Top

Published in:

01-12-2020 | Stroke | Review Article

Neuroradiologic manifestations of COVID-19: what the emergency radiologist needs to know

Authors: Michael F. Goldberg, Morton F. Goldberg

Published in: Emergency Radiology | Issue 6/2020

Abstract

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), is a global pandemic with a wide spectrum of clinical signs and symptoms. Neurologic manifestations are relatively common, with severe cases often demonstrating striking findings on neuroimaging. Because the neuroradiologic findings may be the first evidence of COVID-19, the emergency radiologist has a critical role to play in not only the detection and management of the disease but also in the safety of other patients and hospital staff. Therefore, radiologists, especially those who specialize in emergency radiology, need to be aware of the neuroradiologic manifestations of COVID-19.

Phelan AL, Katz R, Gostin LO (2020) The novel coronavirus originating in Wuhan, China. Jama 323(8):709. https://doi.org/10.1001/jama.2020.1097CrossRefPubMed

Johns Hopkins University Coronavirus Resource Center. https://coronavirus.jhu.edu/. Accessed on 5 Aug 2020

Zhou F, Yu T, Du R et al (2020) Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 395(10229):1054–1062. https://doi.org/10.1016/s0140-6736(20)30566-3CrossRefPubMedPubMedCentral

Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, Chang J, Hong C, Zhou Y, Wang D, Miao X, Li Y, Hu B (2020) Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol 77:683. https://doi.org/10.1001/jamaneurol.2020.1127CrossRefPubMed

Kotfis K, Roberson SW, Wilson JE, Dabrowski W, Pun BT, Ely EW (2020) COVID-19: ICU delirium management during SARS-CoV-2 pandemic. Crit Care 24(1). https://doi.org/10.1186/s13054-020-02882-x

Filatov A, Sharma P, Hindi F, Espinosa PS (2020) Neurological complications of coronavirus disease (COVID-19): encephalopathy. Cureus. https://doi.org/10.7759/cureus.7352

Mahammedi A, Saba L, Vagal A, Leali M, Rossi A, Gaskill M, Sengupta S, Zhang B, Carriero A, Bachir S, Crivelli P, Paschè A, Premi E, Padovani A, Gasparotti R (2020) Imaging in neurological disease of hospitalized COVID-19 patients: an Italian multicenter retrospective observational study. Radiology. 201933:201933. https://doi.org/10.1148/radiol.2020201933CrossRef

Chougar L, Shor N, Weiss N, Galanaud D, Leclercq D, Mathon B, Belkacem S, Stroër S, Burrel S, Boutolleau D, Demoule A, Rosso C, Delorme C, Seilhean D, Dormont D, Morawiec E, Raux M, Demeret S, Gerber S, Trunet S, Similowski T, Degos V, Rufat P, Corvol JC, Lehéricy S, Pyatigorskaya N, On behalf of the CoCo Neurosciences study group (2020) Retrospective observational study of brain magnetic resonance imaging findings in patients with acute SARS-CoV-2 infection and neurological manifestations. Radiology. 202422:202422. https://doi.org/10.1148/radiol.2020202422CrossRef

Yaghi S, Ishida K, Torres J et al (2020) SARS2-CoV-2 and stroke in a New York healthcare system. Stroke. https://doi.org/10.1161/strokeaha.120.03033

10.

Helms J, Kremer S, Merdji H, Clere-Jehl R, Schenck M, Kummerlen C, Collange O, Boulay C, Fafi-Kremer S, Ohana M, Anheim M, Meziani F (2020) Neurologic features in severe SARS-CoV-2 infection. N Engl J Med 382:2268–2270. https://doi.org/10.1056/nejmc2008597CrossRefPubMed

11.

Oxley TJ, Mocco J, Majidi S et al (2020) Large-vessel stroke as a presenting feature of Covid-19 in the young. N Engl J Med 382(20). https://doi.org/10.1056/nejmc2009787

12.

Goldberg MF, Goldberg MF, Cerejo R, Tayal A (2020) Cerebrovascular disease in COVID-19. Am J Neuroradiol 41:1170–1172. https://doi.org/10.3174/ajnr.a6588CrossRefPubMedPubMedCentral

13.

Yaghi S, Ishida K, Torres J, Mac Grory B, Raz E, Humbert K, Henninger N, Trivedi T, Lillemoe K, Alam S, Sanger M, Kim S, Scher E, Dehkharghani S, Wachs M, Tanweer O, Volpicelli F, Bosworth B, Lord A, Frontera J (2020) SARS2-CoV-2 and stroke in a New York healthcare system. Stroke. 51:2002–2011. https://doi.org/10.1161/strokeaha.120.030335CrossRefPubMed

14.

Singh TM, Lee A, Vo M et al (2020) Urgent carotid endarterectomy in a COVID-19 patient: standard approach with some adjustments. Vasc Dis Manag 17(5):E104–E109

15.

Franceschi AM, Arora R, Wilson L et al (2020) Neurovascular complications in COVID-19 infection: case series. Am J Neuroradiol. https://doi.org/10.3174/ajnr.a6655

16.

Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, Qiu Y, Wang J, Liu Y, Wei Y, Xia J', Yu T, Zhang X, Zhang L (2020) Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 395(10223):507–513. https://doi.org/10.1016/s0140-6736(20)30211-7CrossRefPubMedPubMedCentral

17.

Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, Wang B, Xiang H, Cheng Z, Xiong Y, Zhao Y, Li Y, Wang X, Peng Z (2020) Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. Jama 323(11):1061. https://doi.org/10.1001/jama.2020.1585CrossRefPubMedPubMedCentral

18.

Wan S, Xiang Y, Fang W, Zheng Y, Li B, Hu Y, Lang C, Huang D, Sun Q, Xiong Y, Huang X, Lv J, Luo Y, Shen L, Yang H, Huang G, Yang R (2020) Clinical features and treatment of COVID-19 patients in Northeast Chongqing. J Med Virol 92:797–806. https://doi.org/10.1002/jmv.25783CrossRefPubMed

19.

Tang N, Li D, Wang X, Sun Z (2020) Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost 18(4):844–847. https://doi.org/10.1111/jth.14768CrossRefPubMedPubMedCentral

20.

Wang W, Sun Q, Bao Y, Liang M, Meng Q, Chen H, Li J, Wang H, Li H, Shi Y, Li Z, Wang X, Zhao S, Wang H, Xiao J, Chen L, Zheng Y, Wang D, Jiao J, Han K (2020) Analysis of risk factors for the thromboembolic events from 88 patients with COVID-19 pneumonia in Wuhan, China: a retrospective report. SSRN Electron J. https://doi.org/10.2139/ssrn.3559633

21.

Zhang Y, Xiao M, Zhang S et al (2020) N Engl J Med 382(17). https://doi.org/10.1056/nejmc2007575

22.

Ackermann M, Verleden SE, Kuehnel M, Haverich A, Welte T, Laenger F, Vanstapel A, Werlein C, Stark H, Tzankov A, Li WW, Li VW, Mentzer SJ, Jonigk D (2020) Pulmonary vascular endothelialitis, thrombosis, and angiogenesis in Covid-19. N Engl J Med 383:120–128. https://doi.org/10.1056/nejmoa2015432CrossRefPubMedPubMedCentral

23.

Varga Z, Flammer AJ, Steiger P, Haberecker M, Andermatt R, Zinkernagel AS, Mehra MR, Schuepbach RA, Ruschitzka F, Moch H (2020) Endothelial cell infection and endotheliitis in COVID-19. Lancet 395(10234):1417–1418. https://doi.org/10.1016/s0140-6736(20)30937-5CrossRefPubMedPubMedCentral

24.

Hoffmann M, Kleine-Weber H, Schroeder S et al (2020) SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell 181(2). https://doi.org/10.1016/j.cell.2020.02.052

25.

Clerkin KJ, Fried JA, Raikhelkar J, Sayer G, Griffin JM, Masoumi A, Jain SS, Burkhoff D, Kumaraiah D, Rabbani LR, Schwartz A, Uriel N (2020) COVID-19 and cardiovascular disease. Circulation. 141(20):1648–1655. https://doi.org/10.1161/circulationaha.120.046941CrossRefPubMed

26.

Umapathi T, Kor AC, Venketasubramanian N, Lim CCT, Pang BC, Yeo TT, Lee CC, Lim PL, Ponnudurai K, Chuah KL, Tan PH, Tai DYH, Ang SPB (2004) Large artery ischaemic stroke in severe acute respiratory syndrome (SARS). J Neurol 251(10):1227–1231. https://doi.org/10.1007/s00415-004-0519-8CrossRefPubMedPubMedCentral

27.

Xie Y, Wang X, Yang P, Zhang S (2020) COVID-19 Complicated by acute pulmonary embolism. Radiol: Cardiothor Imag 2(2). https://doi.org/10.1148/ryct.2020200067

28.

Cavalcanti DD, Raz E, Shapiro M et al (2020) Cerebral venous thrombosis associated with COVID-19. Am J Neuroradiol 41(8). https://doi.org/10.3174/ajnr.a6644

29.

Chougar L, Shor N, Mathon B, Degos V, Weiss N (2020) Atypical deep cerebral vein thrombosis with hemorrhagic venous infarction in a COVID-19-positive patient. Am J Neuroradiol 41(8). https://doi.org/10.3174/ajnr.a6641

30.

Hemasian H, Ansari B (2020) First case of Covid-19 presented with cerebral venous thrombosis: a rare and dreaded case. Rev Neurol 176:521–523. https://doi.org/10.1016/j.neurol.2020.04.013CrossRefPubMed

31.

Klein DE, Libman R, Kirsch C, Arora R (2020) Cerebral venous thrombosis: atypical presentation of COVID-19 in the young. J Stroke Cerebrovasc Dis 104989:104989. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.104989CrossRef

32.

Poillon G, Obadia M, Perrin M, Savatovsky J, Lecler A (2020) Cerebral venous thrombosis associated with COVID-19 infection: causality or coincidence? J Neuroradiol. https://doi.org/10.1016/j.neurad.2020.05.003

33.

Patrícia C, Ferro JM, Lindgren AG, Bousser M-G, Stam J, Barinagarrementeria F (2005) Causes and predictors of death in cerebral venous thrombosis. Stroke. 36(8):1720–1725. https://doi.org/10.1161/01.str.0000173152.84438.1cCrossRef

34.

Ferro JM, Patrícia C, Stam J, Bousser M-G, Barinagarrementeria F (2004) Prognosis of cerebral vein and dural sinus thrombosis. Stroke. 35(3):664–670. https://doi.org/10.1161/01.str.0000117571.76197.26CrossRefPubMed

35.

Muhammad S, Petridis A, Cornelius JF, Hänggi D (2020) Letter to editor: severe brain haemorrhage and concomitant COVID-19 infection: a neurovascular complication of COVID-19. Brain Behav Immun. https://doi.org/10.1016/j.bbi.2020.05.015

36.

Nicholson P, Alshafai L, Krings T (2020) Neuroimaging findings in patients with COVID-19. Am J Neuroradiol 41(8). https://doi.org/10.3174/ajnr.a6630

37.

Magro C, Mulvey JJ, Berlin D, Nuovo G, Salvatore S, Harp J, Baxter-Stoltzfus A, Laurence J (2020) Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: a report of five cases. Transl Res 220:1–13. https://doi.org/10.1016/j.trsl.2020.04.007CrossRefPubMedPubMedCentral

38.

Fitsiori A, Pugin D, Thieffry C, Lalive P, Vargas MI (2020) Unusual microbleeds in brain MRI of Covid-19 patients. J Neuroimaging. https://doi.org/10.1111/jon.12755

39.

Kremer S, Lersy F, Sèze JD et al (2020) Brain MRI findings in severe COVID-19: a retrospective observational study. Radiology. 2020:202222. https://doi.org/10.1148/radiol.2020202222CrossRef

40.

Berlin DA, Gulick RM, Martinez FJ (2020) Severe Covid-19. N Engl J Med. https://doi.org/10.1056/nejmcp2009575

41.

Mehta P, Mcauley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ (2020) COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet 395(10229):1033–1034. https://doi.org/10.1016/s0140-6736(20)30628-0CrossRefPubMedPubMedCentral

42.

Franceschi A, Ahmed O, Giliberto L, Castillo M (2020) Hemorrhagic posterior reversible encephalopathy syndrome as a manifestation of COVID-19 infection. Am J Neuroradiol 41:1173–1176. https://doi.org/10.3174/ajnr.a6595CrossRefPubMedPubMedCentral

43.

Desforges M, Coupanec AL, Stodola JK, Meessen-Pinard M, Talbot PJ (2014) Human coronaviruses: viral and cellular factors involved in neuroinvasiveness and neuropathogenesis. Virus Res 194:145–158. https://doi.org/10.1016/j.virusres.2014.09.011CrossRefPubMedPubMedCentral

44.

Calcagno N, Colombo E, Maranzano A, Pasquini J, Keller Sarmiento IJ, Trogu F, Silani V (2020) Rising evidence for neurological involvement in COVID-19 pandemic. Neurol Sci 41:1339–1341. https://doi.org/10.1007/s10072-020-04447-wCrossRefPubMedPubMedCentral

45.

Kim J-E, Heo J-H, Kim H-O, Song SH, Park SS, Park TH, Ahn JY, Kim MK, Choi JP (2017) Neurological complications during treatment of Middle East respiratory syndrome. J Clin Neurol 13(3):227–233. https://doi.org/10.3988/jcn.2017.13.3.227CrossRefPubMedPubMedCentral

46.

Morris M, Zohrabian V (2020) Neuroradiologists, be mindful of the neuroinvasive potential of COVID-19. Am J Neuroradiol 41:E37–E39. https://doi.org/10.3174/ajnr.a6551CrossRefPubMedPubMedCentral

47.

Li YC, Bai WZ, Hashikawa T (2020) The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. J Med Virol 92(6):552–555. https://doi.org/10.1002/jmv.25728CrossRefPubMed

48.

Desforges M, Coupanec AL, Dubeau P et al (2019) Human coronaviruses and other respiratory viruses: underestimated opportunistic pathogens of the central nervous system? Viruses. 12(1):14. https://doi.org/10.3390/v12010014CrossRefPubMedCentral

49.

Politi LS, Salsano E, Grimaldi M (2020) Magnetic resonance imaging alteration of the brain in a patient with coronavirus disease 2019 (COVID-19) and anosmia. JAMA Neurol 77:1028. https://doi.org/10.1001/jamaneurol.2020.2125CrossRefPubMed

50.

Algahtani H, Subahi A, Shirah B (2016) Neurological complications of Middle East respiratory syndrome coronavirus: a report of two cases and review of the literature. Case Rep Neurol Med 2016:1–6. https://doi.org/10.1155/2016/3502683CrossRef

51.

Yeh EA, Collins A, Cohen ME, Duffner PK, Faden H (2003) Detection of coronavirus in the central nervous system of a child with acute disseminated encephalomyelitis. Pediatrics 113(1). https://doi.org/10.1542/peds.113.1.e73

52.

Poyiadji N, Shahin G, Noujaim D, Stone M, Patel S, Griffith B (2020) COVID-19–associated acute hemorrhagic necrotizing encephalopathy: CT and MRI features. Radiology. 2020:201187. https://doi.org/10.1148/radiol.2020201187CrossRef

53.

Bartynski W (2008) Posterior reversible encephalopathy syndrome, part 1: fundamental imaging and clinical features. Am J Neuroradiol 29(6):1036–1042. https://doi.org/10.3174/ajnr.a0928CrossRefPubMedPubMedCentral

54.

Radmanesh A, Derman A, Lui YW, Raz E, Loh JP, Hagiwara M, Borja MJ, Zan E, Fatterpekar GM (2020) COVID-19 –associated diffuse leukoencephalopathy and microhemorrhages. Radiology. 2020:202040. https://doi.org/10.1148/radiol.2020202040CrossRef

55.

Utukuri P, Bautista A, Lignelli A, Moonis G (2020) Possible acute disseminated encephalomyelitis related to severe acute respiratory syndrome coronavirus 2 infection. Am J Neuroradiol. https://doi.org/10.3174/ajnr.a6714

56.

Parsons T, Banks S, Bae C, Gelber J, Alahmadi H, Tichauer M (2020) COVID-19-associated acute disseminated encephalomyelitis (ADEM). J Neurol. https://doi.org/10.1007/s00415-020-09951-9

57.

Zanin L, Saraceno G, Panciani PP, Renisi G, Signorini L, Migliorati K, Fontanella MM (2020) SARS-CoV-2 can induce brain and spine demyelinating lesions. Acta Neurochir 162(7):1491–1494. https://doi.org/10.1007/s00701-020-04374-xCrossRefPubMed

58.

Palao M, Fernández-Díaz E, Gracia-Gil J, Romero-Sánchez C, Díaz-Maroto I, Segura T (2020) Multiple sclerosis following SARS-CoV-2 infection. Multiple Sclerosis Relat Disord 45:102377. https://doi.org/10.1016/j.msard.2020.102377CrossRef

Title: Neuroradiologic manifestations of COVID-19: what the emergency radiologist needs to know
Authors: Michael F. Goldberg
Morton F. Goldberg
Publication date: 01-12-2020
Publisher: Springer International Publishing
Keywords: Stroke
Cranial MRI
SARS-CoV-2
COVID-19
Encephalopathy
Posterior Reversible Encephalopathy Syndrome
Published in: Emergency Radiology / Issue 6/2020
Print ISSN: 1070-3004
Electronic ISSN: 1438-1435
DOI: https://doi.org/10.1007/s10140-020-01840-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Neuroradiologic manifestations of COVID-19: what the emergency radiologist needs to know

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 6/2020

Impact of the COVID-19 pandemic on emergency CT head utilization in Ontario—an observational study of tertiary academic hospitals

Responding to coronavirus disease 2019: LA County hospital experience

An unresponsive COVID-19 patient

The role of initial chest X-ray in triaging patients with suspected COVID-19 during the pandemic

Qualitative and quantitative chest CT parameters as predictors of specific mortality in COVID-19 patients

Intussusception in a child with COVID-19 in the USA