Multifocal laminar cortical brain lesions: a consistent MRI finding in neuro-COVID-19 patients
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LETTER TO THE EDITORS
Multifocal laminar cortical brain lesions: a consistent MRI finding in neuro‑COVID‑19 patients Nicoletta Anzalone1 · Antonella Castellano1 · Roberta Scotti1 · Anna Mara Scandroglio2 · Massimo Filippi3 · Fabio Ciceri4 · Moreno Tresoldi5 · Andrea Falini1 Received: 10 May 2020 / Revised: 28 May 2020 / Accepted: 30 May 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Dear Sirs, Neurologic manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been recently reported [1, 2], with relevance to vascular aetiology [2, 3]. The neuroinvasive potential of SARS-CoV-2 has also been advocated, by infecting the CNS through hematogenous or neuronal retrograde route [4]. Here we report four cases of subacute encephalopathy occurring in patients with SARS-CoV-2 infection. They are part of a series of 21 patients presenting with neurological symptoms studied with brain MRI with otherwise no significant imaging findings. A multifocal involvement of the cortex was evident in all cases (Figs. 1, 2). The multiple areas, from punctiform to some millimeters in extension, appeared hyperintense on T2-weighted and FLAIR images and were located in the parietal, occipital and frontal regions. On diffusion MRI, all but two of the lesions were characterized by the absence of apparent diffusion coefficient (ADC) changes (Figs. 1c,
* Nicoletta Anzalone [email protected] Antonella Castellano [email protected] Roberta Scotti [email protected] Anna Mara Scandroglio [email protected] Massimo Filippi [email protected] Fabio Ciceri [email protected] Moreno Tresoldi [email protected]
2c). A minimum involvement of the adjacent subcortical white matter was evident in only a few lesions. Susceptibility-weighted imaging (SWI) sequences were acquired in all patients and did not show any alteration. Very subtle contrast enhancement was detected only in a cortical lesion. In one patient a follow-up MRI scan was obtained after one month, demonstrating a complete resolution of all the lesions (Fig. 2f–l). All patients (2 men, 2 women; age range 46–63 years) have been intubated in the first week from onset of ARDS and presented neurological signs of agitation and spatial disorientation after weaning from mechanical ventilation. One patient had a generalized seizure. The time interval from onset of neurological symptoms to MRI was 2–6 days. Diagnosis of COVID-19 was made by detection of SARSCoV-2 viral nucleic acid in a nasopharyngeal swab specimen. All patients received the same treatment for SARSCoV-2 infection. None of the patients had a relevant clinical history or previous treatment or hypertension. Laboratory findings revealed in all cases a second smaller C-reactive 1
Department of Neuroradiology, IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy
2
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele U
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