COVID-19's effects on the Egyptian population's brain: Could MRI and specialized MR spectroscopic analysis be beneficial?

ABSTRACT

Background: The recent pandemic of COVID-19 has thrown the world into chaos due to its high rate of transmissions. Recently viewed neurological manifestations among hospitalized Egyptian patients with COVID-19 in quarantine centres. Ataxia, disturbed consciousness and convulsions should be further evaluated by MRI and MRS for CNS involvement by SARS-CoV-2. How COVID-19 targeting the CNS is still under study, as it is difficult to predict which diagnostic neurological tests will be used to identify high-risk COVID-19 patients. MR spectroscopy represents a non-invasive in vivo diagnostic technique for evaluation of metabolic profile of the brain and can reveal important information about the underlying pathologies. Multiple recent reports in the medical literature had confirmed the neurological complications in COVID-19 infection, though few studies has reported the MR spectroscopic findings in these patients. This cross-sectional study aimed to use MRI and MR spectroscopic findings for evaluation of the neurological manifestation of Egyptian COVID-19 patients. Results: Ninety-one male and twenty-seven female met the inclusion criteria, with a mean age of 52 years +/- 10 (SD) (age range;12-78 years). The commonest neurological manifestations were disturbed conscious level (82.2%). The most common MRI findings were acute ischemic insult with/without haemorrhagic areas (42.3%), demyelinating patches of altered signal intensity (31.3%). Sixty cases who had haemorrhagic areas were excluded to perform MRS due to contamination of the spectra by blood component. However, the remaining 67 patients had NAA reduction, choline elevation, glutamate/glutamine and lactate elevation in short TE35, with mean of NAA/Cr ratio= 1.04 +/- 0.14, Choline/Cr= 0.49 +/- 0.04 and Glx/Cr= 1.56 +/- 0.22. Conclusions: During the current pandemic of COVID-19, radiologists should be aware of wide spectrum of MRI and MRS findings of COVID-19-related CNS involvement.