Neurological complications of COVID-19

"There is a dramatic increase in the number of vascular events, ischemic strokes, and thrombosis, which is likely due to the virus affecting coagulating mechanisms." - Alessandro Pezzini, MD, Associate Professor of Neurology, University of Brescia
Statement published in Neurology Today

Image from Poyiadji et. al. (2020): T2 MRI FLAIR sequence, featuring bilateral medial temporal lobe and thalami haemorrhage

Poyiadji et. al. (2020) reported the first case of acute necrotising encephalopathy(ANE) from COVID-19 in a female airline worker [1]

ANE is rare, related to cytokind-storms and the breakdown of the blood-brain-barrier. This is seen more often in children but can also present in adults.

In this patient, It is thought that this was related to the cytokine-storm from COVID-19.

Her MRI imaging demonstrated hemorrhagic rim enhancing lesions within the bilateral thalami, medial temporal lobes, and subinsular regions (see image)

Learning point:

As part of your diagnostic workup, consider a chest x-ray and testing for COVID-19 status in patients with new onset seizures or confusion/delirium.

References:

1. Neo Poyiadji, Gassan Shahin, Daniel Noujaim, Michael Stone, Suresh Patel, Brent Griffith, COVID-19–associated Acute Hemorrhagic Necrotizing Encephalopathy: CT and MRI Features, RSNA Images in Radiology, Published Online:Mar 31 2020, https://doi.org/10.1148/radiol.2020201187

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