Early postmortem brain MRI findings in COVID-19 non-survivors

Abstract

ImportanceThe severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is considered to have potential neuro-invasiveness that might lead to acute brain disorders or contribute to respiratory distress in patients with coronavirus disease 2019 (COVID-19). Brain magnetic resonance imaging (MRI) data in COVID-19 patients are scarce due to difficulties to obtain such examination in infected unstable patients during the COVID-19 outbreak.ObjectiveTo investigate the occurrence of structural brain abnormalities in non-survivors of COVID-19 in a virtopsy framework.DesignProspective, case series study with postmortem brain MRI obtained early (<24h) after death.SettingMonocentric study.ParticipantsFrom 31/03/2020 to 24/04/2020, consecutive decedents who fulfilled the following inclusion criteria were included: death <24 hours, SARS-CoV-2 detection on nasopharyngeal swab specimen, chest computerized tomographic (CT) scan suggestive of COVID-19, absence of known focal brain lesion, and MRI compatibility.Main Outcome(s) andMeasure(s)Signs of acute brain injury and MRI signal abnormalities along the olfactory tract and brainstem were searched independently by 3 neuroradiologists, then reviewed with neurologists and clinicians.ResultsAmong the 62 patients who died from COVID-19 during the inclusion period, 19 decedents fulfilled inclusion criteria. Subcortical micro- and macro-bleeds (2 decedents), cortico-subcortical edematous changes evocative of posterior reversible encephalopathy syndrome (PRES, one decedent), and nonspecific deep white matter changes (one decedent) were observed. Asymmetric olfactory bulbs were found in 4 other decedents without downstream olfactory tract abnormalities. No brainstem MRI signal abnormality.Conclusions and RelevancePostmortem brain MRI demonstrates hemorrhagic and PRES-related brain lesions in non-survivors of COVID-19 that might be triggered by the virus-induced endothelial disturbances. SARS-CoV-2-related olfactory impairment seems to be limited to olfactory bulbs. The absence of brainstem MRI abnormalities does not support a brain-related contribution to respiratory distress in COVID-19.Key PointsQuestionIs there common brain MRI abnormalities patterns in non-survivors of coronavirus disease 2019 ?FindingsIn a case series of 19 non-survivors of severe COVID-19 disease, early postmortem brain MRI demonstrated patterns evocative of intracranial vasculopathy in 4 decedents: subcortical micro- and macro-bleeds (2 decedents), cortico-subcortical edematous changes evocative of posterior reversible encephalopathy syndrome (PRES, one decedent), and nonspecific deep white matter changes (one decedent). Asymmetric olfactory bulbs were found in 4 other decedents but without downstream olfactory tract abnormalities.MeaningPostmortem brain MRI demonstrates hemorrhagic and PRES-related brain lesions in non-survivors of COVID-19 that might be triggered by virus-induced endothelial disturbances.

COVID-19 and the Chemical Senses: Supporting Players Take Center Stage

“…In contrast, clinical signs of encephalitis (i.e., infection of neurons), such as increased risk of seizures and inflammatory CSF, have not been commonly observed (Lu et al, 2020). This perspective is consistent with recent MRI findings in COVID-19 patients (Beyrouti et al, 2020;Coolen et al, 2020), and two separate autopsy series that failed to identify any signs of encephalitis (Schaller et al, 2020;Solomon et al, 2020). At this point, therefore, the balance of the clinical evidence points to SARS-CoV-2 influencing the brain indirectly through effects on vasculature, although this view may change as we learn more about viral pathogenesis and we gain access to more detailed clinical information.…”

De Novo Movement Disorders and COVID‐19: Exploring the Interface

“…In most cases of neurological complications associated with SARS-CoV-2 infection, the neural substrates for movement disorders are spared; in fact, pure cortical, corticosubcortical interface and deep white matter involvement predominates, as evidenced by various imaging-based studies. 76,[82][83][84][85] Furthermore, movement disorders following an infectiousautoimmune process typically develop after a period of weeks to months. Hence, there remains a possibility that expected parenchymal changes in the brain are just waiting to reach a threshold level to manifest as delayed movement disorders.…”

A comprehensive review of imaging findings in COVID-19 - status in early 2021

“…However, a recent study from Spain documented anosmia in only 4.9% and ageusia in 6.2% of 841 COVID-19 patients [210]. In an early post-mortem MRI study in COVID-19 non-survivors, olfactory bulb asymmetry and atrophy was detected in 4 of 19 (21%) subjects [211]. MRI signal alterations of the olfactory bulb (Fig.…”