The Pattern of Brain Microhemorrhages After Severe Lung Failure Resembles the One Seen in High-Altitude Cerebral Edema

Riech, Sebastian; Kallenberg, Kai; Moerer, Onnen; Hellen, Peter; Bärtsch, Peter; Quintel, Michael; Knauth, Michael

doi:10.1097/ccm.0000000000001150

Cited by 59 publications

(47 citation statements)

References 24 publications

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“…Similar imaging ndings are reported in severe acute respiratory distress syndromes [14], including high altitude cerebral edema (HACE). [15] Interestingly, in these published cases, microbleeds in the corpus callosum are associated with a restriction on diffusion-weighted sequences, as for cytotoxic edema.…”

Section: Discussionsupporting

confidence: 71%

Central Nervous System thrombotic microangiopathy in COVID-19 patients: an intriguing hypothesis?

Agostinis

Napolitano

Cava

et al. 2020

Preprint

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Objectives: Neurological manifestations of COVID-19 disease are being increasingly recognized. A growing number of studies has been showing CNS abnormalities on brain imaging.Purpose is to describe brain imaging findings of a population of COVID-19 patients with neurological manifestations and peculiar abnormalities on susceptibility weighted imaging (SWI) sequences.Methods: we retrospectively evaluated imaging data from 50 patients affected by SARS-CoV-2 infection, who underwent a brain MRI because of neurological symptoms between March and June 2020.We focused on those presenting with abnormalities on brain MRI on SWI (positive MRI, P-MRI). We also carried out comparative investigations using patients without SWI abnormalities (negative MRI, N-MRI) as a control group. Non-parametric tests were used. A p-value < 0.05 was considered significant.Results: From 50 patients presenting with neurological symptoms, 10 patients showed brain abnormalities on SWI (P-MRI). Mean age in P-MRI group was 63±12 years; 7 were men. Six patients were admitted to Intensive Care Units (ICUs) and needed invasive ventilation support. P-MRI subjects showed lymphopenia and significantly higher levels of inflammatory markers such as CRP, IL-6, and fibrinogen. No significant differences were found in the coagulation profile. MRI showed diffuse SWI hypointense lesions mostly in occipital and temporal lobes, predominantly located at the grey-white matter junction. Genu and splenium of corpus callosum were involved in 8 of 10 patients. No restricted diffusion or enhancement was associated to SWI lesions.Conclusions: SWI abnormalities in patients with COVID-19 with neurological symptoms may reflect microvascular endothelial damage in the setting of a pro-inflammatory state.

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Section: Discussionsupporting

confidence: 71%

Central Nervous System thrombotic microangiopathy in COVID-19 patients: an intriguing hypothesis?

Agostinis

Napolitano

Cava

et al. 2020

Preprint

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“…Since coagulation disorders are associated with intracerebral hemorrhages in ECMO patients, these microinfarctions could have presumably led to secondary disseminated multifocal intracerebral bleedings. Previously, cerebral microhemorrhages were reported in ECMO patients ( 12 – 15 ), which interestingly have been comparable to cerebral injuries seen in high altitude brain edema ( 16 ).…”

mentioning

confidence: 54%

Disseminated Multifocal Intracerebral Bleeding Events in Three Coronavirus Disease 2019 Patients on Extracorporeal Membrane Oxygenation As Rescue Therapy

Bihlmaier

Coras

Willam

et al. 2020

Critical Care Explorations

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“…59 actually occurs due to rupture of fragile Ab-laden convexity leptomeningeal vessels. 59 actually occurs due to rupture of fragile Ab-laden convexity leptomeningeal vessels.…”

Section: Radiotherapymentioning

confidence: 99%

“…Potentially due to hypoxia-induced hydrostatic or chemical effects on the blood-brain barrier resulting in CMBs. 59,60 Moyamoya Rupture of small collateral vessels, especially in patients of Asian descent. 61…”

Section: Radiotherapymentioning

confidence: 99%

Cerebral amyloid angiopathy: Review of clinico‐radiological features and mimics

et al. 2018

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Cerebral amyloid angiopathy (CAA) is an important cause of lobar intracerebral haemorrhage (ICH) in the elderly, but has other clinico-radiological manifestations. In the last two decades, certain magnetic resonance imaging (MRI) sequences, namely gradient-recalled echo imaging and the newer and more sensitive susceptibility-weighted imaging, have been utilised to detect susceptibility-sensitive lesions such as cerebral microbleeds and cortical superficial siderosis. These can be utilised sensitively and specifically by the Modified Boston Criteria to make a diagnosis of CAA without the need for 'gold-standard' histopathology from biopsy. However, recently, other promising MRI biomarkers of CAA have been described which may further increase precision of radiological diagnosis, namely chronic white matter ischaemia, cerebral microinfarcts and lobar lacunes, cortical atrophy, and increased dilated perivascular spaces in the centrum semiovale. However, the radiological manifestations of CAA, as well as their clinical correlates, may have other aetiologies and mimics. It is important for the radiologist to be aware of these clinico-radiological features and mimics to accurately diagnose CAA. This is increasingly important in a patient demographic that has a high prevalence for use of antiplatelet and antithrombotic medications for other comorbidities which inherently carries an increased risk of ICH in patients with CAA.

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The Pattern of Brain Microhemorrhages After Severe Lung Failure Resembles the One Seen in High-Altitude Cerebral Edema

Cited by 59 publications

References 24 publications

Central Nervous System thrombotic microangiopathy in COVID-19 patients: an intriguing hypothesis?

Central Nervous System thrombotic microangiopathy in COVID-19 patients: an intriguing hypothesis?

Disseminated Multifocal Intracerebral Bleeding Events in Three Coronavirus Disease 2019 Patients on Extracorporeal Membrane Oxygenation As Rescue Therapy

Cerebral amyloid angiopathy: Review of clinico‐radiological features and mimics

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