Brain microvascular occlusive disorder in COVID-19: a case report

We describe the case of a COVID-19 patient with severely impaired consciousness after sedation hold, showing magnetic resonance imaging (MRI) findings of (i) acute bilateral supratentorial ischemic lesions involving the fronto-parietal white matter and the corpus callosum and (ii) multiple diffuse s...

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Published inNeurological sciences Vol. 41; no. 12; pp. 3401 - 3404
Main Authors Saitta, Laura, Molin, Alexandre, Villani, Flavio, Insorsi, Angelo, Roccatagliata, Luca, Inglese, Matilde, Bassetti, Matteo, Pelosi, Paolo, Castellan, Lucio, Gerevini, Simonetta, Robba, Chiara, Patroniti, Nicolò
Format Journal Article
LanguageEnglish
Published Cham Springer International Publishing 01.12.2020
Springer Nature B.V
Subjects
Aged
Betacoronavirus
Brain Ischemia - pathology
Brain Ischemia - virology
Case reports
Central nervous system
Cerebrospinal fluid
Coronavirus Infections - complications
Coronaviruses
Corpus callosum
COVID-19
Diabetes Mellitus
Fatal Outcome
Humans
Hypertension - complications
Ischemia
Magnetic resonance imaging
Male
Medicine
Medicine & Public Health
Microvasculature
Microvessels - pathology
Neuroimaging
Neurology
Neuroradiology
Neurosciences
Neurosurgery
Pandemics
Pneumonia, Viral - complications
Psychiatry
Ribonucleic acid
RNA
SARS-CoV-2
Severe acute respiratory syndrome coronavirus 2
Substantia alba
Inflammation
Microthrombi
Covid-19
Ischemia
Neurological complications
Coagulopathy
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Summary:We describe the case of a COVID-19 patient with severely impaired consciousness after sedation hold, showing magnetic resonance imaging (MRI) findings of (i) acute bilateral supratentorial ischemic lesions involving the fronto-parietal white matter and the corpus callosum and (ii) multiple diffuse susceptibility weighted imaging (SWI) hypointense foci, infra and supratentorial, predominantly bithalamic, suggestive of microhemorrhage or alternatively microthrombi. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) RNA was detected in the cerebrospinal fluid. Our findings suggest the occurrence of vascular damage, predominantly involving microvessels. The underlying mechanisms, which include direct and indirect penetration of the virus to the central nervous system and systemic cardiorespiratory complications, are yet to be elucidated, and a direct correlation with SARS-CoV-2 infection remains uncertain.
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ISSN:1590-1874
1590-3478
1590-3478
DOI:10.1007/s10072-020-04795-7