Abstract
Background and Purpose:To describe the neurological and cerebrovascular findings in patients who tested positive for SARS-CoV-2 and underwent head imaging in ambulatory and inpatient settings.Methods:Consecutive patients aged ≥18 years with SARS-CoV-2 infection diagnosed or treated at Mayo Clinic sites from 3/11/2020 to 7/23/2020 with head CT or brain MRI within 30 days of SARS-CoV-2 diagnosis were included. Demographics, medical history, indication for SARS-CoV-2 testing, neurologic symptoms, indication for brain imaging, neuroimaging findings, etiology of cerebrovascular events, and hospital course were abstracted from medical records.Results:Of 8,675 patients with SARS-CoV-2, 180 (2.07%) had head imaging. Mean age of the entire cohort was 42 ± 18 years, whereas mean age of those with head imaging was 62 ± 19 years. Common indications for imaging were headache (34.4%), encephalopathy (33.4%), focal neurologic symptom (16.7%), and trauma (13.9%). While 86.1% of patients who underwent head imaging had normal exams, cerebrovascular events occurred in 18 patients (0.21% of the total cohort). Of patients with cerebrovascular events, 8 (44.5%) had acute infarct; 6 (33.3%), acute intracranial hemorrhage; 5 (2.8%), subacute infarct; and 1 (0.6%) posterior reversible encephalopathy syndrome. In the thirteen patients with ischemic stroke, 6 (46.2%) had cryptogenic stroke; 3 (23.1%), other defined causes; 2 (15.4%), small vessel stroke; 1 (7.7%), large vessel stroke; and 1 (7.7%) cardioembolic stroke.Conclusion:In ambulatory and hospitalized patients with SARS-CoV-2 infection, the rate of head imaging is low, with common indications of encephalopathy and headache. Cerebrovascular events occurred rarely, and cryptogenic stroke was the most common stroke mechanism.
Highlights
Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) has caused over 31 million infections worldwide, with over 961,000 deaths as of September 21, 2020
Diverse neurological manifestations were originally reported in 36.4% of patients with coronavirus disease 2019 (COVID-19) in one large cohort from Wuhan, China early in the global pandemic[2] Subsequent case reports, case series, and systematic reviews have investigated both central nervous system and peripheral nervous system manifestations of COVID-19.2-13 Neurologic manifestations range from nonspecific symptoms such as dizziness, headache, myalgias, and fatigue to more specific symptoms of anosmia and dysgeusia that serve as a hallmark of the disease.[14,15]
The objective of this study is to describe the neurologic and radiographic findings in a cohort of patients from a single, multi-state, multi-hospital healthcare system within the United States who tested positive for SARS-CoV-2 and underwent head imaging, with a particular focus on those with acute cerebrovascular manifestations
Summary
Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) has caused over 31 million infections worldwide, with over 961,000 deaths as of September 21, 2020. The objective of this study is to describe the neurologic and radiographic findings in a cohort of patients from a single, multi-state, multi-hospital healthcare system within the United States who tested positive for SARS-CoV-2 and underwent head imaging, with a particular focus on those with acute cerebrovascular manifestations. To describe the neurological and cerebrovascular findings in patients who tested positive for SARS-CoV-2 and underwent head imaging in ambulatory and inpatient settings. Demographics, medical history, indication for SARS-CoV-2 testing, neurologic symptoms, indication for brain imaging, neuroimaging findings, etiology of cerebrovascular events, and hospital course were abstracted from medical records. Conclusion: In ambulatory and hospitalized patients with SARS-CoV-2 infection, the rate of head imaging is low, with common indications of encephalopathy and headache. Cerebrovascular events occurred rarely, and cryptogenic stroke was the most common stroke mechanism
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