Brain MR Spectroscopic Findings in 3 Consecutive Patients with COVID-19: Preliminary Observations

Abstract

Brain multivoxel MR spectroscopic imaging was performed in 3 consecutive patients with coronavirus disease 2019 . These included 1 patient with COVID-19-associated necrotizing leukoencephalopathy, another patient who had a recent pulseless electrical activity cardiac arrest with subtle white matter changes, and a patient without frank encephalopathy or a recent severe hypoxic episode. The MR spectroscopic imaging findings were compared with those of 2 patients with white matter pathology not related to Severe Acute Respiratory Syndrome coronavirus 2 infection and a healthy control subject. The NAA reduction, choline elevation, and glutamate/glutamine elevation found in the patient with COVID-19-associated necrotizing leukoencephalopathy and, to a lesser degree, the patient with COVID-19 postcardiac arrest, follow a similar pattern as seen with the patient with delayed posthypoxic leukoencephalopathy. Lactate elevation was most pronounced in the patient with COVID-19 necrotizing leukoencephalopathy.

Susceptibility-weighted imaging reveals cerebral microvascular injury in severe COVID-19

“…Hypercoagulability, inflammation, hypoxia, and endothelial cell infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are potential mechanisms contributing to global brain dysfunction [4]. Although brain imaging studies in patients with neurological manifestations of severe COVID-19 are rapidly emerging [5][6][7][8][9][10][11][12][13][14], performing and interpreting MRI in this critically ill population remains challenging, and fundamental questions about the pathogenesis of brain injury in these patients remain.…”

Brain Imaging in COVID-19

“…The patient with white matter disorder showed more pronounced alterations reflecting neuroinflammation. 1 …”

“…Magnetic resonance imaging (MRI), computed tomography (CT), and MR spectroscopy (MRS) of the brain are used for the evaluation of metabolic and structural abnormalities involving enlarged volumes of various brain regions, such as olfactory cortices, hippocampus, and cingulate gyrus. 1 Concerning the cases of neurological and neuropsychiatric abnormalities in the COVID-19 survivors, the viral footprint in the brain is well established. The knowledge of clinicoradiological manifestations should be considered of upmost priority which can be used for patient care and better understanding of the disease.…”

Brain Stress Mapping in COVID-19 Survivors Using MR Spectroscopy: New Avenue of Mental Health Status Monitoring$

“…Despite this, there are only a few published sources that demonstrate the findings based on neuroimaging techniques to monitor neurological infection in COVID-19 patients [29]. Researchers are analyzing the hyperintensities from FLAIR images and metabolites information from single-voxel MRS which indicates the changes in structure and the level of metabolites in the brain, respectively [60,61]. Based on the prior knowledge, we are proposing a scheme for examining the GSH, glutamatergic systems in the hippocampal and dorsolateral prefrontal cortex area of the brain.…”