ABSTRACT
OBJECTIVES: Cerebrovascular injury associated with COVID-19 has been recognized, but the mechanisms remain uncertain. Acute respiratory distress syndrome (ARDS) is a severe pulmonary injury, which is associated with both ischemic and hemorrhagic stroke. It remains unclear if cerebrovascular injuries associated with severe COVID-19 are unique to COVID-19 or a consequence of severe respiratory disease or its treatment. The frequency and patterns of cerebrovascular injury on brain MRI were compared among patients with COVID-19 ARDS and non-COVID-19 ARDS. DESIGN: A case-control study. SETTING: A tertiary academic hospital system. PATIENTS: Adult patients (>18 yr) with COVID-19 ARDS (March 2020 to July 2021) and non-COVID-19 ARDS (January 2010-October 2018) who underwent brain MRI during their index hospitalization. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Cerebrovascular injury on MRI included cerebral ischemia (ischemic infarct or hypoxic ischemic brain injury) and intracranial hemorrhage (intraparenchymal, subarachnoid, or subdural, and cerebral microbleed [CMB]).Twenty-six patients with COVID-19 ARDS and sixty-six patients with non-COVID ARDS underwent brain MRI during the index hospitalization, resulting in 23 age- and sex-matched pairs. The frequency of overall cerebrovascular injury (57% vs 61%), cerebral ischemia (35% vs 43%), intracranial hemorrhage (43% vs 48%), and CMB (52% vs 41%) between COVID-19 ARDS and non-COVID-19 ARDS patients was similar (all p values >0.05). However, four of 26 patients (15%) with COVID-19 and no patients with non-COVID-19 ARDS had disseminated leukoencephalopathy with underlying CMBs, an imaging pattern that has previously been reported in patients with COVID-19. CONCLUSIONS: In a case-control study of selected ARDS patients with brain MRI, the frequencies of ischemic and hemorrhagic cerebrovascular injuries were similar between COVID-19 versus non-COVID-19 ARDS patients. However, the MRI pattern of disseminated hemorrhagic leukoencephalopathy was unique to the COVID-19 ARDS patients in this cohort.
Subject(s)
Brain Ischemia , COVID-19 , Leukoencephalopathies , Respiratory Distress Syndrome , Adult , Brain Ischemia/diagnostic imaging , Brain Ischemia/epidemiology , COVID-19/complications , Case-Control Studies , Humans , Intracranial Hemorrhages , Magnetic Resonance Imaging , Respiratory Distress Syndrome/diagnostic imaging , Respiratory Distress Syndrome/epidemiology , Respiratory Distress Syndrome/etiologyABSTRACT
Patients with COVID-19 have a fairly high risk of neurologic complications, including encephalopathy, stroke, central nervous system infection, seizures, and neuromuscular diseases. Many report losing their senses of smell and taste, and many survivors report lingering neurocognitive impairment. The diagnosis and treatment of these complications does not differ from that in other patients, although sophisticated testing may not be readily available for a patient in intensive care and respiratory isolation. Clinicians should therefore be alert to these complications.
Subject(s)
COVID-19 , Central Nervous System Diseases , Neuromuscular Diseases , SARS-CoV-2 , Seizures , Stroke , COVID-19/complications , COVID-19/physiopathology , COVID-19/psychology , Central Nervous System Diseases/etiology , Central Nervous System Diseases/therapy , Cerebrospinal Fluid/virology , Diagnosis, Differential , Electroencephalography/methods , Humans , Magnetic Resonance Imaging/methods , Neuromuscular Diseases/etiology , Neuromuscular Diseases/therapy , Patient Care Management/methods , SARS-CoV-2/isolation & purification , SARS-CoV-2/pathogenicity , Seizures/etiology , Seizures/therapy , Stroke/etiology , Stroke/therapy , Symptom Assessment/methodsABSTRACT
Ischemic stroke may be a presenting feature of COVID-19. Its etiology remains unclear, but severe COVID-19 disease might increase the risk of large-artery strokes. More evidence is needed to substantiate the current reports and provide insights for optimal management.