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Early postmortem brain MRI findings in COVID-19 non-survivors
Open accessAbstract
Importance: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is considered to have potential neuro-invasiveness that might lead to acute brain disorders or contribute to respiratory distress in patients with coronavirus disease 2019 (COVID-19). Brain magnetic resonance imaging (MRI) data in COVID-19 patients are scarce due to difficulties to obtain such examination in infected unstable patients during the COVID-19 outbreak. Objective: To investigate the occurrence of structural brain abnormalities in non-survivors of COVID-19 in a virtopsy framework. Design: Prospective, case series study with postmortem brain MRI obtained early (<24h) after death. Setting: Monocentric study. Participants: From 31/03/2020 to 24/04/2020, consecutive decedents who fulfilled the following inclusion criteria were included: death <24 hours, SARS-CoV-2 detection on nasopharyngeal swab specimen, chest computerized tomographic (CT) scan suggestive of COVID-19, absence of known focal brain lesion, and MRI compatibility. Main Outcome(s) andMeasure(s): Signs of acute brain injury and MRI signal abnormalities along the olfactory tract and brainstem were searched independently by 3 neuroradiologists, then reviewed with neurologists and clinicians. Results: Among the 62 patients who died from COVID-19 during the inclusion period, 19 decedents fulfilled inclusion criteria. Subcortical micro- and macro-bleeds (2 decedents), cortico-subcortical edematous changes evocative of posterior reversible encephalopathy syndrome (PRES, one decedent), and nonspecific deep white matter changes (one decedent) were observed. Asymmetric olfactory bulbs were found in 4 other decedents without downstream olfactory tract abnormalities. No brainstem MRI signal abnormality. Conclusions and Relevance: Postmortem brain MRI demonstrates hemorrhagic and PRES-related brain lesions in non-survivors of COVID-19 that might be triggered by the virus-induced endothelial disturbances. SARS-CoV-2-related olfactory impairment seems to be limited to olfactory bulbs. The absence of brainstem MRI abnormalities does not support a brain-related contribution to respiratory distress in COVID-19. Key Points: Question: Is there common brain MRI abnormalities patterns in non-survivors of coronavirus disease 2019 ? Findings: In a case series of 19 non-survivors of severe COVID-19 disease, early postmortem brain MRI demonstrated patterns evocative of intracranial vasculopathy in 4 decedents: subcortical micro- and macro-bleeds (2 decedents), cortico-subcortical edematous changes evocative of posterior reversible encephalopathy syndrome (PRES, one decedent), and nonspecific deep white matter changes (one decedent). Asymmetric olfactory bulbs were found in 4 other decedents but without downstream olfactory tract abnormalities. Meaning: Postmortem brain MRI demonstrates hemorrhagic and PRES-related brain lesions in non-survivors of COVID-19 that might be triggered by virus-induced endothelial disturbances.
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“Multiple immunostaining studies reveal that ACE2 protein in the human brain is predominantly or exclusively expressed in vasculature (and specifically expressed within pericytes) (52, 53, 70), and many neurological symptoms associated with CoV-2 infection like stroke or altered consciousness are consistent with an underlying vasculopathy (71-76).”
From Non-neuronal expression of SARS-CoV-2 entry genes in the olfactory system suggests mechanisms underlying COVID-19-associated anosmia (2020) · cites this paper as [74]
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Metadata
- Authors
- Coolen, T., Lolli, V., Sadeghi, N., Rovaï, A., Trotta, N., Taccone, F. S., Creteur, J., Henrard, S., Goffard, J.-C., De Witte, O., Naeije, G., Goldman, S., & De Tiège, X.
- Affiliations
- Université Libre de Bruxelles (BE)
- Erasmus Hospital (BE)
- ORCID
- Venue
- Neurology
- Publisher
- openRxiv
- Published
- 2020-05-08
- Volume
- 95
- Issue
- 14
- Pages
- e2016-e2027
- ISSN
- 0028-3878 (ISSN-L)
- OpenAlex
- W3035385080
- Cited by
- 256
- References
- 52
- Citations by year
- 2026: 2 · 2025: 8 · 2024: 17 · 2023: 25 · 2022: 61 · 2021: 90 · 2020: 53
- FWCI
- 24.77
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Locations
- Neurology (publishedVersion)
- medRxiv (acceptedVersion)
- PubMed (publishedVersion)
- Dépôt institutionnel de l'Université libre de Bruxelles (Université Libre de Bruxelles) (submittedVersion, other-oa)
- Funders
- Fonds Erasme
- Fonds De La Recherche Scientifique - FNRS
- Topics
- Health Sciences › Medicine › Clinical Neurology › Long-Term Effects of COVID-19
- Health Sciences › Medicine › Infectious Diseases › Infectious Encephalopathies and Encephalitis
- Health Sciences › Medicine › Clinical Neurology › Neurological Complications and Syndromes
- Keywords
- COVID-19 pandemic, SARS-CoV-2, non-survivors, neuroinvasiveness, posterior reversible encephalopathy syndrome, olfactory dysfunction, brainstem MRI, respiratory distress, structural brain abnormalities
- MeSH terms
- Betacoronavirus, COVID-19, SARS-CoV-2, Aged, Aged, 80 and over, Brain, Brain Edema, Cerebral Hemorrhage, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Olfactory Bulb, Pneumonia, Viral, Postmortem Changes, Prospective Studies, Coronavirus Infections, Diffusion Magnetic Resonance Imaging, Posterior Leukoencephalopathy Syndrome, Pandemics, White Matter
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