Cerebrovascular Disease in COVID-19

Abstract

Coronavirus disease 19 (COVID-19) is a pandemic originating in Wuhan, China, in December 2019. Early reports suggest that there are neurologic manifestations of COVID-19, including acute cerebrovascular disease. We report a case of COVID-19 with acute ischemic stroke. To our knowledge, this is the first reported case of COVID-19-related cerebral infarcts that includes brain imaging at multiple time points and CT angiography. There is a growing body of published evidence that complications of COVID-19 are not limited to the pulmonary system. Neuroradiologists should be aware of a wide range of neurologic manifestations, including cerebrovascular disease.

FIG 1.

A, NCCT on the day of admission demonstrates subtle findings of acute ischemia in the right MCA (arrowheads) and bilateral ACA (arrows) territories, including hypoattenuation and loss of gray-white differentiation. B, Repeat NCCT on hospital day 2 demonstrates progression of acute infarcts in the right MCA and bilateral ACA territories, including worsening edema and mass effect.

FIG 2.

A, Sagittal MIP image from the extracranial CTA performed on the day of admission demonstrates a segmental high-grade stenosis of the proximal right internal carotid artery (arrows). There is normal flow in the right common carotid and external carotid arteries. B, Axial MIP of the intracranial CTA performed on the day of admission demonstrates markedly decreased vascular flow within the branches of the right MCA (arrowheads) and bilateral ACAs (arrows). Conversely, there is normal vascular flow in the left MCA and bilateral posterior cerebral artery territories.