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 MRI—brain | 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 MRI—brain | 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 MRI—brain | 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 CTA MRI—brain | 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 MRI MRA MRV | ||
22 | COVID-19-associated encephalopathy: neurological manifestation of COVID-19 [29] | CT—head MRI—brain | 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 MRI—brain | 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 MRI—brain | 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 MRI—brain | No abnormality | |
29 | Delirium as a presenting feature in COVID-19: neuroinvasive infection or autoimmune encephalopathy? [36] | CT—head MRI—brain | 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 CTA | 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 MRI—brain | 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 MRI—brain | 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 MRI—brain | 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 MRA | 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 MRI—brain | 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 MRI—brain | 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 MRI—brain | 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 CTA MRI—brain | 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 MRA | Nonspecific white matter hyperintensities Normal MRA | |
57 | Steroid-responsive encephalitis in coronavirus disease 2019 [62] | CT—head MRI—brain | No abnormalities | |
58 | Stroke and COVID19: not only a large-vessel disease [63] | CTA MRI—brain | 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 MRI—brain | 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 MRI—brain | 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 | |