What the neuroradiologist should additionally consider in SARS-CoV-2 infection
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LETTER TO THE EDITOR
What the neuroradiologist should additionally consider in SARS-CoV-2 infection J. Finsterer 1 & F. A. Scorza 2
&
C. A. Scorza 2
&
A. C. Fiorini 3,4
Received: 23 August 2020 / Accepted: 12 November 2020 # American Society of Emergency Radiology 2020
Letter to the Editor With interest, we read the review article by Goldberg et al. about the neuro-radiological implications of COVID-19/ SARS-CoV-2 infection [1]. It was concluded that the emergency radiologist plays a critical role not only in the detection and management of COVID-19 but also in the safety of other patients and hospital staff, as neuroradiologic findings may provide the first evidence of COVID-19 [1]. We have the following comments and concerns. Several neurological conditions associated with SARSCoV-2 were not addressed. Cerebrovascular disease occurs in 1.4% of patients hospitalized for COVID-19 [2]. One of the causes of cerebrovascular events is vasculitis, which may affect small and large arteries [3]. In a study of 125 patients with neuropsychiatric manifestations from the UK, 1% had cerebral vasculitis [4]. At least in some of these cases, the underlying pathophysiology may be endotheliitis [5]. Thus,
* J. Finsterer [email protected] F. A. Scorza [email protected] C. A. Scorza [email protected] A. C. Fiorini [email protected] 1
Klinik Landstrasse, Messerli Institute, Postfach 20, 1180 Vienna, Austria
2
Disciplina de Neurociência, Universidade Federal de São Paulo/ Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil
3
Programa de Estudos Pós-Graduado em Fonoaudiologia, Pontifícia Universidade Católica de São Paulo (PUC-SP), São Paulo, Brazil
4
Departamento de Fonoaudiologia, Escola Paulista de Medicina/ Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
the emergency neuroradiologist should consider cerebral vasculitis as an early manifestation of COVID-19. Another cerebral disease occasionally occurring in SARSCoV-2-infected patients is cerebellitis [6]. Cerebellitis was reported in a 47-year-old male from Wuhan in whom cerebral MRI showed edema of the cerebellar hemispheres associated with leptomeningeal enhancement [6]. SARS-CoV-2associated cerebellitis manifests on FDG-PET as hypometabolism [7]. A third cerebral SARS-CoV-2-associated condition is acute cerebral demyelination, as has been reported in a 54year-old female [8]. Among spinal cord manifestations of SARS-CoV-2, neuroradiologists should consider myelitis. Though myelitis has been reported in only single patients, it should not be missed, as delayed treatment may have strong implications on the outcome. In a 61-year-old female with COVID-19, spinal MRI revealed longitudinally extensive transverse myelitis [9]. The patient profited from repeated rounds of plasma exchange [9]. In addition to several other cases with SARSCoV-2-associated myelitis in adults [10, 11], SARS-CoV-2associated myelitis has been also reported in children [12]. A fifth neurological manifestation of SARS-CoV-2 not mentioned in the review is polyr
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