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CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2023; 33(03): 351-360
DOI: 10.1055/s-0043-1768060
Original Article

Neuroimaging Spectrum in COVID-19 Infection: A Single-Center Experience

Sarbesh Tiwari 
1   Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
,
Pawan Kumar Garg 
1   Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
,
Samhita Panda
2   Department of Neurology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
,
Aanchal Gupta 
1   Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
,
Adarsh Hegde
1   Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
,
Deepak Kumar
3   Department of General Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
,
Daisy Khera
4   Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
,
Pradeep Kumar Bhatia
5   Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
,
Mayank Garg
6   Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
,
Taruna Yadav
1   Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Abstract

Background and Purpose The ongoing coronavirus disease 2019 (COVID-19) pandemic is a multisystemic disease and involvement of the nervous system is well established. The neurological and neuroimaging features of the disease have been extensively evaluated. Our study aimed to elucidate the neuroradiological findings in COVID-19 infected patients admitted to our institute during the first and second waves of the pandemic in India.

Methods This was a single-center retrospective study of all COVID-19 positive patients who underwent neuroimaging between March 2020 and May 2021. The presenting neurological complaints, the imaging findings in computed tomography (CT) imaging, and/or magnetic resonance imaging (MRI) were recorded. They recorded the findings in the subheadings of ischemic stroke, hemorrhagic stroke, parainfectious demyelination, acute encephalitis syndrome, and changes of global hypoxic changes. Patients with age-related, chronic, and incidental findings were excluded.

Results The study comprised of 180 COVID-19 positive patients who underwent neuroimaging. CT scan was performed for 169 patients, MRI for 28, and a combination of both CT and MRI was performed for 17 patients. Seventy percent of patients were males, and median age was 61.5 years (interquartile range: 48.25–70.75). Out of the 180 patients, 66 patients had nonspecific findings that could not be attributed to COVID-19 infection. In the remaining 114 patients, 77 (42.7%) had ischemic findings, while 22 (12.2%) had hemorrhagic stroke. Hypoxic ischemic changes were noted in five patients. The rest of the patients had a spectrum of changes including, cerebellitis (3), tumefactive demyelination (1), COVID-19-associated encephalitis (1), hemorrhagic acute demyelinating encephalomyelitis (1), transverse myelitis (1), cytotoxic lesions of corpus callosum (1), Guillain-Barre syndrome (1), and COVID-19-associated microhemorrhages (1).

Conclusion Neurological manifestations of COVID-19 infection are not uncommon, and our understanding of this topic is expanding. A complex interplay of neurotropism and direct central nervous system invasion, immune activation and cytokine storm, vasculitis, and parainfectious processes are implicated in the pathophysiology. While the most common imaging finding was ischemic stroke, followed by hemorrhagic stroke, a diverse range of parainfectious findings was also noted in our study.

Keywords

cerebellitis - COVID-19 - COVID-19-associated encephalitis - neuroimaging


Publication History

Article published online:
28 April 2023

© 2023. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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Letter to this article:

Neuroimaging Abnormalities in Severe Acute Respiratory Syndrome Coronavirus 2 Infected are More Diverse than Previously Thought and Depend on the Methods UsedIndian J Radiol Imaging 2024; 34(02): 365-366
DOI: 10.1055/s-0043-1776412

 

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