Abstract
Background and PurposeCoronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with several complications of the central nervous system (CNS), including acute encephalopathy.MethodsIn this pilot study, we report a series of 39 patients (66.5 ± 9.2 years; 10.3% female) with acute encephalopathy, who underwent a standard brain magnetic resonance imaging (MRI) at 1.5 T during the acute symptomatic phase. In addition to diffusion-weighted imaging, MR angiography and susceptibility-weighted images, high-resolution vascular black blood sequences (in 34 cases) were used to investigate the vasculature of the brain.ResultsIn 29 out of 34 patients with COVID-19 encephalopathy (85%) with high-resolution vessel wall imaging, we found a circular enhancement and thickening of the basilar and vertebral arteries, without any correlation with ischemia or microbleeds (reported in 21% and 59%, respectively).ConclusionWe report a high prevalence of vascular changes suggestive of endotheliitis as reported in other organs. This could suggest an inflammatory mechanism underlying this encephalopathy.
Highlights
Coronavirus disease 2019 (COVID-19), which has spread all over the globe causing mainly respiratory symptoms, has been associated with extrapulmonary manifestations [1], including idiopathic encephalopathy—the COVID-19 encephalopathy [2]
Background and Purpose Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with several complications of the central nervous system (CNS), including acute encephalopathy. In this pilot study, we report a series of 39 patients (66.5 ± 9.2 years; 10.3% female) with acute encephalopathy, who underwent a standard brain magnetic resonance imaging (MRI) at 1.5 T during the acute symptomatic phase
No specific intrathecal IgG synthesis was observed in the 13 patients with available cerebrospinal fluid (CSF). In this series of patients with COVID-19, we focused on patients with acute encephalopathy
Summary
Coronavirus disease 2019 (COVID-19), which has spread all over the globe causing mainly respiratory symptoms, has been associated with extrapulmonary manifestations [1], including idiopathic encephalopathy—the COVID-19 encephalopathy [2]. The hypothesis of an endotheliitis (due to the so-called cytokine storm or via the angiotensin-converting enzyme 2 present on the vascular wall) for this encephalopathy has been raised due to the observed vascular patterns in some cases. This suggests that investigating the brain vasculature with modern Magnetic Resonance (MR) techniques is the logical step. Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with several complications of the central nervous system (CNS), including acute encephalopathy
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