Brain microvascular occlusive disorder in COVID-19: a case report
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COVID-19
Brain microvascular occlusive disorder in COVID-19: a case report Laura Saitta 1 & Alexandre Molin 2 & Flavio Villani 3 & Angelo Insorsi 2 & Luca Roccatagliata 1,4 & Matilde Inglese 5,6 & Matteo Bassetti 4,7 & Paolo Pelosi 2,8 & Lucio Castellan 1 & Simonetta Gerevini 9 & Chiara Robba 2 & Nicolò Patroniti 2,8 Received: 25 June 2020 / Accepted: 4 October 2020 # Fondazione Società Italiana di Neurologia 2020
Abstract We describe the case of a COVID-19 patient with severely impaired consciousness after sedation hold, showing magnetic resonance imaging (MRI) findings of (i) acute bilateral supratentorial ischemic lesions involving the fronto-parietal white matter and the corpus callosum and (ii) multiple diffuse susceptibility weighted imaging (SWI) hypointense foci, infra and supratentorial, predominantly bithalamic, suggestive of microhemorrhage or alternatively microthrombi. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) RNA was detected in the cerebrospinal fluid. Our findings suggest the occurrence of vascular damage, predominantly involving microvessels. The underlying mechanisms, which include direct and indirect penetration of the virus to the central nervous system and systemic cardiorespiratory complications, are yet to be elucidated, and a direct correlation with SARS-CoV-2 infection remains uncertain. Keywords Covid-19 . Neurological complications . Coagulopathy . Microthrombi . Inflammation . Ischemia
Introduction
Case report
Neurological manifestations have been observed in a relevant proportion of patients with COVID-19 [1] with different magnetic resonance imaging (MRI) patterns [2]. We report the case of a patient with severe neurological complications and brain MRI evidence of multiple supratentorial areas of restricted diffusion at diffusion-weighted imaging (DWI), consistent with acute ischemic lesions, and several susceptibilityweighted imaging (SWI) punctate hypointensities, most referable to microbleeds or alternatively microthrombi. Collection and scientific use of the patient’s data were approved by the regional ethics committee (CER Liguria: 173/ 2020-DB id 10512). Consent to data publication was verbally obtained from the next of kin.
On March 25, a 68-year-old man with previous history of hypertension and diabetes mellitus presented to the emergency department with dyspnea, fever, fatigue, and productive cough. Diagnosis of coronavirus 2 (SARS-CoV-2) pneumonia was confirmed by nasopharyngeal swab specimen using the transcriptase-polymerase chain reaction assay. Following the development of severe acute respiratory syndrome and acute kidney failure, the patient was admitted to our intensive care unit (ICU) and intubated; mechanical ventilation and continuous veno-venous hemodialysis (CVVHD) were started. Table 1 reports the main mechanical ventilation settings, data on respiratory function, and laboratory results. He was started on steroids, hydroxychloroquine, and ceftaroline. A prophylactic
* Chiara Robba [email protected]
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Department of Neuroscience, Rehabi
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