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Serial Imaging of Virus-Associated Necrotizing Disseminated Acute Leukoencephalopathy (VANDAL) in COVID-19

S Agarwal1, J Conway1, V Nguyen2

  • 1From the Department of Neurology (S.A., J.C., A.L., K.M., S.G.).

AJNR. American Journal of Neuroradiology
|October 23, 2020
PubMed

Insights

Critically ill COVID-19 patients can develop acute disseminated leukoencephalopathy. This condition progresses to brain atrophy and cystic lesions, often leading to poor outcomes and mortality.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Radiology

Background:

  • Coronavirus disease 2019 (COVID-19) is associated with various neurological complications, including leukoencephalopathy.
  • Acute disseminated leukoencephalopathy has been observed in critically ill COVID-19 patients.

Purpose of the Study:

  • To describe the clinical and imaging features of acute disseminated leukoencephalopathy in critically ill COVID-19 patients.
  • To document the short-term imaging evolution of these neurological changes.

Main Methods:

  • Retrospective review of clinical data, laboratory results, and imaging findings.
  • Analysis of outcomes for 8 critically ill patients with COVID-19 and acute disseminated leukoencephalopathy.

Main Results:

  • All patients showed white matter changes, predominantly in posterior regions.
  • Follow-up imaging revealed brain atrophy and evolution of lesions into necrotizing cystic cavitations.
  • Patients exhibited inflammatory markers, prolonged ventilator support, poor functional outcomes, and significant mortality.

Conclusions:

  • Critically ill COVID-19 patients can develop acute disseminated leukoencephalopathy with rapid evolution to cystic degeneration and brain atrophy.
  • This entity, termed virus-associated necrotizing disseminated acute leukoencephalopathy, may stem from COVID-19-related endothelial injury, cytokine storm, or thrombotic microangiopathy.
Abstract

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