Brain MR Spectroscopic Findings in Three Consecutive Covid-19 Patients: Preliminary Observations

Abstract

Brain magnetic resonance spectroscopic imaging (MRSI) was performed in three consecutive COVID-19 patients, as part of a pilot investigation of the pathophysiological processes underlying the brain involvement by the SARS-CoV-2 infection. These included one with necrotizing leukoencephalopathy, one after recent PEA cardiac arrest without leukoencephalopathy, and one without frank encephalopathy or recent severe hypoxic episode. The MRSI findings were compared to those of two patients with white matter pathology not SARS-CoV2 infection related, and a control patient without clinical encephalopathy. The N-acetyl-aspartate reduction, choline elevation, and glutamate/glutamine elevation found in the COVID necrotizing leukoencephalopathy patient and, to a lesser degree, the COVID post-cardiac arrest patient, follow a similar pattern as seen with the delayed post-hypoxic leukoencephalopathy patient. Lactate elevation was most pronounced in the patient with COVID necrotizing leukoencephalopathy.

Delayed reemergence of consciousness in survivors of severe COVID-19

“…To improve the accuracy of prognostication in patients with disorders of consciousness after severe COVID-19, we need to elucidate the relative utility of EEG, head CT, conventional MRI, and advanced imaging techniques such as functional MRI [17], magnetic resonance spectroscopy [22], and diffusion tensor imaging [23,24]. Comprehensive safety precautions to protect hospital staff and other patients must be implemented before transporting a patient with severe COVID-19 from the ICU to the MRI scanner.…”