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Brain MRI Findings in Severe COVID-19: A Retrospective Observational Study

Stéphane Kremer 1, 2 François Lersy 1 Jérome de Sèze 1 Jean-Christophe Ferré 3 Adel Maamar 4 Béatrice Carsin-Nicol 3 Olivier Collange 1 Fabrice Bonneville 5 Gilles Adam 5 Guillaume Martin-Blondel 5 Marie Rafiq 5 Thomas Geeraerts 5 Louis Delamarre 5 Sylvie Grand 6 Alexandre Krainik 6 Manel Alleg 7 Mathieu Anheim 8 René Anxionnat 9 François-Daniel Ardellier 1 Seyyid Baloglu 1 Blanche Bapst 10 Joseph Benzakoun 11 Jérome Berge 12 Federico Bolognini 13 Grégoire Bornet 14 Clotilde Boulay 1 Grégoire Boulouis 11 Claire Boutet 15 Jean Christophe Brisset 16 Sophie Caillard 1, 17 Sophie Carré 7 Pierre-Olivier Comby 18 Jean Marc Constans 19 Jean-Stéphane David 20 Isaure de Beaurepaire 14 Hubert Desal 21 Myriam Edjlali-Goujon 11 Xavier Fabre 22 Samira Fafi-Kremer 1 Philippe Feuerstein 23 Marie-Cécile Henry Feugeas 24 Géraud Forestier 25 Augustin Gaudemer 24 Yves Hansmann 26 Adrien Heintz 19 Julie Helms 27, 28 Céline Hemmert 23 Ghazi Hmeydia 11 Lavinia Jager 29 Apolline Kazémi 30 Basile Kerleroux 11 Antoine Khalil 24 Audrey Lacalm 20 Augustin Lecler 31 Claire Lecocq 7 Nicolas Lefèbvre 26 Muriel Matthieu 32 Imen Megdiche 10 Paul-Michel Mertes 1 Julien Messié 13 Serge Metanbou 19 Nicolas Meyer 26 Ferhat Meziani 33 Véronique Mutschler 32 Patrick Nesser 29 Hélène Oesterlé 13 Mickael Ohana 27 Catherine Oppenheim 11 Nadya Pyatigorskaya 34 Frédéric Ricolfi 18 Suzana Saleme 25 Maleka Schenck 32 Emmanuelle Schmitt 9 Francis Schneider 32 Nathan Sebag 23 Yannick Talla Mba 29 Pierre Thouant 18 Thibault Willaume 32 François Zhu 9 Pierre-Emmanuel Zorn 32 François Cotton 35 
Abstract : Background Brain MRI parenchymal signal abnormalities have been associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Purpose To describe the neuroimaging findings (excluding ischemic infarcts) in patients with severe coronavirus disease 2019 (COVID-19) infection. Materials and Methods This was a retrospective study of patients evaluated from March 23, 2020, to April 27, 2020, at 16 hospitals. Inclusion criteria were (a) positive nasopharyngeal or lower respiratory tract reverse transcriptase polymerase chain reaction assays, (b) severe COVID-19 infection defined as a requirement for hospitalization and oxygen therapy, (c) neurologic manifestations, and (d) abnormal brain MRI findings. Exclusion criteria were patients with missing or noncontributory data regarding brain MRI or brain MRI showing ischemic infarcts, cerebral venous thrombosis, or chronic lesions unrelated to the current event. Categorical data were compared using the Fisher exact test. Quantitative data were compared using the Student t test or Wilcoxon test. P < .05 represented a significant difference. Results Thirty men (81%) and seven women (19%) met the inclusion criteria, with a mean age of 61 years ± 12 (standard deviation) (age range, 8–78 years). The most common neurologic manifestations were alteration of consciousness (27 of 37, 73%), abnormal wakefulness when sedation was stopped (15 of 37, 41%), confusion (12 of 37, 32%), and agitation (seven of 37, 19%). The most frequent MRI findings were signal abnormalities located in the medial temporal lobe in 16 of 37 patients (43%; 95% confidence interval [CI]: 27%, 59%), nonconfluent multifocal white matter hyperintense lesions seen with fluid-attenuated inversion recovery and diffusion-weighted sequences with variable enhancement, with associated hemorrhagic lesions in 11 of 37 patients (30%; 95% CI: 15%, 45%), and extensive and isolated white matter microhemorrhages in nine of 37 patients (24%; 95% CI: 10%, 38%). A majority of patients (20 of 37, 54%) had intracerebral hemorrhagic lesions with a more severe clinical presentation and a higher admission rate in intensive care units (20 of 20 patients [100%] vs 12 of 17 patients without hemorrhage [71%], P = .01) and development of the acute respiratory distress syndrome (20 of 20 patients [100%] vs 11 of 17 patients [65%], P = .005). Only one patient had SARS-CoV-2 RNA in the cerebrospinal fluid. Conclusion Patients with severe coronavirus disease 2019 and without ischemic infarcts had a wide range of neurologic manifestations that were associated with abnormal brain MRI scans. Eight distinctive neuroradiologic patterns were described.
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https://www.hal.inserm.fr/inserm-03482261
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Submitted on : Wednesday, December 15, 2021 - 5:54:35 PM
Last modification on : Tuesday, September 27, 2022 - 4:19:51 AM

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Stéphane Kremer, François Lersy, Jérome de Sèze, Jean-Christophe Ferré, Adel Maamar, et al.. Brain MRI Findings in Severe COVID-19: A Retrospective Observational Study. Radiology, Radiological Society of North America, 2020, 297 (2), pp.E242-E251. ⟨10.1148/radiol.2020202222⟩. ⟨inserm-03482261⟩

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