Neuroimaging characteristics of hospitalized patients with COVID-19 with new onset of neurologic symptomsa
| Neuroimaging Characteristics | All Patients (n = 135), CT (n = 132) or MR imaging (n = 36) |
|---|---|
| T2/FLAIR white matter signal abnormality | |
| Nonconfluent punctate deep and subcortical white matter disease | 22/36 (61) |
| Isolated, nonspecific | 9/36 (25) |
| Associated restricted diffusion onlyb | 6/36 (17) |
| Associated microhemorrhage onlyb | 3/36 (8) |
| Associated microhemorrhage and restricted diffusionb | 4/36 (11) |
| Confluent symmetric T2 hyperintensity without restricted diffusion or hemorrhage | 2/36 (5) |
| Confluent symmetric T2 hyperintensity with mild restricted diffusionc | 2/36 (5) |
| Enhancement (MR imaging with and without IV contrast) Leptomeningeald Parenchymale Cranial nerves | 2/17 (12) 2/17 (12) 0/17 (0) |
| Acute ischemic infarcts Vascular territory Small/watershed infarcts Cardioembolic | 36/135 (27) 21/135 (15) 10/135 (7) 5/135 (4) |
| Intracranial hemorrhages Parenchymal Subarachnoid Microhemorrhage | 14/135 (10) 3/135 (2) 4/135 (3) 7/36 (19) |
| Acute leukoencephalopathyc | 4/36 (11) |
| PRES | 3/36 (8) |
| Hypoxic-ischemic encephalopathy | 2/36 (5) |
| TIPICf | 2/7 (28) |
↵a Numbers in parentheses are percentages.
↵b Thought to be most consistent with acute lacunar infarcts with a few associated microhemorrhages (Figs 4 and 6).
↵c Acute leukoencephalopathy. A 48-year-old man without a history of seizures presented with convulsion and altered mental status (Fig 3).
↵d Seen on FLAIR postcontrast only and likely related to PRES (Fig 5).
↵e Septic emboli with atypical left parietal abscess. A 70-year-old woman with high blood pressure, chronic kidney disease, and type 2 diabetes mellitus. Long admission in the intensive care unit with intubation for COVID-19 and bilateral pneumonia. She presented with alteration of mental state and difficulty to progress in the weaning process. No history of malignancy (Online Supplemental Data).
↵f Left TIPIC (carotidynia). A 40 -year-old man without significant medical history or known trauma presented with myoclonus and acute tenderness overlying the left carotid artery with increased pulsation. His symptoms significantly improved after steroid therapy (Fig 7).