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Cerebral Microbleeds and Leukoencephalopathy in Critically Ill Patients With COVID-19
Shashank Agarwal1, Rajan Jain2,3, Siddhant Dogra2
1Department of Neurology (S.A., A.L., K.M., S.G.), NYU Langone Health, New York, NY.
Insights
Cerebral microbleeds and leukoencephalopathy were found in 30.4% of hospitalized COVID-19 patients who underwent brain MRI. These findings correlate with critical illness, longer hospital stays, and worse functional outcomes in coronavirus disease 2019 patients.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Investigating neurological complications of COVID-19 is crucial.
- Cerebral microbleeds and leukoencephalopathy are potential neurological sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
Purpose of the Study:
- To determine the prevalence and distribution of cerebral microbleeds and leukoencephalopathy in hospitalized coronavirus disease 2019 (COVID-19) patients.
- To correlate these neuroimaging findings with clinical, laboratory, and functional outcomes.
Main Methods:
- Retrospective chart review of 4131 adult COVID-19 patients admitted to tertiary care hospitals.
- Analysis of brain magnetic resonance imaging (MRI) scans to identify leukoencephalopathy and/or cerebral microbleeds.
- Comparison of clinical, laboratory, and functional outcomes between patients with and without these neuroimaging findings.
Main Results:
- Of 115 patients with brain MRI, 35 (30.4%) showed leukoencephalopathy and/or cerebral microbleeds.
- Patients with these findings had later neuroimaging, were clinically sicker (lower GCS), and had higher D-dimer and INR levels.
- They also experienced longer ventilator support, higher rates of moderate/severe ARDS, longer hospitalizations, worse functional status, and higher mortality.
Conclusions:
- Leukoencephalopathy and/or cerebral microbleeds are present in a significant subset of hospitalized COVID-19 patients.
- These neuroimaging abnormalities are associated with critical illness severity.
- The presence of these findings predicts worse functional outcomes and increased mortality in COVID-19 patients.
Background And Purpose:
We conducted this study to investigate the prevalence and distribution of cerebral microbleeds and leukoencephalopathy in hospitalized patients with coronavirus disease 2019 (COVID-19) and correlate with clinical, laboratory, and functional outcomes.
Methods:
We performed a retrospective chart review of 4131 COVID-19 positive adult patients who were admitted to 3 tertiary care hospitals of an academic medical center at the epicenter of the COVID-19 pandemic in New York City from March 1, 2020, to May 10, 2020, to identify patients who had magnetic resonance imaging (MRI) of the brain. We evaluated the MRIs in detail, and identified a subset of patients with leukoencephalopathy and/or cerebral microbleeds. We compared clinical, laboratory, and functional outcomes for these patients to patients who had a brain MRI that did not show these findings.
Results:
Of 115 patients who had an MRI of the brain performed, 35 (30.4%) patients had leukoencephalopathy and/or cerebral microbleeds. Patients with leukoencephalopathy and/or cerebral microbleeds had neuroimaging performed later during the hospitalization course (27 versus 10.6 days; P<0.001), were clinically sicker at the time of brain MRI (median GCS 6 versus 14; P<0.001), and had higher peak D-dimer levels (8018±6677 versus 3183±3482; P<0.001), lower nadir platelet count (116.9±62.2 versus 158.3±76.2; P=0.03), higher peak international normalized ratio (2.2 versus 1.57; P<0.001) values when compared with patients who had a brain MRI that did not show these findings. They required longer ventilator support (34.6 versus 9.1 days; P<0.001) and were more likely to have moderate and severe acute respiratory distress syndrome score (88.6% versus 23.8%, P<0.001). These patients had longer hospitalizations (42.1 versus 20.9 days; P<0.001), overall worse functional status on discharge (mRS 5 versus 4; P=0.001), and higher mortality (20% versus 9%; P=0.144).
Conclusions:
The presence of leukoencephalopathy and/or cerebral microbleeds is associated with a critical illness, increased mortality, and worse functional outcome in patients with COVID-19.
