Abstract
Coronavirus disease (COVID-19) has been associated with neurologic sequelae and neuroimaging abnormalities in several case series previously. In this study, the neuroimaging findings and clinical course of adult patients admitted with COVID-19 to a tertiary care hospital network in Canada were characterized. This is a retrospective observational study conducted at a tertiary hospital network in Ontario, Canada. All adult patients with PCR-confirmed COVID-19 admitted from February 1, 2020 to July 22, 2020 who received neuroimaging related to their COVID-19 admission were included. CT and MR images were reviewed and categorized by fellowship-trained neuroradiologists. Demographic and clinical data were collected and correlated with imaging findings. We identified 422 patients admitted with COVID-19 during the study period. 103 (24.4%) met the inclusion criteria and were included: 30 ICU patients (29.1%) and 73 non-ICU patients (70.9%). A total of 198 neuroimaging studies were performed: 177 CTs and 21 MRIs. 17 out of 103 imaged patients (16.8%) had acute abnormalities on neuroimaging: 10 had macrohemorrhages (58.8%), 9 had acute ischemia (52.9%), 4 had SWI abnormalities (23.5%), and 1 had asymmetric sulcal effacement suggesting possible focal encephalitis (5.8%). ICU patients were more likely to have positive neuroimaging findings, more specifically acute ischemia and macrohemorrhages (P < 0.05). Macrohemorrhages were associated with increased mortality (P < 0.05). Macrohemorrhages, acute ischemia and SWI abnormalities were the main neuroimaging abnormalities in our cohort of hospitalized COVID-19 patients. Acute ischemia and hemorrhage were associated with worse clinical status.
Highlights
Coronavirus disease 2019 (COVID-19) caused by the SARSCoV-2 virus is primarily a respiratory illness presenting most commonly with fever, dyspnea and cough
Inclusion criteria were: age >18, patients admitted to a medical ward and/or the intensive care unit (ICU), and a positive diagnosis of SARS-CoV-2 infection using reverse transcriptase polymerase chain reaction (RT-PCR) detection of viral RNA in nasopharyngeal swab, oropharyngeal swab, or bronchoscopy washings
A total of 422 hospitalized patients with PCR-confirmed COVID-19 were included in the analysis. 150 patients underwent neuroimaging during the study period; 103 patients had neuroimaging during and related to their COVID-19 admission (Figure 1)
Summary
Coronavirus disease 2019 (COVID-19) caused by the SARSCoV-2 virus is primarily a respiratory illness presenting most commonly with fever, dyspnea and cough. Acute infarction and hemorrhage are often the most commonly reported abnormalities in an early Italian series, followed by cerebral venous thrombosis, hemorrhagic and non-hemorrhagic encephalopathy, posterior reversible encephalopathy, and Guillain-Barre syndrome.[7] Extensive petechial hemorrhages in the juxtacortical white matter appear to be a common feature.[8,9,10,11,12,13] Additional brain MRI findings describe signal abnormalities of the medial temporal lobe,[8] variably enhancing multifocal white matter hyperintensities,[8,9,10] diffuse leukoencephalopathy,[13] basal ganglia abnormalities,[10] hemorrhagic and non-hemorrhagic encephalopathy,[2,7] and cytotoxic lesions of the corpus callosum.[9,10]
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