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MRI of Cerebrovascular Injury Associated With COVID-19 and Non-COVID-19 Acute Respiratory Distress Syndrome: A Matched Case-Control Study.
Shoskes, Aaron; Huang, Merry; Gedansky, Aron; Hassett, Catherine; Buletko, A Blake; Duggal, Abhijit; Uchino, Ken; Cho, Sung-Min.
  • Shoskes A; Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH.
  • Huang M; Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH.
  • Gedansky A; Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH.
  • Hassett C; Cerebrovascular Center, Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH.
  • Buletko AB; Cerebrovascular Center, Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH.
  • Duggal A; Department of Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, OH.
  • Uchino K; Cerebrovascular Center, Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH.
  • Cho SM; Division of Neuroscience Critical Care, Division of Cardiac Surgery, Departments of Neurology, Cardiac Surgery, Neurosurgery, Anesthesiology, and Critical Care Medicine, Johns Hopkins University, Baltimore, MD.
Crit Care Med ; 50(11): 1638-1643, 2022 Nov 01.
Article in English | MEDLINE | ID: covidwho-2077907
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)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Distress Syndrome / Brain Ischemia / Leukoencephalopathies / COVID-19 Type of study: Cohort study / Observational study / Prognostic study Topics: Long Covid Limits: Adult / Humans Language: English Journal: Crit Care Med Year: 2022 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Distress Syndrome / Brain Ischemia / Leukoencephalopathies / COVID-19 Type of study: Cohort study / Observational study / Prognostic study Topics: Long Covid Limits: Adult / Humans Language: English Journal: Crit Care Med Year: 2022 Document Type: Article