Spectrum of neuroimaging findings in COVID-19

Abstract

An outbreak of corona virus disease 2019 (COVID-19) began in China in December 2019, and rapidly spread to become a worldwide pandemic. Neurological complications encountered in hospitalized patients include acute arterial ischemic cerebrovascular stroke, cerebral venous thrombosis, critical illness-associated cerebral microbleeds, hypertensive hemorrhagic posterior reversible encephalopathy, meningoencephalitis/flare up of infections, flare up of multiple sclerosis, acute disseminated encephalomyelitis, cerebral hemodynamic/hypoxic changes such as watershed ischemic changes and hypoxic ischemic encephalopathy, and spine manifestations of Guillain Barre syndrome and viral myelitis. The purpose of our study is to illustrate the different neuroimaging features in critically ill hospitalized COVID-19 positive patients in the State of Qatar.

Acute disseminated encephalomyelitis and COVID-19: A systematic synthesis of worldwide cases

“…In adults, we observed a male predominance (73.68%, 14 cases) ( Abdi et al, 2020 ; Assunção et al, 2020 ; El Beltagi et al, 2021 ; Freire-Álvarez et al, 2020 ; Langley et al, 2020 ; Lopes et al, 2020 ; McCuddy et al, 2020 ; Paterson et al, 2020 ; Pilotto et al, 2021 ; Umapathi et al, 2020 ; Utukuri et al, 2020 ). The mean age was 49.8 years (25 to 70 years).…”

“…The comorbidity most frequently described was hypertension ( Lopes et al, 2020 ; McCuddy et al, 2020 ; Umapathi et al, 2020 ), followed by diabetes ( Lopes et al, 2020 ; McCuddy et al, 2020 ). Regarding the COVID-19 symptoms, 66.7% were severe ( N = 12/18)( Assunção et al, 2020 ; Langley et al, 2020 ; Lopes et al, 2020 ; McCuddy et al, 2020 ; Parsons et al, 2020 ; Paterson et al, 2020 ; Umapathi et al, 2020 ), 22.2% mild ( N = 4/18) ( El Beltagi et al, 2021 ; Freire-Álvarez et al, 2020 ; Kumar et al, 2020 ) and 11.1% asymptomatic ( N = 2/18)( Abdi et al, 2020 ; Utukuri et al, 2020 ). The COVID-19 diagnosis was made using a PCR test in 20 cases ( Abdi et al, 2020 ; Assunção et al, 2020 ; El Beltagi et al, 2021 ; Espíndola et al, 2021 ; Freire-Álvarez et al, 2020 ; Kumar et al, 2020 ; Langley et al, 2020 ; Lopes et al, 2020 ; McCuddy et al, 2020 ; Parsons et al, 2020 ; Paterson et al, 2020 ; Pilotto et al, 2021 ; Umapathi et al, 2020 ; Utukuri et al, 2020 ) and a serum antibody test (IgM and IgG antibody) in our case.…”

“…Including our original case report, we identified 30 patients (pediatric = 09, adults = 21) diagnosed with ADEM related with COVID-19 from 18 documents ( Abdel-Mannan et al, 2020 ; Abdi et al, 2020 ; Assunção et al, 2020 ; De Miranda Henriques-Souza et al, 2021 ; Dominguez- Rojas et al, El Beltagi et al, 2021 ; Espíndola et al, 2021 ; Freire-Álvarez et al, 2020 ; Kumar et al, 2020 ; Langley et al, 2020 ; Lindan et al, 2020 ; Lopes et al, 2020 ; McCuddy et al, 2020 ; Parsons et al, 2020 ; Paterson et al, 2020 ; Pilotto et al, 2021 ; 2020; Umapathi et al, 2020 ; Utukuri et al, 2020 ). Only one document was reported in non-English language (Spanish).…”

“…Thirteen cases (68.42%) had moderate/severe ADEM clinical presentation. The most frequent clinical characteristics were encephalopathy (84.2%, N = 16/19)( Abdi et al, 2020 ; Assunção et al, 2020 ; Espíndola et al, 2021 ; Freire-Álvarez et al, 2020 ; Kumar et al, 2020 ; Langley et al, 2020 ; Lopes et al, 2020 ; McCuddy et al, 2020 ; Parsons et al, 2020 ; Paterson et al, 2020 ; Pilotto et al, 2021 ; Umapathi et al, 2020 ; Utukuri et al, 2020 ), pyramidal signs (motor deficits such as hemiparesis or quadriparesis, hyperreflexia, or pathological reflexes such as Babinski) (63.1%, N = 12/19)( Abdi et al, 2020 ; El Beltagi et al, 2021 ; Langley et al, 2020 ; Lopes et al, 2020 ; McCuddy et al, 2020 ; Parsons et al, 2020 ; Paterson et al, 2020 ; Pilotto et al, 2021 ; Umapathi et al, 2020 ), brainstem involvement (15.7%, N = 3/19) ( Espíndola et al, 2021 ; Paterson et al, 2020 ), ataxia (15.7%, N = 3/19) ( El Beltagi et al, 2021 ; Utukuri et al, 2020 ), peripheral nerve involvement (confirmed by electromyography) (10.5%, N = 2/19) ( Kumar et al, 2020 ; Lopes et al, 2020 ) and seizures (5.3%, N = 1/19) ( Abdi et al, 2020 ). Most of the images found on the MRI, were hyperintensities in T2 and FLAIR.…”

“…Lesions in the subcortical white matter were multiple and less frequent in the periventricular area. Other frequent findings were brainstem lesions (45%, N = 9/20) ( Abdi et al, 2020 ; Assunção et al, 2020 ; El Beltagi et al, 2021 ; Kumar et al, 2020 ; McCuddy et al, 2020 ; Pilotto et al, 2021 ; Umapathi et al, 2020 ), hemorrhagic lesions (35%, N = 7/20) ( Langley et al, 2020 ; Lopes et al, 2020 ; Parsons et al, 2020 ; Paterson et al, 2020 ; Umapathi et al, 2020 ), spinal cord lesions (20%, N = 4/20) ( El Beltagi et al, 2021 ; Umapathi et al, 2020 ; Utukuri et al, 2020 ), deep gray matter compromise (25%, N = 5/20) ( Abdi et al, 2020 ; Freire-Álvarez et al, 2020 ; Lopes et al, 2020 ; Pilotto et al, 2021 ) and cerebellum involvement (15%, N = 3/20) ( Lopes et al, 2020 ; McCuddy et al, 2020 ; Umapathi et al, 2020 ). Likewise, 70% of cases had at least two affected territories, 100% had supratentorial involvement and 55% infratentorial involvement.…”