Neuroimaging findings in hospitalized patients with COVID-19

Abstract

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.

Imaging of COVID-19 vasculopathy from head to toe: Egyptian collective experience after 2 years of the pandemic

“…Agreeing with Saleh et al [ 16 ], and Abdelzaher et al [ 17 ], the ischemic infarctions were the most common neurovascular complications and a disturbed level of consciousness was the most common clinical presentation. Meanwhile, the presence of hemorrhagic insults and vasculitis was infrequent.…”

“…The incidence of thromboembolic complications was 124/1245 (10%) which was near to this study (8%). Saleh et al [ 16 ], and Abdelzaher et al [ 17 ] studied only the vascular and non-vascular neurological complications of COVID-19 infection. The former included 70 patients over 14 months till July 2021 and the latter included 135 patients over six months till December 2020.…”

Topographical Distribution of Neuroanatomical Abnormalities Following COVID-19 Invasion

“…This finding corroborates the observations of previous studies [ 13 , 127 , 128 ]. Other neuroimaging findings included ischaemic or haemorrhagic stroke [ 37 , 56 , 81 ], cerebral venous sinus thrombosis [ 21 , 88 , 105 ], and acute or subacute infarction [ 54 , 68 , 107 ]. Of note, Ntaios et al demonstrated that patients with ischaemic stroke related to COVID-19 had worse functional outcomes and higher mortality than patients with ischaemic stroke and without COVID-19 [ 129 ].…”