COVID‐19 is Associated with an Unusual Pattern of Brain Microbleeds in Critically Ill Patients
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- 8 July 2020
- journal article
- research article
- Published by Wiley in Journal of Neuroimaging
- Vol. 30 (5), 593-597
- https://doi.org/10.1111/jon.12755
Abstract
BACKGROUND AND PURPOSE Covid‐19, initially described as a respiratory system's infection, is currently more and more recognized as a multiorganic disease, including neurological manifestations. There is growing evidence about a potential neuroinvasive role of SARS‐CoV‐2. The purpose of this study is to describe new findings, in the form of cerebral microbleeds affecting different brain structures, observed in MRIs of critically ill patients. METHODS For this purpose, the MR images of 9 patients with a common pattern of abnormal findings (2 women/7 men; 55‐79 years of age; mean age: 67.7 years) were depicted. All patients were tested positive for SARS‐CoV‐2 and presented with delayed recovery of consciousness or important agitation, requiring brain MRI. RESULTS All patients had suffered from severe (5/9) or moderate (4/9) acute respiratory distress syndrome, requiring prolonged stay in the intensive care unit. Their common MRI finding was the presence of microbleeds in unusual distribution with a specific predilection for the corpus callosum. Other uncommon locations of microbleeds were the internal capsule (5/9), as well as middle cerebellar peduncles (5/9). Subcortical regions were also affected in the majority of patients. CONCLUSIONS Brain MRI raised evidence that Covid‐19 or its related treatment may involve the brain with an unusual pattern of microbleeds, predominantly affecting the corpus callosum. The mechanism of this finding is still unclear but the differential diagnosis should include thrombotic microangiopathy related to direct or indirect—through the cytokine cascade—damage by the SARS‐CoV‐2 on the endothelium of brain's vessels, as well as mechanisms similar to the hypoxemia brain‐blood‐barrier injury.Keywords
This publication has 18 references indexed in Scilit:
- Cutaneous manifestations in COVID‐19: a first perspectiveJournal of the European Academy of Dermatology and Venereology, 2020
- Global coronavirus pandemic (2019‐nCOV): implication for an Italian medium size dermatological clinic of a II level hospitalJournal of the European Academy of Dermatology and Venereology, 2020
- Evidence of the COVID-19 Virus Targeting the CNS: Tissue Distribution, Host–Virus Interaction, and Proposed Neurotropic MechanismsACS Chemical Neuroscience, 2020
- The neuroinvasive potential of SARS‐CoV2 may play a role in the respiratory failure of COVID‐19 patientsJournal of Medical Virology, 2020
- A new coronavirus associated with human respiratory disease in ChinaNature, 2020
- Critical Illness–Associated Cerebral MicrobleedsStroke, 2017
- The Pattern of Brain Microhemorrhages After Severe Lung Failure Resembles the One Seen in High-Altitude Cerebral EdemaCritical Care Medicine, 2015
- Diffuse Cerebral Microbleeds after Extracorporeal Membrane Oxygenation SupportAmerican Journal of Respiratory and Critical Care Medicine, 2015
- Susceptibility-weighted imaging in patient with consciousness disturbance after traffic accidentThe American Journal of Emergency Medicine, 2013
- Subclinical Brain Injury Caused by H5N1 Influenza Virus InfectionJournal of Virology, 2011