Neurovascular and perfusion imaging findings in coronavirus disease 2019: Case report and literature review

Abstract

Central nervous system involvement in severe acute respiratory syndrome caused by coronavirus disease 2019 (COVID-19) has increasingly been recognised in the literature, and possible mechanisms of neuroinvasion, neurotropism and neurovirulence have been described. Neurological signs have been described in 84% of COVID-19 intensive care unit patients, and haemostatic abnormalities in such patients may play an important role, with a broad spectrum of neuroimaging findings. This report describes the magnetic resonance imaging neurovascular findings in an acutely ill patient with COVID-19, including perfusion abnormalities depicted in the arterial spin labelling technique.

Keywords: COVID-19; arterial spin labelling (ASL); cerebral blood flow (CBF); neurointensivism; neuroradiology; neurovascular.

Figure 1.

(a), (b) and (c) Susceptibility weighted imaging (SWI) showing diffuse small hypo-intense dots related to microbleeds located at the cortico-subcortical junction and corpus callosum (yellow arrows). There is also intraparenchymal haematoma in the left thalamus and posterior internal capsule draining to the lateral ventricle (red arrow). (d), (e) and (f) Axial FLAIR images showing subarachnoid haemorrhage in the right fronto-parietal convexity (yellow arrows in (e) and (f)) and haematoma in (d).

Figure 2.

(a), (b) and (c) Perfusion arterial spin labelling (ASL) imaging showing reduction of cerebral blood flow in the bilateral fronto-parietal regions (red arrows). (d), (e) and (f) Some areas also demonstrate decreased cerebral blood volume in the dynamic susceptibility contrast perfusion (white arrows).

Figure 3.

Follow-up brain magnetic resonance imaging with conventional imaging using axial FLAIR ((a), (b) and (c)), sagittal T1 (d) and axial SWI ((e )and (f)), showing partial reabsorption of the subarachnoid haemorrhage, foci of cortical laminar necrosis (blue arrows), gliosis in the right prefrontal cortex (green arrow), superficial siderosis (red arrows) and resolution of both cortical and subarachnoid contrast-enhancement, with no additional signs of acute ischaemia.