Mild to Severe Neurological Manifestations of COVID-19: Cases Reports

Abstract

The main focus of Coronavirus disease 2019 (COVID-19) infection is pulmonary complications through virus-related neurological manifestations, ranging from mild to severe, such as encephalitis, cerebral thrombosis, neurocognitive (dementia-like) syndrome, and delirium. The hospital screening procedures for quickly recognizing neurological manifestations of COVID-19 are often complicated by other coexisting symptoms and can be obscured by the deep sedation procedures required for critically ill patients. Here, we present two different case-reports of COVID-19 patients, describing neurological complications, diagnostic imaging such as olfactory bulb damage (a mild and unclear underestimated complication) and a severe and sudden thrombotic stroke complicated with hemorrhage with a low-level cytokine storm and respiratory symptom resolution. We discuss the possible mechanisms of virus entrance, together with the causes of COVID-19-related encephalitis, olfactory bulb damage, ischemic stroke, and intracranial hemorrhage.

Keywords: COVID-19 outbreak; anosmia; encephalitis thrombosis; intensive care unit.

Figure 1

In the images above, we can see the hyperintensity of both olfactory bulbs (Panel A,B, sagittal FLAIR images) and olfactory tracts (Panel C coronal T2 FRFSE image; Panel D,E coronal FLAIR images) in the sequences obtained in the first magnetic resonance (MR) executed on the patient. In the coronal T2 FRFSE sequence (Panel C), we can also see that both olfactory tracts are swollen and hyperintense in their central portion, and that is even more evident for the right olfactory tract.

Figure 2

Acute ischemia with hemorrhagic infarction in the absence of any vascular malformation with acute quote of cerebral edema showed on CT head scan images. In panel (A), we can see the hemorrhagic infarction of the parietal and temporal lobes, with edema on the white matter of the antero-lateral portion of the temporal lobe with added “mass effect” on the adjacent structures. In panel (B), we can see the hemorrhagic infarction of the occipital and temporal lobes, and the subarachnoid hemorrhage on the cerebellar tentorium margin.