RT Journal Article
SR Electronic
T1 Serial Imaging of Virus-Associated Necrotizing Disseminated Acute Leukoencephalopathy (VANDAL) in COVID-19
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 279
OP 284
DO 10.3174/ajnr.A6898
VO 42
IS 2
A1 S. Agarwal
A1 J. Conway
A1 V. Nguyen
A1 S. Dogra
A1 P. Krieger
A1 D. Zagzag
A1 A. Lewis
A1 K. Melmed
A1 S. Galetta
A1 R. Jain
YR 2021
UL http://www.ajnr.org/content/42/2/279.abstract
AB BACKGROUND AND PURPOSE: Various patterns of leukoencephalopathy have been described in coronavirus disease 2019 (COVID-19). In this article, we aimed to describe the clinical and imaging features of acute disseminated leukoencephalopathy in critically ill patients with COVID-19 and the imaging evolution during a short-term follow-up.MATERIALS AND METHODS: We identified and reviewed the clinical data, laboratory results, imaging findings, and outcomes for 8 critically ill patients with COVID-19 with acute disseminated leukoencephalopathy.RESULTS: All patients demonstrated multiple areas of white matter changes in both cerebral hemispheres; 87.5% (7/8) of patients had a posterior predilection. Four patients (50%) had short-term follow-up imaging within a median of 17 days after the first MR imaging; they developed brain atrophy, and their white matter lesions evolved into necrotizing cystic cavitations. All (8/8) patients had inflammatory cytokine release syndrome as demonstrated by elevated interleukin-6, D-dimer, lactate dehydrogenase, erythrocyte sedimentation rate, C-reactive protein, and ferritin levels. Most (7/8; 87.5%) patients were on prolonged ventilator support (median, 44.5 days; interquartile range, 20.5 days). These patients had poor functional outcomes (6/8 [75%] patients were discharged with mRS 5) and high mortality (2/8, 25%).CONCLUSIONS: Critically ill patients with COVID-19 can develop acute disseminated leukoencephalopathy that evolves into cystic degeneration of white matter lesions with brain atrophy during a short period, which we dubbed virus-associated necrotizing disseminated acute leukoencephalopathy. This may be the result of COVID-19-related endothelial injury, cytokine storm, or thrombotic microangiopathy.ADEMacute disseminated encephalomyelitisARDSacute respiratory distress syndromeCRPC-reactive proteinCOVID-19coronavirus disease 2019ESRerythrocyte sedimentation rateGCSGlasgow Coma ScaleIL-6interleukin-6INRinternational normalized ratioIQRinterquartile rangeLDHlactate dehydrogenasePRESposterior reversible encephalopathy syndromeSARS-CoV-2Severe Acute Respiratory Syndrome coronavirus 2VANDALVirus Associated Necrotizing Disseminated Acute LeukoencephalopathyWMwhite matter