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- FIG 1.
A 65-year-old female patient with a history of rheumatoid arthritis and type 2 diabetes mellitus presented to an outside hospital with fevers and was found to be positive for COVID-19, with pneumonia on chest imaging. The patient’s respiratory status declined despite ventilation, prompting transfer and initiation of VV-ECMO. One day after initiation of ECMO, the patient’s right pupil was fixed on neurologic examination, prompting emergent head CT. This showed a large mixed-attenuation intraparenchymal hemorrhage centered in the right basal ganglia (dotted arrow) with intraventricular extension (dashed arrow) and right-to-left midline shift or subfalcine herniation (solid arrow). Additional intraparenchymal hemorrhages are seen throughout the supratentorial brain (dotted arrow) as well as ventricular dilation and right uncal herniation. Subarachnoid hemorrhage was also seen, such as in the interpeduncular cistern (solid arrow).
- FIG 2.
A 60-year-old male patient with a history of asthma and hypertension presented to an outside hospital with fever, dyspnea, and chest imaging demonstrating multifocal pneumonia. The patient tested positive for COVID-19. The patient was intubated, but his condition worsened despite mechanical ventilation, and he was subsequently placed on VV-ECMO. Three days later, the patient demonstrated anisocoria on physical examination, prompting a CT scan of the head. There was diffuse cerebral edema with sulcal and cisternal effacement and multiple intraparenchymal hemorrhages (solid arrows) resulting in left-to-right midline shift, intraventricular extension (dotted arrow), and subfalcine and uncal herniations.
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