Brain Imaging Use and Findings in COVID-19: A Single Academic Center Experience in the Epicenter of Disease in the United States

Abstract

Coronavirus disease 2019 (COVID-19) is a serious public health crisis and can have neurologic manifestations. This is a retrospective observational case series performed March 1-31, 2020, at New York University Langone Medical Center campuses. Clinical and imaging data were extracted, reviewed, and analyzed. Two hundred forty-two patients with COVID-19 underwent CT or MRI of the brain within 2 weeks after the positive result of viral testing (mean age, 68.7 6 16.5 years; 150 men/92 women [62.0%/38.0%]). The 3 most common indications for imaging were altered mental status (42.1%), syncope/fall (32.6%), and focal neurologic deficit (12.4%). The most common imaging findings were nonspecific white matter microangiopathy (134/55.4%), chronic infarct (47/19.4%), acute or subacute ischemic infarct (13/5.4%), and acute hemorrhage (11/4.5%). No patients imaged for altered mental status demonstrated acute ischemic infarct or acute hemorrhage. White matter microangiopathy was associated with higher 2-week mortality (P , .001). Our data suggest that in the absence of a focal neurologic deficit, brain imaging in patients with early COVID-19 with altered mental status may not be revealing.

Neuroimaging findings of brain MRI and CT in patients with COVID-19: A systematic review and meta-analysis

“…An updated literature search for studies published between July 30, 2020 and October 9, 2020 resulted in 346 studies, of which seven studies met the same eligibility criteria [ [27] , [28] , [29] , [30] , [31] , [32] , [33] ]. Overall, 21 articles with a total of 2125 patients were included [ 4 , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] ]. No additional eligible study was found after a search of references within the included studies.…”

“…Of the 21 studies, all study designs were retrospective, except for two prospective studies [ 28 , 39 ]. Nine studies were multi-center studies [ 4 , 29 , 31 , 33 , 36 , 38 , 40 , 42 , 43 ] whereas the other 12 were performed at single centers [ 27 , 28 , 30 , 32 , 34 , 35 , 37 , 39 , 41 , [44] , [45] , [46] ]. The cohort sizes ranged from 9 to 454 patients.…”

COVID-19–associated Diffuse Leukoencephalopathy and Microhemorrhages

“…Although initial reports of brain imaging findings in patients with COVID-19 showed ischemic and hemorrhagic complications ( 2 , 5 ), there are now increasing reports of other findings such as patchy demyelinating lesions ( 6 ) and acute hemorrhagic necrotizing encephalopathy involving the thalami and medial temporal lobes ( 3 ). Our report comprises 11 patients in a single 3-week period in April 2020, with all patients having been critically ill and on mechanical ventilation for a mean duration of 26.5 days.…”

“…We believe the diffuse leukoencephalopathy and microhemorrhages described herein are late complications of critically ill patients with COVID-19 and likely related to hypoxemia. Previously, we reported brain imaging findings in 242 consecutive patients with COVID-19 seen at our institution in March 2020 ( 2 ). None of those patients demonstrated these diffuse patterns of white matter involvement that we describe here.…”

“…Coronavirus disease 2019 (COVID-19) started with an outbreak in Wuhan, China, in December 2019, and quickly became a worldwide public health crisis. A variety of neurologic manifestations have been reported ( 1 ), and a few reports of brain imaging findings, encompassing ischemic infarct, hemorrhage, and acute hemorrhagic necrotizing encephalopathy, are available ( 2 , 3 ). Herein we report diffuse leukoencephalopathy and juxtacortical or callosal microhemorrhages as two brain imaging features in patients with COVID-19 and discuss the possible pathogeneses.…”