MRI findings in COVID-19 positive and COVID-19 negative patients presenting with acute neurological symptoms – a case-control study

Abstract

Background & Objective: Neurological manifestations of novel-coronavirus disease (COVID-19) have been described in various studies. None of these studies has compared the findings in COVID-19 patients with COVID-negative patients presenting with similar clinical symptomatology during the same period. We undertook this case-control study with an aim to establish a direct relationship between COVID-19 infection and CNS related clinical and imaging presentations. Methods: This study was a review of retrospectively collected data of the patients who presented with different neurological symptoms to a tertiary care hospital in India. Based on results of Reverse transcriptase-polymerase chain reaction for SARS-Co-V-2, patients were classified into COVID-19 positive and COVID-19 negative groups. MRI findings in both groups were reviewed for acute ischemic stroke, intracranial bleed and other acute imaging abnormalities. Basic demographic information and stroke-related co-morbidities were also compared. Results: Eighty four patients in COVID-19 positive group and 323 patients in COVID-19 negative group underwent brain MRI for acute neurological symptoms during the same period. There was no statistically significant difference in presenting symptoms, sex distribution and risk factors for stroke. There was a higher prevalence of increased coagulability in COVID-19 positive group (p-value = 0.009). No statistically significant association was observed for infarcts or their hemorrhagic transformation, intracranial bleed, intracranial infection or dural sinus thrombosis. An association was found between acute diffuse leukoencephalopathy and COVID-19 infection (p value < 0.05). Conclusion: The current study points towards a weak direct association between COVID-19 infection and acute abnormalities in MRI brain studies, especially in patients with pre-existing co-morbidities.