Unusual Microbleeds in Brain MRI of Covid-19 Patients
Unusual Microbleeds in Brain MRI of Covid-19 Patients
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DOI：
10.1111/jon.12755
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发表时间：
2020-07-08
影响因子：
2.4
通讯作者：
Vargas, Maria Isabel
中科院分区：
文献类型：
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作者：
Fitsiori, Aikaterini;Pugin, Deborah;Vargas, Maria Isabel
背景与目的Covid-19最初被描述为一种呼吸系统感染，目前越来越多的人认为它是一种多器官疾病，包括神经系统症状。越来越多的证据表明，SARS-CoV-2可能具有神经侵袭作用。本研究的目的是描述在危重患者的mri中观察到的影响不同脑结构的脑微出血形式的新发现。方法对9例具有常见异常表现的患者（2女7男，55-79岁，平均67.7岁）的MR图像进行分析。所有患者均检测出SARS-CoV-2阳性，并出现意识恢复延迟或严重躁动，需要进行脑部MRI。结果所有患者均患有重度（5/9）或中度（4/9）急性呼吸窘迫综合征，需要延长重症监护病房的住院时间。他们共同的MRI发现是微出血在异常分布的存在，特别倾向于胼胝体。其他不常见的微出血部位为内囊（5/9）和小脑中柄（5/9）。大多数患者的皮层下区域也受到影响。结论脑MRI提示，新冠肺炎及其相关治疗可能累及大脑，出现异常微出血模式，主要影响胼胝体。这一发现的机制尚不清楚，但鉴别诊断应包括与SARS-CoV-2对脑血管内皮的直接或间接细胞因子级联损伤相关的血栓性微血管病，以及类似于低氧血症脑血屏障损伤的机制。
BACKGROUND AND PURPOSE Covid-19, initially described as a respiratory system's infection, is currently more and more recognized as a multiorganic disease, including neurological manifestations. There is growing evidence about a potential neuroinvasive role of SARS-CoV-2. The purpose of this study is to describe new findings, in the form of cerebral microbleeds affecting different brain structures, observed in MRIs of critically ill patients. METHODS For this purpose, the MR images of 9 patients with a common pattern of abnormal findings (2 women/7 men; 55-79 years of age; mean age: 67.7 years) were depicted. All patients were tested positive for SARS-CoV-2 and presented with delayed recovery of consciousness or important agitation, requiring brain MRI. RESULTS All patients had suffered from severe (5/9) or moderate (4/9) acute respiratory distress syndrome, requiring prolonged stay in the intensive care unit. Their common MRI finding was the presence of microbleeds in unusual distribution with a specific predilection for the corpus callosum. Other uncommon locations of microbleeds were the internal capsule (5/9), as well as middle cerebellar peduncles (5/9). Subcortical regions were also affected in the majority of patients. CONCLUSIONS Brain MRI raised evidence that Covid-19 or its related treatment may involve the brain with an unusual pattern of microbleeds, predominantly affecting the corpus callosum. The mechanism of this finding is still unclear but the differential diagnosis should include thrombotic microangiopathy related to direct or indirect-through the cytokine cascade-damage by the SARS-CoV-2 on the endothelium of brain's vessels, as well as mechanisms similar to the hypoxemia brain-blood-barrier injury.