tetano
Editor, Senior Moderator
Clin Radiol
. 2020 Sep 15;S0009-9260(20)30392-5.
doi: 10.1016/j.crad.2020.09.002. Online ahead of print.
COVID-19-related intracranial imaging findings: a large single-centre experience
V Sawlani[SUP] 1 [/SUP], S Scotton[SUP] 2 [/SUP], S Jacob[SUP] 3 [/SUP], K Nader[SUP] 4 [/SUP], J P Jen[SUP] 5 [/SUP], M Patel[SUP] 4 [/SUP], K Gokani[SUP] 2 [/SUP], P Denno[SUP] 2 [/SUP], M Thaller[SUP] 2 [/SUP], C Englezou[SUP] 2 [/SUP], U Janjua[SUP] 5 [/SUP], M Bowen[SUP] 5 [/SUP], C Hoskote[SUP] 6 [/SUP], T Veenith[SUP] 7 [/SUP], G Hassan-Smith[SUP] 3 [/SUP]
Affiliations
Abstract
Aim: To describe the neuroradiological changes in patients with coronavirus disease 2019 (COVID-19).
Materials and methods: A retrospective review was undertaken of 3,403 patients who were confirmed positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and admitted to Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK between 1 March 2020 and 31 May 2020, and who underwent neuroimaging. Abnormal brain imaging was evaluated in detail and various imaging patterns on magnetic resonance imaging MRI were identified.
Results: Of the 3,403 patients with COVID-19, 167 (4.9%) had neurological signs or symptoms warranting neuroimaging. The most common indications were delirium (44/167, 26%), focal neurology (37/167, 22%), and altered consciousness (34/167, 20%). Neuroimaging showed abnormalities in 23% of patients, with MRI being abnormal in 20 patients and computed tomography (CT) in 18 patients. The most consistent neuroradiological finding was microhaemorrhage with a predilection for the splenium of the corpus callosum (12/20, 60%) followed by acute or subacute infarct (5/20, 25%), watershed white matter hyperintensities (4/20, 20%), and susceptibility changes on susceptibility-weighted imaging (SWI) in the superficial veins (3/20, 15%), acute haemorrhagic necrotising encephalopathy (2/20, 10%), large parenchymal haemorrhage (2/20, 10%), subarachnoid haemorrhage (1/20, 5%), hypoxic-ischaemic changes (1/20, 5%), and acute disseminated encephalomyelitis (ADEM)-like changes (1/20, 5%).
Conclusion: Various imaging patterns on MRI were observed including acute haemorrhagic necrotising encephalopathy, white matter hyperintensities, hypoxic-ischaemic changes, ADEM-like changes, and stroke. Microhaemorrhages were the most common findings. Prolonged hypoxaemia, consumption coagulopathy, and endothelial disruption are the likely pathological drivers and reflect disease severity in this patient cohort.
. 2020 Sep 15;S0009-9260(20)30392-5.
doi: 10.1016/j.crad.2020.09.002. Online ahead of print.
COVID-19-related intracranial imaging findings: a large single-centre experience
V Sawlani[SUP] 1 [/SUP], S Scotton[SUP] 2 [/SUP], S Jacob[SUP] 3 [/SUP], K Nader[SUP] 4 [/SUP], J P Jen[SUP] 5 [/SUP], M Patel[SUP] 4 [/SUP], K Gokani[SUP] 2 [/SUP], P Denno[SUP] 2 [/SUP], M Thaller[SUP] 2 [/SUP], C Englezou[SUP] 2 [/SUP], U Janjua[SUP] 5 [/SUP], M Bowen[SUP] 5 [/SUP], C Hoskote[SUP] 6 [/SUP], T Veenith[SUP] 7 [/SUP], G Hassan-Smith[SUP] 3 [/SUP]
Affiliations
- PMID: 33023738
- DOI: 10.1016/j.crad.2020.09.002
Abstract
Aim: To describe the neuroradiological changes in patients with coronavirus disease 2019 (COVID-19).
Materials and methods: A retrospective review was undertaken of 3,403 patients who were confirmed positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and admitted to Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK between 1 March 2020 and 31 May 2020, and who underwent neuroimaging. Abnormal brain imaging was evaluated in detail and various imaging patterns on magnetic resonance imaging MRI were identified.
Results: Of the 3,403 patients with COVID-19, 167 (4.9%) had neurological signs or symptoms warranting neuroimaging. The most common indications were delirium (44/167, 26%), focal neurology (37/167, 22%), and altered consciousness (34/167, 20%). Neuroimaging showed abnormalities in 23% of patients, with MRI being abnormal in 20 patients and computed tomography (CT) in 18 patients. The most consistent neuroradiological finding was microhaemorrhage with a predilection for the splenium of the corpus callosum (12/20, 60%) followed by acute or subacute infarct (5/20, 25%), watershed white matter hyperintensities (4/20, 20%), and susceptibility changes on susceptibility-weighted imaging (SWI) in the superficial veins (3/20, 15%), acute haemorrhagic necrotising encephalopathy (2/20, 10%), large parenchymal haemorrhage (2/20, 10%), subarachnoid haemorrhage (1/20, 5%), hypoxic-ischaemic changes (1/20, 5%), and acute disseminated encephalomyelitis (ADEM)-like changes (1/20, 5%).
Conclusion: Various imaging patterns on MRI were observed including acute haemorrhagic necrotising encephalopathy, white matter hyperintensities, hypoxic-ischaemic changes, ADEM-like changes, and stroke. Microhaemorrhages were the most common findings. Prolonged hypoxaemia, consumption coagulopathy, and endothelial disruption are the likely pathological drivers and reflect disease severity in this patient cohort.