Pathological brain CT scans in severe COVID-19 ICU patients
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Pathological brain CT scans in severe COVID‑19 ICU patients Antonella Castellano1,2, Nicoletta Anzalone1,2* , Silvia Pontesilli1, Evgeny Fominskiy3 and Andrea Falini1,2 © 2020 Springer-Verlag GmbH Germany, part of Springer Nature
Dear Editor, Neurologic involvement in patients with COVID-19 has been recently reported, with central nervous system symptoms being more common in patients with severe infection [1]. Accordingly, preliminary brain MRI findings in patients in the intensive care unit (ICU) have been described in a cohort of 27 patients with neurologic symptoms in a multi-center setting [2]. However, no data have yet been reported on brain computed tomography (CT) findings in COVID-19 patients in the ICU, and the relationship between acute imaging abnormalities, respiratory failure severity and alteration of laboratory parameters has not been investigated yet. Here we report a single-center retrospective analysis on brain CT findings in 23 patients with COVID-19 infection (21 M, 2F, mean age 60.2 ± 7.9 years), admitted to the two mobile ICUs at our hospital. All patients received invasive mechanical ventilation, six of them had venovenous extracorporeal membrane oxygenation (VVECMO). As soon as clinical state allowed, both chest and brain CT in one run were performed. Brain CT scans demonstrated acute lesions in 9 out of 23 cases (39%), with imaging findings being highly consistent throughout all the studies. Multifocal, linear hyperdensities suggestive for hemorrhages, involving both the cortex and the adjacent subarachnoid space, were evident in seven out of nine cases (30% of all the patients), with very subtle superficial enhancement after contrast administration (Fig. 1). The remaining two cases (8.6%) showed cortical–subcortical areas of hypoattenuation with sulcal effacement, consistent with *Correspondence: [email protected] 1 Department of Neuroradiology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy Full author information is available at the end of the article
acute–subacute ischemia, with hemorrhagic transformation in one case (4.3%). CT-positive patients had significantly higher C-reactive protein (173.4 vs. 64 mg/L, p = 0.002) and elevated D-dimer (2.96 vs. 1.54 µg/mL, p = 0.018) than CT-negative patients. Moreover, a significantly lower P aO2/FIO2 ratio was observed in brain CT-positive patients (116 vs. 161, p = 0.033) (see Electronic Supplementary Material, e-Table 1 and e-Fig. 1). Age and time intervals (from symptoms’ onset and from ICU admission to brain CT), as well as other laboratory parameters recorded on the day of brain CT (FiO2, minimum and maximum P aO2 and PaCO2, LDH, ferritin, white blood cell count, platelet count, PT, and aPTT), were not significantly different in the two groups of the patients (see Electronic Supplementary Material, e-Table 1 and e-Fig. 1 ). No significant associations were observed between the presence of pathological neuroradiological findings and medical comorbidities, use of VV-ECMO, presence o
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