Post-COVID-19 syndrome: persistent neuroimaging changes and symptoms 9 months after initial infection

Abstract

A previously healthy and active middle-aged woman acquired COVID-19 as an occupational exposure with subsequent persistent post-COVID-19 symptoms including headache, dyspnoea on exertion, chest pressure, tachycardia, anosmia, parosmia, persistent myalgia, vertigo, cognitive decline and fatigue. She presented to a tertiary medical centre for further evaluation after 9 months of persistent symptoms and had a largely unremarkable workup with the exception of a persistently elevated monocyte chemoattractant protein 1, blunted cardiovagal response and non-specific scattered areas of low-level hypometabolism at the bilateral frontal, left precuneus, occipital and parietal regions on PET scan.

Keywords: COVID-19; Neuroimaging; Radiology.

Figure 1

Mild olfactory enhancement noted on initial MRI, resolved on follow-up.

Figure 2

Non-enhancing T2 signal white matter changes at the anterior left frontal lobe especially along frontal horn lateral ventricle, as well as a non-specific tiny focus of superior left frontal lobe, unchanged between MRIs.

Figure 3

Prominent perivascular spaces in the right greater than left basal ganglia were visualised on MRI.

Figure 4

Global view of PET scan results performed at 9-month mark. The majority of Z-scores are noted to be in the negative range consistent with widespread hypometabolism.

Figure 5

Transverse view of PET. Non-specific scattered areas of low-level hypometabolism are present at the bilateral frontal, left precuneus, occipital and parietal regions. Notably, the gyrus rectus is spared.