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Table 1 Reported studies on COVID-19 patients with neurological manifestations with positive findings on major imaging modalities

From: Neurological manifestations and neuroimaging findings in patients with SARS-CoV2—a systematic review

  Article name Imaging modality Neuroimaging findings
1 A case of COVID-19 respiratory Illness with Subsequent seizure and hemiparesis [9] CT—head Subcortical hypoattenuation with sulcal effacement in the left occipital and posterior parietal lobes suggestive of ischemic changes  
2 A case series of devastating intracranial hemorrhage during venovenous extracorporeal membrane oxygenation for COVID-19 [3] CT—head Multicompartment intracranial hemorrhage with marked diffuse edema and secondary infarction of the left anterior and posterior cerebral artery territories due to vascular compression
Multifocal intracerebral hemorrhage (ICH) with left hemispheric lobar hemorrhage and right cerebellar hemorrhage
Small left frontal cortical subarachnoid hemorrhage (SAH)
3 A first case of meningitis/encephalitis associated with SARS-coronavirus-2 [10] MRI—brain Diffusion weighted images (DWI) showed hyperintensity along the wall of inferior horn of right lateral ventricle.
Fluid-attenuated inversion recovery (FLAIR) images showed hyperintense signal changes in the right mesial temporal lobe and hippocampus—suggestive of right lateral ventriculitis and encephalitis.
4 Acute abducens nerve palsy in a patient with the novel coronavirus disease (COVID-19) [11] MRI—brain Denervation of CN VI- as evident by hyperintensity on T2 weighting of atrophic left lateral rectus muscle
5 Acute disseminated encephalomyelitis after SARS-CoV-2 infection [12] MRI—brain and spine 6 enhancing lesions, most with ring enhancement and some with nodular enhancement
Hyperintense signal of the optic nerves bilaterally
Hyperintense spindle-like T8 lesion
6 Acute myelitis as a neurological complication of COVID-19: a case report and MRI findings [13] Gadolinium-enhanced MRI—spine Extensive diffuse hyperintense signal of the gray matter of cervical, dorsal, and lumbar regions of the spinal cord
Mild enlargement and swelling of the cervical cord
Areas of restricted diffusion on DWI and apparent diffusion coefficient (ADC)
7 Acute polyradiculoneuritis with locked-in syndrome in a patient with COVID-19 [14] MRI—spine Massive symmetrical contrast enhancement of the spinal nerve roots at all levels of the spine including the cauda equina
8 Acute profound sensorineural hearing loss after COVID-19 pneumonia [15] MRI—brain Pronounced contrast enhancement in the right cochlea and a partially decreased fluid signal in the basal turn of the right cochlea
Adjacent to the temporal bone, meningeal contrast enhancement was seen at the base of the right temporal lobe
Signs of an inflammatory process in the cochlea
9 Basal ganglia involvement and altered mental status: a unique neurological manifestation of coronavirus disease 2019 [16] CT—head
B/L basal ganglia hyper-density suggestive of subacute hemorrhagic event
Involvement of basal ganglia in subacute bleeding
10 Bilateral posterior cerebral artery territory infarction in a SARS-Cov-2 infected patient: discussion about an unusual case [17] MRI—brain B/L and asymmetric acute occipito-temporal infarction of the posterior cerebral arteries (PCA) with occlusion of P3 segments
Hemorrhagic transformation of the previous lesions
11 Bilateral trochlear nerve palsy due to cerebral vasculitis related to COVID-19 infection [18] MRI—brain Signs of vasculitis of the vertebrobasilar system
Inflammatory signs in the periaqueductal region, along the topography of the trochlear nuclei
12 Cerebral microhemorrhage and purpuric rash in COVID-19: the case for a secondary microangiopathy [19] MRI—brain Multiple areas of micro-hemorrhage throughout the corpus callosum, B/L juxtacortical white matter, basal ganglia, cerebellum, and brain- stem, without clear asymmetry
Discrete areas of FLAIR hyperintensity correlating with some of the larger areas of SWI changes suggesting larger macro-hemorrhage
Areas of diffusion restriction
13 Cerebral nervous system vasculitis in a COVID-19 patient with pneumonia [20] CT—headMRI—brain Cortical-subcortical blood-related hyperdensities in the right occipital lobes and B/L fronto-parietal
Signal restriction of the cortex in a parietal and parieto-occipital region and at the pons level suggestive of subacute phase of cortical inflammation and ischemia
14 Cerebral venous thrombosis: a typical presentation of COVID-19 in the young [21] CT—head
Left temporoparietal hemorrhagic venous infarct with edema and mass effect with 5 mm rightward shift
Hyperintense DWI signal of the left temporoparietal hemorrhagic infarct with mass effect and effacement of the left lateral and third ventricle with 4 mm rightward shift
Absence of flow in the sigmoid sinus, left transverse and internal jugular vein (IJV) secondary to venous thrombosis
15 Coexistence of COVID-19 and acute ischemic stroke report of four cases [22] MRI—brain Total middle cerebral artery (MCA) infarction
Left lenticulostriate artery infarction
Right pontine infarction
16 Concomitant neurological symptoms observed in a patient diagnosed with coronavirus disease 2019 [23] CT—head No abnormality
17 Coronavirus 2019 (COVID-19)-associated encephalopathies and cerebrovascular disease: the New Orleans experience [24] CT—head
Focal encephalitides and vasculolitides
Diffuse hypoattenuation, focal hypodensities in deep structures, subacute ischemic strokes, and subcortical parenchymal hemorrhages
Viral encephalitis: restriction and FLAIR changes in corpus callosum as well as B/L deep structures
18 COVID-19 presenting as stroke [25] CT—head
Case 1—Loss of gray-white differentiation at the left occipital and parietal lobes, consistent with acute infarct.
Evolution of a large acute infarct in the left MCA territory with hyperdense appearance of left MCA vessels—consistent with an acute thrombus
Case 2—Moderate hypodensity in the right frontal lobe suggestive of an acute infarct
Case 3—Occlusion of the right internal carotid artery (ICA) at origin with a core infarct in the right MCA distribution and a surrounding ischemic penumbra
Case 4—acute infarct in the left medial temporal lobe
Chronic microvascular ischemic changes
Acute left MCA infarct
Multiple small acute infarcts in B/L cerebral hemispheres
Large acute hemorrhage in the brainstem and right cerebral hemisphere
Ischemic and hemorrhagic stroke, hypoxic anoxic brain injury, encephalitis
Severe cerebral edema with mass effect, diffuse cerebral sulcal effacement, brainstem compression with narrowing of the 4th ventricle due to downward cerebellar tonsillar herniation
Severe diffuse cerebral arterial and dural venous sinus constriction
19 COVID-19 presenting with seizures [26] CT—head
20 COVID-19 related neuroimaging findings: a signal of thromboembolic complications and a strong prognostic marker of poor patient outcome [27] CT—head
21 COVID-19-associated encephalopathy with fulminant cerebral vasoconstriction: CT and MRI findings [28] CT—Head
22 COVID-19-associated encephalopathy: neurological manifestation of COVID-19 [29] CT—head
Hypodensity of bilateral thalami
Signal changes of brain parenchyma including insula, B/L dorsal frontal lobes, and thalamus with restricted diffusion of globus pallidus (features of encephalopathy)
23 COVID-19-associated ophthalmoparesis and hypothalamic involvement [30] MRI—brain T2/FLAIR Hyperintensity (HI) in the brainstem, including the medial temporal lobes, mammillary bodies, CN VI nuclei, thalami, and hypothalamus
24 COVID-19-associated pulmonary and cerebral thromboembolic disease [31] CT—head
Partial right Sylvian segment (M2), superior division occlusion and right opercular (M3), parietal segment occlusions
Multiple, discrete, peripheral acute infarctions of the right MCA territory with some hemorrhagic conversion
25 COVID-19-related acute necrotizing encephalopathy with brain stem involvement in a patient with aplastic anemia [32] CT—head
Increased hypodensity and swelling of the brain stem, and a new area of cortical and subcortical hypodensity in the left occipital lobe suggestive of an acute posterior circulation infarct
Extensive, symmetrical changes in the supratentorial and infratentorial compartments.
Hemorrhage and diffuse swelling in the amygdalae and brain stem
Microhemorrhage and extensive abnormal signal were found in a symmetrical distribution within the dorsolateral putamina, ventrolateral thalamic nuclei, sub-insular regions, splenium of the corpus callosum, cingulate gyri, and subcortical perirolandic regions
26 COVID-19-related strokes in adults below 55 years of age: a case series [33] CT—head Right MCA, Left MCA, and left basal ganglia infarction
27 COVID-19-associated encephalitis mimicking glial tumor [34] MRI—brain Hyperintense signal in the left temporal lobe in T2 and T2 FLAIR imaging suggestive of high-grade glioma
28 De novo status epilepticus in patients with COVID-19 [35] CT—head
No abnormality
29 Delirium as a presenting feature in COVID-19: neuroinvasive infection or autoimmune encephalopathy? [36] CT—head
Case 1—3 hyperintense foci on diffusion suggesting cellular infiltration/inflammation or small infarcts
Case 2—Changes in the limbic system with partial diffusion restriction, consistent with limbic encephalitis
30 Emergency room neurology in times of COVID-19: malignant ischaemic stroke and SARS-CoV-2 infection [7] CT—head
Established infarct in the territory of the left MCA with a mild deviation of the midline
Occlusion of the left MCA, ACA and ICA with a free-floating thrombus in the ascending aorta
31 Encephalopathy and seizure activity in a COVID-19 well controlled HIV patient [37] CT—head
No abnormality
32 COVID-19-associated myositis with severe proximal and bulbar weakness [38] MRI—brain Extensive edema and enhancement suggestive of inflammatory myopathy
Central nonenhancement in the vastus medialis, consistent with myonecrosis
33 Evolution and resolution of brain involvement associated with SARS- CoV2 infection: a close clinical—paraclinical follow up study of a case [39] CT—head
High signal abnormalities in B/L pons, thalami, and medial temporal lobes
34 First case of focal epilepsy associated with SARS-coronavirus-2 [40] CTA
Proximal left ICA plaques with focal calcification
Dilated ventricular system with a prominent and patent aqueduct of Sylvius
35 First case of SARS-COV-2 sequencing in cerebrospinal fluid of a patient with suspected demyelinating disease [41] MRI—brain No abnormality
36 First motor seizure as presenting symptom of SARS-CoV-2 infection [42] CT—head No abnormality
37 Focal EEG changes indicating critical illness associated cerebral microbleeds in a COVID-19 patient [43] MRI—brain Focal injury without encephalopathy
Diffuse microbleeds in B/L juxtacortical white matter, corpus callosum, and internal capsule
38 Fulminant cerebral edema as a lethal manifestation of COVID-19 [44] CT—head Extensive vasogenic edema and herniation of temporal lobes toward the brain stem with obliteration of basal cerebral cisterns, multiple juxtacortical microbleeds, which may
be compatible with venous hemorrhagic infarction, effacement of ventricles and peripheral sulci and gyri
39 Intracranial hemorrhage in a young COVID-19 patient [45] CT—head Large, multiloculated right ICH associated with vasogenic edema; uncal and sub-falcine herniation without an underlying ischemic stroke
40 Ischemic stroke associated with novel coronavirus 2019: a report of three cases [46] CT—head Case 1. Low-density lesion at right cerebellar suggestive of acute ischemic stroke
Case 2. Attenuation and effacement at the right hemisphere around the Sylvian fissure
Case 3. Hypo-density at left basal ganglion
41 Locked-in with COVID-19 [47] MRI—brain
Numerous foci of restricted diffusion within the pons, (correlating with FLAIR signal abnormality) consistent with acute pontine ischemic infarcts
Decreased flow in distal right vertebral artery with a patent basilar artery
42 Macrothrombosis and stroke in patients with mild COVID-19 infection [48] CT—head
Nonocclusive thrombus in the right common carotid artery, extending into the ICA
Acute stroke in the territory of the right MCA
43 Malignant cerebral ischemia in a COVID-19 infected patient: case review and histopathological findings [49] CT—head Large right MCA infarct
44 Multiple sclerosis following SARS-CoV-2 infection [50] MRI—brain Supratentorial periventricular demyelinating lesions in right occipital lobe and left temporal
45 Necessity of brain imaging in COVID-19 infected patients presenting with acute neurological deficits [51] CT—head Case 1—B/L subacute infarcts, basilar cistern effacement, a left-to-right midline shift, intraparenchymal hemorrhage, sub-falcine, and uncal herniation
Case 2—Pre-op - large volume hemorrhage within the right temporal and parietal lobes, surrounding edema, midline shift, uncal herniation, and entrapment of the temporal horns.
Post-op—right-sided craniectomy and anterior temporal lobectomy—improvement in overall mass effect
46 Neuralgic amyotrophy following infection with SARS-CoV-2 [52] MRI—brain Edema and inflammatory contrast enhancement of the right distal median nerve
Minor right C5-C6 disk protrusion without nerve root impingement, and mild T2-signal increase of the ipsilateral C7-C8 roots, suggestive of proximal edema
47 Neurological manifestations in critically ill patients with COVID-19: a retrospective study [53] CT—head Low density lesions in the following:
Case 1. B/L parietal and frontal lobes, right occipital lobe
Case 2. Left hemisphere, B/L temporal, and occipital lobes
Case 3. B/L parietal and frontal lobes
Case 4. Right hemisphere
Case 5. Left midbrain
Case 6. Right side of the periventricular area
48 Novel coronavirus (COVID-19)-associated Guillain-Barré syndrome: case report [54] MRI—spine No evidence of myelopathy or radiculopathy
49 Olfactory gyrus intracerebral hemorrhage in a patient with COVID-19 infection [55] CT—head
Right olfactory gyrus ICH with surrounding edema, with no evidence of soft tissue injury or cerebral contusion
50 Orbitofrontal involvement in a neuroCOVID-19 patient [56] MRI—brain Hyperintensity of the right orbital prefrontal cortex adjacent to the olfactory bulb, which seemed to spread toward the right caudate nucleus and mesial prefrontal cortex
51 Posterior reversible encephalopathy syndrome (PRES): another imaging manifestation of COVID-19 [57] CT—head
Symmetric hypoattenuation of the external capsules and posterior subcortical cerebral white matter
Hyperintensity with increased diffusion in the internal and external capsules, subcortical, deep cerebral, and cerebellar white matter
52 Prolonged confusional state as first manifestation of COVID-19 [6] CT—head Mild chronic small vessel ischemic changes
53 Reversible cerebral vasoconstriction syndrome and dissection in the setting of COVID-19 infection [58] CT—head B/L convexity SAH
Left vertebral artery dissection
54 Reversible encephalopathy syndrome (PRES) in a COVID-19 patient [59] CT—head
Posterior frontal and temporo-parieto-occipital symmetrical B/L hypodensity of the subcortical white matter, and a small left occipital parenchymal hemorrhage
Absence of vascular malformation and alterations of posterior circle vessel caliber- suggestive of vasoconstriction mechanism
Onset of right temporal hypodensity, correlated to hemorrhagic process
55 SARS-CoV-2-associated Guillain-Barré syndrome with dysautonomia [60] CT—head No abnormalities
56 Severe headache as the sole presenting symptom of COVID-19 pneumonia: a case report [61] MRI—brain
Nonspecific white matter hyperintensities
Normal MRA
57 Steroid-responsive encephalitis in coronavirus disease 2019 [62] CT—head
No abnormalities
58 Stroke and COVID19: not only a large-vessel disease [63] CTA
Small cortical acute ischemic lesions in the right pre- and post- central gyrus, without signs of previous ischemic lesions and hemorrhagic infarction
59 Stroke in patients with SARS-CoV-2 infection: case series [64] CT—head
Case 1—CT showed numerous hypodense lesions involving different cortical and subcortical regions of B/L cerebral hemispheres
Case 2—Ischemic lesion involving the frontal lobe on the right side; Occlusion of the right pericallosal artery; multiple, B/L supratentorial and infra-tentorial ischemic lesions.
Case 3—Small hypodense area in the right thalamus of presumed ischemic origin
Case 4—Focal T2-FLAIR HI lesion in the left precentral gyrus with a bright signal on DWI sequence, and mild post-contrast enhancement of the head of right caudate nucleus
Case 5—Large cerebellar hemorrhage compressing the brainstem and 4th ventricle causing a subsequent obstructive hydrocephalus
Case 6—Diffuse cerebral edema with loss of normal gray—white matter differentiation and obliteration of CSF spaces; large right frontal hemorrhage with other smaller hemorrhages and a bright spot within the sagittal sinus suspected for dural sinus thrombosis
60 Subcortical myoclonus in COVID-19: comprehensive evaluation of a patient [65] MRI—brain Cerebral small-vessel disease of moderate severity
61 Thalamic perforating artery stroke on computed tomography perfusion in a patient with coronavirus disease 2019 [66] CT—head
Small focal hypoperfusion in the paramedian perforating vascular territory supplying the left medial thalamus
2 punctate acute ischemic lesions in each cerebellar hemisphere
62 Two patients with acute meningoencephalitis concomitant with SARS-CoV-2 infection [67] MRI—brain Normal
63 COVID-19 is associated with an unusual pattern of brain microbleeds in critically ill patients [68] MRI—brain Microbleeds in unusual distribution, particularly involving the anterior/posterior limbs of internal capsule (five patients), middle cerebellar peduncles (5/9 patients), and the corpus callosum