Brain MRI findings in COVID-19 patients with PRES: A systematic review

Abstract

Background Numerous case reports and case series have described brain Magnetic Resonance Imaging (MRI) findings in Coronavirus disease 2019 (COVID-19) patients with concurrent posterior reversible encephalopathy syndrome (PRES). Purpose We aim to compile and analyze brain MRI findings in patients with COVID-19 disease and PRES. Methods PubMed and Embase were searched on April 5th, 2021 using the terms “COVID-19”, “PRES”, “SARS-CoV-2” for peer-reviewed publications describing brain MRI findings in patients 21 years of age or older with evidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and PRES. Results Twenty manuscripts were included in the analysis, which included descriptions of 30 patients. The average age was 57 years old. Twenty-four patients (80%) required mechanical ventilation. On brain MRI examinations, 15 (50%) and 7 (23%) of patients exhibited superimposed foci of hemorrhage and restricted diffusion respectively. Conclusions PRES is a potential neurological complication of COVID-19 related disease. COVID-19 patients with PRES may exhibit similar to mildly greater rates of superimposed hemorrhage compared to non-COVID-19 PRES patients.

Posterior reversible encephalopathy syndrome on COVID-19

“…The restricted diffusion area is commonly reported similar as well. Hemorrhage in PRES estimated as in 15-17% of patients [1] . Nevertheless, in this case, there was no hemorrhage found.…”

“…Furthermore, the symptoms of PRES have various presentations, for example, headache, unconsciousness, seizures, and loss of vision. The main feature of this disease is the emergence of edema in the white matter, especially occurring in the posterior parietal and occipital region of the cerebrum [1] .…”

Starting signal: Aberrant kinase activation as a trigger for SARS-CoV-2 induced axonal damage

“…This method has been successfully used to measure axonal damage in patients with MS (5). Analysis of magnetic resonance imaging (MRI) images from SARS-CoV-2 patients with neurological complications showed significant changes due to infection however a more targeted examination is needed to determine if these changes included axonal injury (40).…”

COVID-19'un santral sinir sistemi tutulumunu değerlendirmek için bir araç olarak manyetik rezonans görüntülemenin etkinliği

“…Although the restricted diffusion rates of patients with encephalopathy due to COVID-19 appear to be the same as patients with encephalopathy without COVID-19, the hemorrhage rate is higher. In some studies, hemorrhage was reported as 36% in patients with COVID-19, but in a more recent study, it was reported as 64.5% [23][24][25] . However, in our study, hemorrhage was detected in only 9 (21%) patients on MRI.…”