Efficacy of magnetic resonance imaging as a tool to assess central nervous system involvement of COVID-19

Year 2022, Volume: 47 Issue: 3, 1220 - 1226, 30.09.2022

Rıdvan Açıkalın , Murat Gokten , Can Sezer

https://doi.org/10.17826/cumj.1133013

Abstract

Purpose: The aim of this study was to identify patients with acute neurological findings associated with COVID-19 and to demonstrate the effectiveness of magnetic resonance imaging (MRI) in its diagnosis.
Materials and Methods: Between June 2020 and December 2021, 90 patients who were diagnosed with Covid-19 in our clinic, had pneumonia findings in the lung, acute neurological findings, and brain MRI were included in the study. Results were evaluated retrospectively for 46 patients without central nervous system (CNS) involvement and 44 patients with CNS findings.
Results: The most common neurological symptoms in COVID-19 patients; Unexplained loss of consciousness by treatment (28/44, 63.6%), focal neurologic deficits (21/44, 47.7%), and seizures (9/44, 20.4%). Increased mortality, increment in the need for ventilator support, and prolonged stay in the intensive care unit were observed in patients with CNS findings. Brain MRI was performed on 44 patients with neurological symptoms. Mean age of 68.3 years (45–78) in patients undergoing MRI. Acute findings were detected in MRI of 32 patients (72%). The most common diagnoses in brain MRI were acute and subacute infarcts.
Conclusion: The mechanism of CNS manifestations is still unclear, and neurological symptoms in COVID-19 patients are an important problem, especially in intensive care units. Therefore, early detection and treatment of CNS involvement are very important.

Keywords

Covid-19, confusion, central nervous system, MRI.

COVID-19'un santral sinir sistemi tutulumunu değerlendirmek için bir araç olarak manyetik rezonans görüntülemenin etkinliği

Abstract

Amaç: Çalışmamızın amacı, COVID-19 ile ilişkili akut nörolojik bulguları olan hastaları tanımlamayı ve tanısında manyetik rezonans görüntüleme (MRG) etkinliğinin gösterilmesini amaçlamaktır.
Gereç ve Yöntem: Haziran 2020 ve Aralık 2021 tarihleri arasında kliniğimizde Covid-19 tanısı almış, akciğerde pnömoni bulguları olan, akut nörolojik bulguları olan ve Beyin MRG olan 90 hasta çalışmaya alındı. Bulgular santral sinir sistemi (SSS) tutulumu bulgulari olmayan 46 hasta ve SSS bulgulari olan 44 hasta retrospektif olarak değerlendirildi.
Bulgular: COVID-19 hastalarında en sık görülen nörolojik belirtiler; tedavi ile açıklanamayan şuur kayıbı (28/44, %63,6), focal nörolojik defisit (21/44, %47,7) and nöbet (9/44, %20,4). SSS tutulumu olan hastalarda yoğunbakımda yatış sürelerinde uzama, ventilator desteği gereksinimde artış ve mortalitede artış görüldü. Nörolojik semptomları olan 44 hastaya beyin MRG çekildi. MRG çekilen hastalarda 68,3 ortalama yaş (45–78). 32 hastanın (%72) MRG’nda akut bulgular saptandı. Beyin MR görüntülemesinde en sık konulan tanılar akut ve subakut infarktlardı.
Sonuç: Merkezi sinir sistemi bulgularının mekanizması hala belirsizdir, COVID-19 hastalarında nörolojik semptomlar özellikle yoğun bakım ünitelerinde önemli bir sorundur. Bu nedenle SSS tutulumunun erken tespiti ve tedavisi çok önemlidir.

Keywords

Covid-19, konfüzyon, santral sinir sistemi, MRI.

References

• 1. Gupta A, Madhavan MV, Sehgal K, Nair N, Mahajan S, Sehrawat TS, Bikdeli B, Ahluwalia N, Ausiello JC, Wan EY, Freedberg DE. Extrapulmonary manifestations of COVID-19. Nature medicine. 2020;26:1017-32.
• 2. Zubair AS, McAlpine LS, Gardin T, Farhadian S, Kuruvilla DE, Spudich S. Neuropathogenesis and neurologic manifestations of the coronaviruses in the age of coronavirus disease 2019: a review. JAMA neurology. 2020;77:1018-27.
• 3. M.A. Ellul, L. Benjamin, B. Singh, S. Lant, B.D. Michael, A. Easton, R. Kneen, S. Defres, J. Sejvar, T. Solomon, Neurological associations of COVID-19, Lancet Neurol. (2020).
• 4. Meinhardt J, Radke J, Dittmayer C, et al. Olfactory transmucosal SARS-CoV-2 invasion as a port of central nervous system entry in individuals with COVID-19. Nat Neurosci. 2021;24:168-175.
• 5. Cooper KW, Brann DH, Farruggia MC, Bhutani S, Pellegrino R, Tsukahara T, Weinreb C, Joseph PV, Larson ED, Parma V, Albers MW. COVID-19 and the chemical senses: supporting players take center stage. Neuron. 2020;107:219-33.
• 6. Paniz‐Mondolfi A, Bryce C, Grimes Z, Gordon RE, Reidy J, Lednicky J, Sordillo EM, Fowkes M. Central nervous system involvement by severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2). Journal of medical virology. 2020;92:699-702.
• 7. Reichard RR, Kashani KB, Boire NA, Constantopoulos E, Guo Y, Lucchinetti CF. Neuropathology of COVID-19: a spectrum of vascular and acute disseminated encephalomyelitis (ADEM)-like pathology. Acta neuropathologica. 2020;140:1-6.
• 8. Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ. HLH across speciality collaboration, UK COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet 2020; 395:1033–1034.
• 9. JainR, YoungM,Dogra S, et al. COVID-19 related neuroimaging findings: a signal of thromboembolic complications and a strong prognostic marker of poor patient outcome. J Neurol Sci 2020;414:116-923.
• 10. Radmanesh A, Raz E, Zan E, et al. Brain imaging use and findings in COVID-19: a single academic center experience in the epicenter of disease in the United States. AJNR Am J Neuroradiol 2020;41:1179–83
• 11. Oxley TJ, Mocco J, Majidi S, et al. Large-vessel stroke as a presenting feature of COVID-19 in the young. N Engl J Med 2020;382:e60
• 12. Bikdeli B, Madhavan MV, Jimenez D, et al; Global COVID-19 Thrombosis Collaborative Group, Endorsed by the ISTH, NATF, ESVM, and the IUA, Supported by the ESC Working Group on Pulmonary Circulation and Right Ventricular Function. COVID-19 and thrombotic or thromboembolic disease: implications for prevention, antithrombotic therapy, and follow-up: JACC state-of-theart review. J Am Coll Cardiol 2020;75:2950–73
• 13. Glass WG, Subbarao K, Murphy B, Murphy PM. Mechanisms of host defense following severe acute respiratory syndrome-coronavirus (SARS-CoV) pulmonary infection of mice. J Immunol. 2004;173:4030–9.
• 14. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, Qiu Y, Wang J, Liu Y, Wei Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395:507–13.
• 15. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, Wang B, Xiang H, Cheng Z, Xiong Y, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. Jama. 2020;323:1061–9.
• 16. Cai H. Sex difference and smoking predisposition in patients with COVID-19.Lancet Respir Med. 2020;8:e20.
• 17. Zhao Y, Zhao Z, Wang Y, Zhou Y, Ma Y, Zuo W. Single-cell RNA expression profiling of ACE2, the putative receptor of Wuhan 2019-nCov. biorxiv. 2020 Jan 1.
• 18. Koeller KK, Shih RY. Viral and Prion Infections of the Central Nervous System: Radiologic-Pathologic Correlation: From the Radiologic Pathology Archives. Radio-Graphics 2017;37:199–233.
• 19. Kelley BP, Patel SC, Marin HL, Corrigan JJ, Mitsias PD, Griffith B. Autoimmune Encephalitis: Pathophysiology and Imaging Review of an Overlooked Diagnosis. AJNR Am J Neuroradiol 2017;38:1070–1078.
• 20. Helms J, Kremer S, Merdji H, Clere-Jehl R, Schenck M, Kummerlen C, Collange O, Boulay C, Fafi-Kremer S, Ohana M, Anheim M. Neurologic features in severe SARS-CoV-2 infection. New England Journal of Medicine. 2020;382:2268-70.