Acta Scientific Neurology (ISSN: 2582-1121)

Short CommunicationVolume 4 Issue 3

COVID-19 Associated Neuroimaging Findings

Niharika Prasad*

Assistant Professor, Department of Radiology, Dr. D.Y. Patil Hospital, Medical College and Research Center, Pune, India

*Corresponding Author: Niharika Prasad, Assistant Professor, Department of Radiology, Dr. D.Y. Patil Hospital, Medical College and Research Center, Pune, India.

Received: January 19, 2021; Published: February 19, 2021

Citation: Niharika Prasad. “COVID-19 Associated Neuroimaging Findings”. Acta Scientific Neurology 4.3 (2021): 31-32.

  Since the first detection of Corona virus in December 2019, there had been a rapid increase in the number of cases, progressing to a pandemic state. Although respiratory system involvement is most well-known, the central nervous system may also get affected. The etiopathogenesis may be related to the following:

  • Direct neural transmission via the olfactory pathway.
  • Hematogenous spread.
  • Angiotensin converting enzyme 2 receptor.

  Neurological symptoms may be vague especially in the elderly with multiple comorbidities and in children. These include altered mental status, headache, anosmia, cerebellar ataxia, seizures, hemiparesis, and syncope. Encephalitis or a Guillain-Barré syndrome like presentation may occur.

  CT (computed tomography) and MRI (Magnetic resonance imaging) are the most common imaging modalities used. Medial temporal lobe has been shown to be a common site of involvement. Confluent or non-confluent white matter T2 and FLAIR hyperintensities with or without myelitis may occur. The findings in adults may include any of the following:

  • Acute disseminated encephalomyelitis (ADEM)
  • Myelitis
  • Infarcts
  • Transient splenial lesions
  • Intracranial haemorrhage
  • Acute haemorrhagic necrotizing encephalopathy.

  What is interesting to note is that neurological manifestations of COVID-19 infection may occur in the absence of any respiratory symptoms. Another finding is that CSF analysis may be unremarkable in many patients.

  Both the above-mentioned findings have been true in my experience. The common CNS findings seen in recent times include infarcts, hemorrhage and two cases of encephalomyelitis with multifocal, non-enhancing and non-restricting demyelinating lesions in cerebral and cerebellar white matter and in the cervico-thoracic spinal cord.

  There have been increasing number of reported cases of children developing systemic inflammatory response (pediatric multisystem inflammatory syndrome temporally associated with COVID-192). A further group of children with a far less severe, Kawasaki-like disease, who respond to a variety of immunomodulatory treatments has been identified. A toxic shock syndrome like presentation may occur. Despite the typically mild acute infection, children may be at high risk of a secondary inflammatory syndrome.

Since majority of pediatric CNS cases are of asymptomatic to mild degree, clinicians need to be alert. The neuroimaging findings in children may include:

  • Acute infarcts
  • Acute necrotizing encephalopathy
  • Diffuse cerebral edema.

  The differential diagnosis may include other viral encephalitis- Herpes, Varicella, HIV associated diseases, Flavivirus, influenza, and enterovirus. A thorough clinical and laboratory investigation is needed to rule out other causes of overlapping presentations such as meningitis, electrolyte disturbance related myelinolysis and opportunistic infections related to immunocompromised state. Previous history of infection, malignancy and treatment and drug history is required. Immunization history in children is important. CSF analysis for cytology and culture should be done to rule out alternative plausible causes. Other causes of infarcts like arterial or venous thrombosis may have to be ruled out. RT- PCR test should be carried out in patients after the basic set of investigations even if chest imaging is normal.

Hence a high index of suspicion is required for the diagnosis and to prevent morbidity and mortality [1-9].

Bibliography

  1. Lang M., et al. “Leukoencephalopathy associated with severe COVID-19 infection: sequela of hypoxemia?”. American Journal of Neuroradiology 9 (2020): 1641-1645.
  2. Utukuri PS., et al. “Possible acute disseminated encephalomyelitis related to severe acute respiratory syndrome coronavirus 2 infection”. American Journal of Neuroradiology (2020): 82-83.
  3. Kandemirli SG., et al. “Brain MRI findings in patients in the intensive care unit with COVID-19 infection”. Radiology (2020): 201697.
  4. Baig AM. “Neurological manifestations in COVID-19 caused by SARS-CoV-2”. CNS Neuroscience and Therapeutics 5 (2020): 499-501.
  5. Kihira S., et al. “Imaging Features of Acute Encephalopathy in Patients with COVID-19: A Case Series”. American Journal of Neuroradiology (2020).
  6. Parsons T., et al. “COVID-19-associated acute disseminated encephalomyelitis (ADEM)”. Journal of Neurology (2020): 1.
  7. Ellul M., et al. “Neurological Associations of COVID-19”. SSRN (2020).
  8. Radmanesh A., et al. “COVID-19-associated Diffuse Leukoencephalopathy and Microhemorrhages”. Radiology (2020): 202040.
  9. Poyiadji N., et al. “COVID-19–associated acute hemorrhagic necrotizing encephalopathy: CT and MRI features”. Radiology (2020): 201187.

Copyright: © 2021 Niharika Prasad. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.



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