVID-19 and altered mental status.
This is the first reported case of COVID-19–associated acute necrotizing hemorrhagic encephalopathy. As the number of patients with COVID-19 increases worldwide, clinicians and radiologists should be watching for this presentation among patients presenting with COVID-19 and altered mental status.