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Assessing Cortical Cerebral Microinfarcts on High Resolution MR Images
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Cerebral Microvascular Injury in Severe COVID-19

John Conklin, Matthew P Frosch, Shibani Mukerji

    Medrxiv : the Preprint Server for Health Sciences
    |August 4, 2020
    PubMed
    Abstract

    Insights

    Microvascular lesions, including hemorrhages and ischemia, are common in severe COVID-19 patients with neurological symptoms. Susceptibility-weighted imaging (SWI) detected these brain lesions, suggesting a link to hypoxia.

    Area of Science:

    • Neurology
    • Radiology
    • Infectious Diseases

    Background:

    • Severe COVID-19 is associated with neurological complications.
    • Microvascular lesions in the brain may contribute to these deficits.

    Approach:

    • Retrospective cohort study of 16 intensive care unit patients with severe COVID-19.
    • Utilized ultrafast, high-resolution susceptibility-weighted imaging (SWI) MRI to identify microvascular lesions.
    • Correlated imaging findings with clinical data and histopathology in one case.

    Key Points:

    • 69% of patients showed SWI lesions in white matter; 25% had corpus callosum involvement.
    • Lesion distribution resembles patterns seen in hypoxic respiratory failure and sepsis.
    • Brain autopsy confirmed SWI lesions represent microvascular injury, including petechial hemorrhages and ischemia.

    Conclusions:

    • SWI lesions are prevalent in severe COVID-19 patients with neurological manifestations.
    • Findings suggest a risk of multifocal microvascular hemorrhagic and ischemic lesions in the brain.
    • These lesions may stem from underlying hypoxic mechanisms common in severe illness.

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