Brain MRI Findings in Severe COVID-19: A Retrospective Observational Study
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Background Brain MRI parenchymal signal abnormalities have been associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Purpose To describe the neuroimaging findings (excluding ischemic infarcts) in patients with severe coronavirus disease 2019 (COVID-19) infection. Materials and Methods This was a retrospective study of patients evaluated from March 23, 2020, to April 27, 2020, at 16 hospitals. Inclusion criteria were (a) positive nasopharyngeal or lower respiratory tract reverse transcriptase polymerase chain reaction assays, (b) severe COVID-19 infection defined as a requirement for hospitalization and oxygen therapy, (c) neurologic manifestations, and (d) abnormal brain MRI findings. Exclusion criteria were patients with missing or noncontributory data regarding brain MRI or brain MRI showing ischemic infarcts, cerebral venous thrombosis, or chronic lesions unrelated to the current event. Categorical data were compared using the Fisher exact test. Quantitative data were compared using the Student t test or Wilcoxon test. P < .05 represented a significant difference. Results Thirty men (81%) and seven women (19%) met the inclusion criteria, with a mean age of 61 years ± 12 (standard deviation) (age range, 8–78 years). The most common neurologic manifestations were alteration of consciousness (27 of 37, 73%), abnormal wakefulness when sedation was stopped (15 of 37, 41%), confusion (12 of 37, 32%), and agitation (seven of 37, 19%). The most frequent MRI findings were signal abnormalities located in the medial temporal lobe in 16 of 37 patients (43%; 95% confidence interval [CI]: 27%, 59%), nonconfluent multifocal white matter hyperintense lesions seen with fluid-attenuated inversion recovery and diffusion-weighted sequences with variable enhancement, with associated hemorrhagic lesions in 11 of 37 patients (30%; 95% CI: 15%, 45%), and extensive and isolated white matter microhemorrhages in nine of 37 patients (24%; 95% CI: 10%, 38%). A majority of patients (20 of 37, 54%) had intracerebral hemorrhagic lesions with a more severe clinical presentation and a higher admission rate in intensive care units (20 of 20 patients [100%] vs 12 of 17 patients without hemorrhage [71%], P = .01) and development of the acute respiratory distress syndrome (20 of 20 patients [100%] vs 11 of 17 patients [65%], P = .005). Only one patient had SARS-CoV-2 RNA in the cerebrospinal fluid. Conclusion Patients with severe coronavirus disease 2019 and without ischemic infarcts had a wide range of neurologic manifestations that were associated with abnormal brain MRI scans. Eight distinctive neuroradiologic patterns were described. © RSNA, 2020
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MRI studies have shown brain structural and micro-structural changes in COVID-19 patients.
“MRI studies have shown brain structural and micro-structural changes in COVID-19 patients [143–146]”
From Cognitive decline following acute viral infections: literature review and projections for post-COVID-19 (2022) · cites this paper as [144]
MRI changes in COVID-19 patients include cortical signal intensity abnormalities and unilateral FLAIR or diffusion hyper-intensities in the medial temporal lobe.
“cortical signal intensity abnormalities and unilateral FLAIR or diffusion hyper-intensities in medial the temporal lobe (MTL) [144, 146]”
From Cognitive decline following acute viral infections: literature review and projections for post-COVID-19 (2022) · cites this paper as [144]
Structural MRI of 30 in vivo severe acute COVID-19 cases revealed multifocal subcortical FLAIR and diffusion-weighted signal changes compatible with oedema, particularly in the mediotemporal lobe, with an aetiological role played by haemorrhagic lesions.
“structural magnetic resonance imaging of 30 in vivo severe acute cases revealed multifocal subcortical FLAIR and diffusion-weighted signal changes, compatible with oedema, particularly in the mediotemporal lobe, with an aetiological role played by haemorrhagic lesions as well (35).”
From The impact of COVID-19 infection and enforced prolonged social isolation on neuropsychiatric symptoms in older adults with and without dementia: A review (2020) · cites this paper as [35]
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Cerebral microhaemorrhage in COVID-19: a critical illness related phenomenon?
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Self-citationDynamic white matter changes in recovered COVID-19 patients: a two-year follow-up study
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Cortical Grey matter volume depletion links to neurological sequelae in post COVID-19 “long haulers”
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Involvement of the nervous system in COVID-19: The bell should toll in the brain
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Neurological complications associated with Covid‐19; molecular mechanisms and therapeutic approaches
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Cellular mechanisms underlying neurological/neuropsychiatric manifestations of COVID‐19
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Acute hemorrhagic leukoencephalitis in a COVID-19 patient—a case report with literature review
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The Impact of the COVID-19 Pandemic on Dementia Risk: Potential Pathways to Cognitive Decline
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Biomimetic Nanomaterial Strategies for Virus Targeting: Antiviral Therapies and Vaccines
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Quantitative susceptibility mapping at 7 T in COVID-19: brainstem effects and outcome associations
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Electroencephalographic findings in COVID-19 patients: A systematic review
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Emerging Neurological and Psychobiological Aspects of COVID-19 Infection
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RSNA International Trends: A Global Perspective on the COVID-19 Pandemic and Radiology in Late 2020
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Age-Associated Neurological Complications of COVID-19: A Systematic Review and Meta-Analysis
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Neurological emergencies associated with COVID-19: stroke and beyond
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Imaging of Multisystem Inflammatory Disease in Children (MIS-C) Associated With COVID-19
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Biomedical Perspectives of Acute and Chronic Neurological and Neuropsychiatric Sequelae of COVID-19
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De Novo Movement Disorders and COVID ‐19: Exploring the Interface
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Therapeutic Approaches to the Neurologic Manifestations of COVID-19
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Pathophysiology, diagnosis, and management of neuroinflammation in covid-19
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Neuro-Axonal Damage and Alteration of Blood–Brain Barrier Integrity in COVID-19 Patients
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- Authors
- Kremer, S., Lersy, F., de Sèze, J., Ferré, J.-C., Maamar, A., Carsin-Nicol, B., Collange, O., Bonneville, F., Adam, G., Martin-Blondel, G., Rafiq, M., Geeraerts, T., Delamarre, L., Grand, S., Krainik, A., For the SFNR-COVID Group, Kremer, S., Adam, G., Alleg, M., Anheim, M., Anxionnat, R., Ardellier, F.-D., Baloglu, S., Bapst, B., Benzakoun, J., Berge, J., Bolognini, F., Bonneville, F., Bornet, G., Boulay, C., Boulouis, G., Boutet, C., Brisset, J. C., Caillard, S., Carré, S., Carsin-Nicol, B., Collange, O., Comby, P.-O., Constans, J. M., David, J.-S., de Beaurepaire, I., de Sèze, J., Delamarre, L., Desal, H., Edjlali-Goujon, M., Fabre, X., Fafi-Kremer, S., Ferré, J.-C., Feuerstein, P., Henry Feugeas, M.-C., Forestier, G., Gaudemer, A., Geeraerts, T., Grand, S., Hansmann, Y., Heintz, A., Helms, J., Hemmert, C., Hmeydia, G., Jager, L., Kazémi, A., Kerleroux, B., Khalil, A., Krainik, A., Lacalm, A., Lecler, A., Lecocq, C., Lefèbvre, N., Lersy, F., Maamar, A., Martin-Blondel, G., Matthieu, M., Megdiche, I., Mertes, P.-M., Messié, J., Metanbou, S., Meyer, N., Meziani, F., Mutschler, V., Nesser, P., Oesterlé, H., Ohana, M., Oppenheim, C., Pyatigorskaya, N., Rafiq, M., Ricolfi, F., Saleme, S., Schenck, M., Schmitt, E., Schneider, F., Sebag, N., Talla Mba, Y., Thouant, P., Willaume, T., Zhu, F., Zorn, P.-E., & Cotton, F.
- Affiliations
- Hôpitaux Universitaires de Strasbourg (FR)
- Centre National de la Recherche Scientifique (FR)
- ORCID
- Alleg, Manel
- Anheim, Mathieu
- Anxionnat, René
- Ardellier, François-Daniel
- Baloglu, Seyyid
- Bapst, Blanche
- Benzakoun, Joseph
- Berge, Jérome
- Bolognini, Federico
- Bornet, Grégoire
- Boulouis, Grégoire
- Boutet, Claire
- Brisset, Jean Christophe
- Caillard, Sophie
- Comby, Pierre-Olivier
- Constans, Jean Marc
- David, Jean-Stéphane
- Desal, Hubert
- Fabre, Xavier
- Fafi-Kremer, Samira
- Feuerstein, Philippe
- Forestier, Géraud
- Gaudemer, Augustin
- Hansmann, Yves
- Helms, Julie
- Hmeydia, Ghazi
- Jager, Lavinia
- Kerleroux, Basile
- Khalil, Antoine
- Lacalm, Audrey
- Lecler, Augustin
- Lecocq, Claire
- Mertes, Paul-Michel
- Messié, Julien
- Meyer, Nicolas
- Meziani, Ferhat
- Mutschler, Véronique
- Oesterlé, Hélène
- Oppenheim, Catherine
- Pyatigorskaya, Nadya
- Ricolfi, Frédéric
- Saleme, Suzana
- Schenck, Maleka
- Schmitt, Emmanuelle
- Schneider, Francis
- Sebag, Nathan
- Talla Mba, Yannick
- Thouant, Pierre
- Willaume, Thibault
- Zhu, François
- Zorn, Pierre-Emmanuel
- Cotton, François
- Venue
- Radiology
- Published
- 2020-11
- Volume
- 297
- Issue
- 2
- Pages
- E242-E251
- ISSN
- 0033-8419 (ISSN-L)
- 1527-1315
- PMC
- PMC7301613
- OpenAlex
- W3035517854
- Cited by
- 460
- References
- 28
- Citations by year
- 2026: 9 · 2025: 17 · 2024: 35 · 2023: 64 · 2022: 80 · 2021: 163 · 2020: 89 · 2019: 1
- FWCI
- 42.87
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Radiology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion)
- Funders
- Agence Nationale de la Recherche (ANR-10-EQPX-0001)
- Topics
- Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
- Health Sciences › Medicine › Infectious Diseases › Infectious Encephalopathies and Encephalitis
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Keywords
- COVID-19 pandemic, SARS-CoV-2, brain MRI findings, neurologic manifestations, altered states of consciousness, white matter hyperintensities, intracerebral hemorrhage, diffusion-weighted imaging, FLAIR, cerebral venous thrombosis, cerebral edema, brain hypometabolism
- MeSH terms
- Betacoronavirus, COVID-19, SARS-CoV-2, Adolescent, Adult, Aged, Brain, Child, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Pneumonia, Viral, Retrospective Studies, Cohort Studies, Coronavirus Infections, Young Adult, Pandemics
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