Abnormal MRI findings of the orbital or visual pathways in patients with severe COVID-19: Observations from the French multicenter COVID-19 cohort

Abstract

Objectives COVID-19 is a multisystemic disease. Ophthalmological abnormalities are relatively rare among COVID-19-infected patients. The aim of our study was to report orbital and visual pathways MRI findings in a nationwide multicenter cohort of patients with severe COVID-19. Methods This IRB-approved retrospective multi-center study included participants presenting with severe COVID-19, who underwent brain MRI from March 4 th to May 1 st 2020. Two neuroradiologists (“blinded”), blinded to all data, individually analyzed morphological MRIs focusing on the orbits and the visual pathways. A second consensus reading session was performed in the case of disagreement between both readers. Clinical and ophthalmological data were compared to MRI findings. Descriptive statistical analysis and interobserver agreement for MRI reading using non-weighted Cohen kappa statistics were performed. Results 129 participants (43 [33%] women and 86 [67%] men, mean age 63 ± 14 years) were included in the study. 17/129 (13%) patients had abnormal MRI findings of the orbit or visual pathways. 11/17 (65%) patients had a FLAIR-WI hyperintense optic disc. 6/17 (35%) patients had abnormal signal of at least one of the visual pathway structures: 6/6 (100%) of the optic nerve, 1/6 (17%) of the optic chiasm, 2/6 (33%) of the optic tract and 1/6 (17%) of the optic radiations. Conclusions Our study showed that a substantial number of patients with severe COVID-19 presented with abnormal MRI findings of the orbit or visual pathways, which might lead to potentially severe visual impairment.

Pupillographic Analysis of COVID-19 Patients: Early and Late Results After Recovery

“…Recently, Lecler et al (27) showed that 13% of patients had abnormal magnetic resonance imaging (MRI) ndings in the orbit and visual pathways, whereas 35% of these patients had an abnormal signal of at least one of the visual pathway structures on uid-attenuated inversion recovery -weighted imaging. Marsiglia et al (38) suggested that COVID-19 could affect both the afferent and efferent components of the visual axis.…”

“…It is a neurological disorder caused by dysfunction of the autonomic nervous system (ANS) that affects the functions of the heart, bladder, sweat gland, intestines, and pupils (32). Thus, pupilometric tests have previously been used to assess autonomic functions and are suggested to have diagnostic value in differentiating underlying conditions (14,27,33). It is well known that pupillary autonomic dysfunction may precede a more generalised involvement of the ANS in various systemic disorders (15,33,34).…”

“…), neuro-psychiatric conditions (Parkinson's disease, Alzheimer's disease, schizophrenia, traumatic brain injury, etc. ), and for the assessment of autonomic function in different disorders (22)(23)(24)(25)(26)(27). The tendency to adopt infrared pupillography as a routine part of the neuro-ophthalmologic examination is increasing.…”

Pupillographic Analysis of COVID-19 Patients: Early and Late Results After Recovery

“…Recently, Lecler et al ( 27 ) showed that 13% of patients had abnormal magnetic resonance imaging (MRI) findings in the orbit and visual pathways, whereas 35% of these patients had an abnormal signal of at least one of the visual pathway structures on fluid-attenuated inversion recovery-weighted imaging. Marsiglia et al ( 28 ) suggested that COVID-19 could affect both the afferent and efferent components of the visual axis.…”

“…), neuro-psychiatric conditions (Parkinson’s disease, Alzheimer’s disease, schizophrenia, traumatic brain injury, etc. ), and for the assessment of autonomic function in different disorders ( 22 - 27 ). The tendency to adopt infrared pupillography as a routine part of the neuro-ophthalmologic examination is increasing.…”