Cerebral Imaging in Patients with COVID-19 and Neurological Symptoms: First Experience from two University Hospitals in Northern Germany

Jensen‐Kondering, Ulf; Neumann, Alexander; Margraf, Nils G.; Gövert, Felix; Brüggemann, Norbert; Schunk, Domagoj; Bahmer, Thomas; Schramm, Peter; Schreiber, Stefan; Jansen, Olav

doi:10.1055/a-1265-7209

Cited by 7 publications

(6 citation statements)

References 15 publications

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“…442 patients (188 females, 42.5%) were included. Some of the patients have already been partially described in previous publications [ 6 – 8 ]. Mean age was 69 ± 16 years (range 19–99).…”

Section: Resultsmentioning

confidence: 99%

Patterns of acute ischemic stroke and intracranial hemorrhage in patients with COVID-19

et al. 2023

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Background Coronavirus disease 2019 (COVID-19) is an infection which can affect the central nervous system. In this study, we sought to investigate associations between neuroimaging findings with clinical, demographic, blood and cerebrospinal fluid (CSF) parameters, pre-existing conditions and the severity of acute COVID-19. Materials and methods Retrospective multicenter data retrieval from 10 university medical centers in Germany, Switzerland and Austria between February 2020 and September 2021. We included patients with COVID-19, acute neurological symptoms and cranial imaging. We collected demographics, neurological symptoms, COVID-19 severity, results of cranial imaging, blood and CSF parameters during the hospital stay. Results 442 patients could be included. COVID-19 severity was mild in 124 (28.1%) patients (moderate n = 134/30.3%, severe n = 43/9.7%, critical n = 141/31.9%). 220 patients (49.8%) presented with respiratory symptoms, 167 (37.8%) presented with neurological symptoms first. Acute ischemic stroke (AIS) was detected in 70 (15.8%), intracranial hemorrhage (IH) in 48 (10.9%) patients. Typical risk factors were associated with AIS; extracorporeal membrane oxygenation therapy and invasive ventilation with IH. No association was found between the severity of COVID-19 or blood/CSF parameters and the occurrence of AIS or IH. Discussion AIS was the most common finding on cranial imaging. IH was more prevalent than expected but a less common finding than AIS. Patients with IH had a distinct clinical profile compared to patients with AIS. There was no association between AIS or IH and the severity of COVID-19. A considerable proportion of patients presented with neurological symptoms first. Laboratory parameters have limited value as a screening tool.

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Section: Resultsmentioning

confidence: 99%

Patterns of acute ischemic stroke and intracranial hemorrhage in patients with COVID-19

et al. 2023

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“…Regional brain alterations appear to persist postinfection [ 37 , 69 , 78 , 85 , 111 ]. For example, Sollini et al.…”

Section: Resultsmentioning

confidence: 99%

Topographical Distribution of Neuroanatomical Abnormalities Following COVID-19 Invasion

Kiyak,

Ijezie,

Ackah

et al. 2023

Clin Neuroradiol

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Purpose This systematic review is aimed at synthesising the literature base to date on the frequency and topographical distribution of neuroanatomical changes seen on imaging following COVID-19 invasion with a focus on both the acute and chronic phases of the disease. Methods In this study, 8 databases were systematically searched to identify relevant articles published from December 2019 to March 2022 and supplemented with a manual reference search. Data were extracted from the included studies and narrative synthesis was employed to integrate the findings. Results A total of 110 studies met the inclusion criteria and comprised 119,307 participants (including 31,073 acute and 143 long COVID-19 patients manifesting neurological alterations) and controls. Considerable variability in both the localisation and nature of neuroanatomical abnormalities are noted along the continuum with a wide range of neuropathologies relating to the cerebrovascular/neurovascular system, (sub)cortical structures (including deep grey and white matter structures), brainstem, and predominant regional and/or global alterations in the cerebellum with varying degrees of spinal involvement. Conclusion Structural regional alterations on neuroimaging are frequently demonstrated in both the acute and chronic phases of SARS-CoV‑2 infection, particularly prevalent across subcortical, prefrontal/frontal and cortico-limbic brain areas as well as the cerebrovascular/neurovascular system. These findings contribute to our understanding of the acute and chronic effects of the virus on the nervous system and has the potential to provide information on acute and long-term treatment and neurorehabilitation decisions.

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“…Ischemic stroke (11.9%) was the most common acute finding. Several hypotheses suggested that the pathogenesis of stroke in COVID-19 may be attributed to the development of coagulopathy or endothelial dysfunction [ 9 , 14 ]. Systemic inflammation and cytokine storm triggers the coagulation system with subsequent development of a hypercoagulable state.…”

Section: Discussionmentioning

confidence: 99%

“…It was found that SARS-CoV-2 shows a high affinity for the angiotensin-converting enzyme 2 (ACE2) receptor, which is expressed in the epithelium of the upper and lower airways, as well as the endothelium of the capillaries including those in the central nervous system [ 14 ]. At the same time, COVID-19 patients, especially severe cases, frequently present severe systemic manifestations such as viremia, hypoxia, cytokine storm, and coagulopathy.…”

Section: Introductionmentioning

confidence: 99%

Neuroimaging findings in hospitalized patients with COVID-19

Abdelzaher

AlQatam

Alsarraf

et al. 2022

Egypt J Radiol Nucl Med

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Background Variable neuroimaging findings have been reported in patients with coronavirus disease 2019 (COVID-19). In addition to respiratory symptoms, many neurologic manifestations of COVID-19 are increasingly reported and variable neuroimaging findings have been observed in patients with COVID-19. Our aim was to describe findings observed in hospitalized patients with COVID-19, presenting with acute neurologic manifestations and undergoing computed tomography (CT) or magnetic resonance imaging (MRI) of the brain. Methods We performed a retrospective study involving patients with laboratory-confirmed SARS-COV-2 infection, admitted to our hospital between July 1 and December 30, 2020. Patients who presented with acute neurologic symptoms and required neuroimaging were only included in the study. Neuroimaging examinations were evaluated for the presence of, infarction, hemorrhage and encephalopathy. The frequency of these findings was correlated with clinical variables, including presence of comorbidities, requirement for intensive care unit admission, and duration between admission and onset of neurologic signs and symptoms as documented in the hospital medical records. Results A total of 135 patients underwent at least one cross-sectional imaging of the brain, the median age of these patients was 63 years, and 72% were men. Disturbed level of consciousness was the most common neurologic symptom (80.7%). Acute neuroimaging findings were found in 34 patients (25.2%) including; acute ischemic infarcts (16/135; 11.9%), intracranial hemorrhages (9/135, 6.7%), cerebral venous thrombosis (2/135; 1.5%), posterior reversible encephalopathy syndrome (1/135; 0.7%), and hypoxic-ischemic encephalopathy (6/135, 4.4%). There was no statistically significant difference in patient age (p = 0.062), sex (0.257), presence of comorbidities (p = 0.204), intensive care unit admission (p = 0.326) and duration between admission and onset of neurologic signs and symptoms (p = 0.755), in patients with positive versus negative neuroimaging studies. Conclusions Our study showed that cerebrovascular complications, ischemic and hemorrhagic were the most frequent imaging finding in hospitalized patients with COVID-19. Knowledge about these potentially serious complications can help optimize management for these patients.

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Cerebral Imaging in Patients with COVID-19 and Neurological Symptoms: First Experience from two University Hospitals in Northern Germany

Cited by 7 publications

References 15 publications

Patterns of acute ischemic stroke and intracranial hemorrhage in patients with COVID-19

Patterns of acute ischemic stroke and intracranial hemorrhage in patients with COVID-19

Topographical Distribution of Neuroanatomical Abnormalities Following COVID-19 Invasion

Neuroimaging findings in hospitalized patients with COVID-19

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