Central Nervous System Injury in Patients With Severe Acute Respiratory Syndrome Coronavirus 2: MRI Findings

Edith Fabiola Mendez Elizondo,Gustavo Barraza Aguirre,Paulette Mariette Dautt Medina,José Arturo Valdez Ramírez,Jorge Berlanga Estens

doi:10.7759/cureus.18052

Edith Fabiola Mendez Elizondo, Gustavo Barraza Aguirre + Show 3 more

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https://doi.org/10.7759/cureus.18052

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Journal: Cureus	Publication Date: Sep 17, 2021
Citations: 9	License type: cc-by

Affiliation: Centro Médico ABC

Abstract

Due to the presence of a new and rapidly spreading coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the World Health Organization declared the coronavirus disease 2019 (COVID-19) outbreak a pandemic on March 11, 2020. This new disease has a multisystemic effect that predominantly targets the respiratory system; however, neurologic symptoms have been documented in approximately 36% of patients with confirmed COVID-19. During the period of March 2020 to March 2021, 481 brain MRI studies were performed by medical request. Of these, 9.7% (n = 47) were hospitalized with a diagnosis of COVID-19 pneumonia confirmed by SARS-CoV-2 reverse transcriptase-polymerase chain reaction (RT-PCR) test with the following findings: microbleeds, osmotic demyelination, arterial thrombosis, ischemic infarcts, venous thrombosis, metabolic cerebellar syndrome, posterior reversible leukoencephalopathy, abnormal signal intensity in the frontal lobes and olfactory bulbs, microangiopathy, gliosis, and findings consistent with hypoxic-ischemic encephalopathy. In patients with histories of malignant central nervous system (CNS) tumors, the most frequent histological lineage being high-grade glioma, 100% progression was identified with respect to previous imaging studies, without other significant findings. In two patients, a brain MRI was performed due to altered alertness, identifying only involutive changes in the brain parenchyma; MRI was repeated 72 hours later, after a lack of improvement in higher functions, without identifying imaging findings. To date, limited studies have documented CNS abnormalities related to COVID-19 using MRI. Therefore, the purpose of this study is to present abnormal imaging findings in patients with SARS-CoV-2 infection and their clinical correlations.

Highlights

IntroductionThe severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in China in the last two months of 2019 and caused a severe pandemic (coronavirus disease 2019 {COVID-19}), characterized by severe acute respiratory syndrome
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in China in the last two months of 2019 and caused a severe pandemic, characterized by severe acute respiratory syndrome
A brain MRI was performed due to altered alertness, identifying only involutive changes in the brain parenchyma; MRI was repeated 72 hours later, after a lack of improvement in higher functions, without identifying imaging findings

Summary

Introduction

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in China in the last two months of 2019 and caused a severe pandemic (coronavirus disease 2019 {COVID-19}), characterized by severe acute respiratory syndrome. COVID-19 has multisystemic involvement due to the virus binding to the cellular receptor for angiotensin-converting enzyme 2 (ACE2), which is found in multiple cells of the human body, including neuronal cells. The virus accesses neuronal cells by a retrograde neuronal pathway or hematogenous dissemination, which explains the neurological symptoms that have been reported in up to 36% of patients who have returned positive SARS-CoV-2 reverse transcriptase-polymerase chain reaction (RT-PCR) tests. The symptoms include disturbed consciousness, paresthesia, anosmia, and headache [1]

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