POSTER SECTIONS Coverpage Learning objectives Background Findings and procedure details Conclusion Personal information and conflict of interest References

ECR 2021 / C-15247

Neuroimaging in patients with COVID-19: The Main Findings!

Congress:

ECR 2021

Poster Number:

C-15247

Type:

Educational Exhibit

Keywords:

Neuroradiology brain, CT, MR, Imaging sequences, Outcomes analysis, Infection, Inflammation, Ischaemia / Infarction

Authors:

A. A. S. M. D. Santos¹, A. R. S. SANTOS¹, A. Gondim¹, F. Oliveira², A. Costa², G. Quintanilha², A. B. Lemer², M. T. Silva², W. Martins¹; ¹Niterói - Rio de Janeiro/BR, ²Niterói-RJ/BR

DOI:

10.26044/ecr2021/C-15247

DOI-Link:

https://dx.doi.org/10.26044/ecr2021/C-15247

Learning objectives

Our aim is to present the clinical and anatomopathological changes described and to demonstrate the main findings in neuroimaging exams of COVID-19 positive patients who presented neurological symptoms and which are important for the knowledge of radiologists, neurologists and physicians general.

Background

COVID-19 is an acute viral disease with systemic involvement, mainly pulmonary, caused by the SARS-CoV-2 virus, with an incubation period of 2 to 14 days (average of 3 to 5 days). In addition to fever, dry cough, dyspnea and myalgia, neurological signs and symptoms may occur during the course of COVID-19.Headache, impaired state of consciousness, dizziness, ataxia, convulsions, acute brainvascular disease, including a reported case of hemorrhagic encephalopathy, have already been reported. Neurological sequelae such as anosmia, hypo or ageusia and altered sensory may occur...

Findings and procedure details

73 patients were found, with 38 cases with abnormalities (52%) and 35 cases with normal exams.The changes found were: cerebrovascular disease, thrombotic microangiopathy and lesions in olfactory bulbs. Some cases were selected in order to demonstrate the main changes found, for iconographic purposes. Case 1: 73 years. Covid 19. Episode of syncope with sphincter liberation and disorientation. Brain CT showed small lacunar infarction. The pulmonary compromise by COVID-19 had small extension (Fig.1)[Fig 1] Case 2: A 71-year-old man admitted with COVID-19 presenting myocarditis, confirmed by...

Conclusion

It is important to know the neuroradiological changes in patients with COVID-19, not only in severe cases but also in patients who had mild and moderate cases and who persist with headache, anosmia/hyposmia and other less specific symptoms. Changes in the brain stem appear to contribute to respiratory failure in some patients.

Personal information and conflict of interest

A. S. Santos: Nothing to disclose A. R. S. SANTOS: Nothing to disclose A. Gondim: Nothing to disclose F. Oliveira: Nothing to disclose A. Costa: Nothing to disclose G. Quintanilha: Nothing to disclose A. B. Lemer: Nothing to disclose M. T. Silva: Nothing to disclose W. Martins: Nothing to disclose

References

Leonardi, Matilde;Padovani, Alessandro; McArthur, Justin. Neurological manifestations associated with COVID-19: a review and a call for action. Journal of Neurology. 267, p. 1573-1576, mai, 2020. DOI: 10.1007 / s00415-020-09896-z. Chen, X., Laurent, S., Onur, O.A.et al.A systematic review of neurological symptoms and complications of COVID-19. Journal of Neurology, July 20, 2020. https://doi.org/10.1007/s00415-020-10067-3. Silva, M.T; Lima M.; Araújo, A.Q.C. SARS-CoV-2: Should We Be Concerned about the Nervous System? The American Journal of Tropical Medicine and Hygiene. V. 103, n. 3, p. 993-998, set., 2020.DOI: 10.4269/ajtmh.20-0447. Chougar,...

Fig 1: Brain CT showed small lacunar infarction in the right semioval center. Chest CT...

Fig 2: Brain MRI. SWI sequences: small sparse foci of hemoglobin degradation products;

Fig 3: Pituitary apoplexy: Volume increase of the pituitary gland with areas of...

Fig 4: Coronal T1-weighted MRI before and after contrast: Enhancement in olfactory...

Fig 5: Control Coronal T1 and T2-weighted MRI showing reduction of volume and...

Fig 6: Coronal T1-weighted MRI showing the olfactory bulb without contrast (blue...

Fig 7: Enhancement of the olfactory bulb (arrows) demonstrated in T1-weighted...

Fig 8: MRI axial sequences T1 before and after paramagnetic contrast venous...

Fig 9: T2-weighted coronal and sagittal MRI sequences demonstrating facial nerve...

Fig 10: T1 Coronal before and after contrast: same case of the previous figure showing...

Fig 11: Multiplanar T1-weighted sequences after contrast showing enhancement of the...

Fig 12: Brain CT showing hypodensity in the right parietal region.

Fig 13: CT scan showing a sign of the dense artery in the right middle brain (acute...

Fig 14: Angiotomography showing obstruction in the right middle cerebral artery (arrows)

Fig 15: MRI demonstrated an extensive area of diffusion restricted in the right...

Fig 16: Coronal T1 and T2 sequences demonstrating the extensive area of ischemia...

Fig 17: Doppler showing recent thrombosis in the left popliteal vein (which is enlarged...

Fig 18: Chest radiography: diffuse infiltrate and extensive areas of consolidation in...

Fig 19: Brain CT demonstrated extensive right parieto-occipital hemorrhage with...

Fig 20: Coronal and sagittal CT scans showing massive intraparenchymal hematoma and...

Fig 21: Massive intraparenchymal hematoma and empty delta sign: cerebral venous...

Fig 22: Head CT showed left parietal subdural hematoma resulting in a small...

Fig 23: Coronal reconstructions showing laminar subdural hematoma on the right, in...

Fig 24: Head CT demonstrated sequelae of vascular injuries in the brainstem, left...

Fig 25: Ischemic sequelae in the brainstem, cerebellum and occipital lobe on the right...

Fig 26: Diffusion sequence in the coronal plane: recent ischemic foci adjacent to the...

Fig 27: Chest CT showed several areas with ground glass attenuation, crazy-paving...

Fig 28: Chest CT performed 10 days after, showed marked reduction of pulmonary...

Fig 29: Head CT. Axial plane: massive intraparenchymal hemorrhage fronto-parietal...

Fig 30: Coronal plane showing the massive intraparenchymal hematoma determining...

Fig 31: Chest CT: areas of ground glass attenuation and consolidations, with moderate...

Fig 32: Head CT showing acute hemorrhage in the brain stem

Fig 33: Sagittal and coronal reconstructions demonstrating acute hemorrhage in the...