COVID-19–associated Diffuse Leukoencephalopathy and Microhemorrhages

TLDR

Diffuse leukoencephalopathy and microhemorrhages are brain imaging findings reported in critically ill COVID‑19 patients, along with ischemic infarcts and hemorrhage. The study reports MRI findings in 11 critically ill COVID‑19 patients with persistent diminished mental status and discusses potential pathogeneses. MRI was performed on these 11 patients between April 5 and April 25, 2020. Imaging revealed confluent T2 hyperintensity with mild restricted diffusion in bilateral deep and subcortical white matter in 10 of 11 patients, and multiple punctate microhemorrhages in juxtacortical and callosal white matter in 7 of 11 patients. © RSNA, 2020; supplemental material available online.

Abstract

Diffuse leukoencephalopathy and juxtacortical and/or callosal microhemorrhages were brain imaging features in critically ill patients with coronavirus disease 2019. Coronavirus disease 2019 (COVID-19) has been reported in association with a variety of brain imaging findings such as ischemic infarct, hemorrhage, and acute hemorrhagic necrotizing encephalopathy. Herein, the authors report brain imaging features in 11 critically ill patients with COVID-19 with persistently diminished mental status who underwent MRI between April 5 and April 25, 2020. These imaging features include (a) confluent T2 hyperintensity and mild restricted diffusion in bilateral supratentorial deep and subcortical white matter (in 10 of 11 patients) and (b) multiple punctate microhemorrhages in juxtacortical and callosal white matter (in seven of 11 patients). The authors also discuss potential pathogeneses. © RSNA, 2020 Online supplemental material is available for this article.