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Brain MRI Findings in Severe COVID-19: A Retrospective Observational Study

2020; Radiological Society of North America; Volume: 297; Issue: 2 Linguagem: Inglês

10.1148/radiol.2020202222

1527-1315

Stéphane Kremer, François Lersy, de Sèze, Jean‐Christophe Ferré, Adel Maamar, B. Carsin-Nicol, Olivier Collange, Fabrice Bonneville, G Adam, Guillaume Martin‐Blondel, Marie Rafiq, Thomas Geeraerts, Louis Delamarre, Sylvie Grand, Alexandre Krainik, Stéphane Kremer, G Adam, Manel Alleg, Mathieu Anheim, René Anxionnat, François-Daniel Ardellier, Seyyid Baloglu, Blanche Bapst, Joseph Benzakoun, Jérôme Berge, Federico Bolognini, Fabrice Bonneville, Grégoire Bornet, Clotilde Boulay, Grégoire Boulouis, Claire Boutet, Jean‐Christophe Brisset, Sophie Caillard, Sophie Carré, B. Carsin-Nicol, Olivier Collange, Pierre‐Olivier Comby, Jean‐Marc Constans, Jean David, Isaure de Beaurepaire, de Sèze, Louis Delamarre, Hubert Desal, Myriam Edjlali, Xavier Fabré, Samira Fafi‐Kremer, Jean‐Christophe Ferré, Philippe Feuerstein, Marie‐Cécile Henry Feugeas, Géraud Forestier, Augustin Gaudemer, Thomas Geeraerts, Sylvie Grand, Yves Hansmann, Adrien Heintz, Julie Helms, Céline Hemmert, Ghazi Hmeydia, Lavinia Jager, Apolline Kazémi, Basile Kerleroux, Antoine Khalil, Alexandre Krainik, Audrey Lacalm, Augustin Lecler, Claire Lecocq, Nicolas Lefèbvre, François Lersy, Adel Maamar, Guillaume Martin‐Blondel, Muriel Matthieu, Imen Megdiche, Paul‐Michel Mertès, Julien Messié, Serge Metanbou, Nicolás Meyer, Ferhat Meziani, Véronique Mutschler, Patrick Nesser, Hélène Oesterlé, Mickaël Ohana, Catherine Oppenheim, Nadya Pyatigorskaya, Marie Rafiq, F. Ricolfi, Suzana Saleme, Maleka Schenck, Emmanuelle Schmitt, Francis Schneider, Nathan Sebag, Yannick Talla, Pierre Thouant, Thibault Willaume, François Zhu, Pierre-Emmanuel Zorn, François Cotton,

COVID-19 Clinical Research Studies

Background Brain MRI parenchymal signal abnormalities have been associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Purpose To describe the neuroimaging findings (excluding ischemic infarcts) in patients with severe coronavirus disease 2019 (COVID-19) infection. Materials and Methods This was a retrospective study of patients evaluated from March 23, 2020, to April 27, 2020, at 16 hospitals. Inclusion criteria were (a) positive nasopharyngeal or lower respiratory tract reverse transcriptase polymerase chain reaction assays, (b) severe COVID-19 infection defined as a requirement for hospitalization and oxygen therapy, (c) neurologic manifestations, and (d) abnormal brain MRI findings. Exclusion criteria were patients with missing or noncontributory data regarding brain MRI or brain MRI showing ischemic infarcts, cerebral venous thrombosis, or chronic lesions unrelated to the current event. Categorical data were compared using the Fisher exact test. Quantitative data were compared using the Student t test or Wilcoxon test. P < .05 represented a significant difference. Results Thirty men (81%) and seven women (19%) met the inclusion criteria, with a mean age of 61 years ± 12 (standard deviation) (age range, 8-78 years). The most common neurologic manifestations were alteration of consciousness (27 of 37, 73%), abnormal wakefulness when sedation was stopped (15 of 37, 41%), confusion (12 of 37, 32%), and agitation (seven of 37, 19%). The most frequent MRI findings were signal abnormalities located in the medial temporal lobe in 16 of 37 patients (43%; 95% confidence interval [CI]: 27%, 59%), nonconfluent multifocal white matter hyperintense lesions seen with fluid-attenuated inversion recovery and diffusion-weighted sequences with variable enhancement, with associated hemorrhagic lesions in 11 of 37 patients (30%; 95% CI: 15%, 45%), and extensive and isolated white matter microhemorrhages in nine of 37 patients (24%; 95% CI: 10%, 38%). A majority of patients (20 of 37, 54%) had intracerebral hemorrhagic lesions with a more severe clinical presentation and a higher admission rate in intensive care units (20 of 20 patients [100%] vs 12 of 17 patients without hemorrhage [71%], P = .01) and development of the acute respiratory distress syndrome (20 of 20 patients [100%] vs 11 of 17 patients [65%], P = .005). Only one patient had SARS-CoV-2 RNA in the cerebrospinal fluid. Conclusion Patients with severe coronavirus disease 2019 and without ischemic infarcts had a wide range of neurologic manifestations that were associated with abnormal brain MRI scans. Eight distinctive neuroradiologic patterns were described. © RSNA, 2020.