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Case Reports
. 2020 Aug;41(8):1384-1387.
doi: 10.3174/ajnr.A6651. Epub 2020 Jun 18.

COVID-19 Neurologic Complication with CNS Vasculitis-Like Pattern

R Hanafi  1   2 , P-A Roger  2 , B Perin  2 , G Kuchcinski  3 , N Deleval  2 , F Dallery  2 , D Michel  2 , L Hacein-Bey  4 , J-P Pruvo  3 , O Outteryck  3 , J-M Constans  2
Affiliations
Case Reports

COVID-19 Neurologic Complication with CNS Vasculitis-Like Pattern

R Hanafi et al. AJNR Am J Neuroradiol. 2020 Aug.

Abstract

Coronavirus disease 2019 (COVID-19) is a viral infection caused by the Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2), which spreads rapidly from person to person and manifests in most symptomatic patients as a respiratory illness, similar to prior SARS viruses. Neurologic manifestations of COVID-19 are uncommon; those so far reported include encephalopathy, stroke from large-vessel occlusion, and polyneuropathy. We report a unique neurologic complication of COVID-19 in a patient who had extensive cerebral small-vessel ischemic lesions resembling cerebral vasculitis in a characteristic combined imaging pattern of ischemia, hemorrhage, and punctuate postcontrast enhancement. Also, a characteristic lower extremity skin rash was present in our patient. Our observation lends support to the increasingly suspected mechanism of "endotheliitis" associated with this novel coronavirus.

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Figures

Fig 1.
Fig 1.
Noncontrast brain CT of presumptive COVID-associated small-vessel injury. Note deep white matter (A), basal ganglia (B), and cerebellar (C) hypodensities (arrows). Bilateral globus pallidus hemorrhage is also present (B, arrows).
Fig 2.
Fig 2.
T2*-weighted MR imaging demonstrates bilateral globus pallidus susceptibility, consistent with microhemorrhage (arrows).
Fig 3.
Fig 3.
Diffuse deep white matter ischemic injuries. DWI shows numerous focal ischemic lesions within the hemispheric deep white matter (A, white arrow), the corpus callosum (A, red arrow), the basal ganglia, the middle cerebellar peduncles, and the cerebellar hemispheres (B, white arrows).
Fig 4.
Fig 4.
Diffuse ischemic lesions on FLAIR imaging. Axial (A–C) and coronal (D) FLAIR images show hyperintense ischemic lesions within the periventricular white matter, basal ganglia, cerebellar peduncles (white arrows), and the corpus callosum (A, red arrow).
Fig 5.
Fig 5.
Patchy/punctate postcontrast enhancement pattern with consistent small vessel involvement. Postcontrast T1 MR imaging shows intense patchy enhancement of all lesions, in particular the globus pallidus bilaterally (A, white arrows), with a punctuate pattern in the middle cerebellar peduncles and cerebellar hemispheres (B, arrow).
Fig 6.
Fig 6.
Coronal 3D reconstruction MRA of the supra-aortic arteries shows no detectable abnormality of large intra- or extracranial vessels.
See this image and copyright information in PMC

Comment in

  • Reply.
    Hanafi R, Hacein-Bey L, Kuchcinski G. Hanafi R, et al. AJNR Am J Neuroradiol. 2021 Jan;42(2):E5. doi: 10.3174/ajnr.A6944. Epub 2021 Jan 14. AJNR Am J Neuroradiol. 2021. PMID: 33446497 Free PMC article. No abstract available.
  • COVID-19 Related Central Nervous System Vasculopathy: Beyond Vasculitis.
    Quintas-Neves M. Quintas-Neves M. AJNR Am J Neuroradiol. 2021 Jan;42(2):E4. doi: 10.3174/ajnr.A6913. Epub 2021 Jan 14. AJNR Am J Neuroradiol. 2021. PMID: 33446498 Free PMC article. No abstract available.

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