Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India.
Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareli Road, Lucknow, Uttar Pradesh, India.
Neurol India. 2021 Mar-Apr;69(2):260-271. doi: 10.4103/0028-3886.314531.
A variety of neuroimaging abnormalities in COVID-19 have been described.
In this article, we reviewed the varied neuroimaging patterns in patients with COVID-19-associated neurological complications.
We searched PubMed, Google Scholar, Scopus and preprint databases (medRxiv and bioRxiv). The search terms we used were "COVID -19 and encephalitis, encephalopathy, neuroimaging or neuroradiology" and "SARS-CoV-2 and encephalitis, encephalopathy, neuroimaging or neuroradiology".
Neuroimaging abnormalities are common in old age and patients with comorbidities. Neuroimaging abnormalities are largely vascular in origin. COVID-19-associated coagulopathy results in large vessel occlusion and cerebral venous thrombosis. COVID-19-associated intracerebral hemorrhage resembles anticoagulant associated intracerebral hemorrhage. On neuroimaging, hypoxic-ischemic damage along with hyperimmune reaction against the SARS-COV-2 virus manifests as small vessel disease. Small vessel disease appears as diffuse leukoencephalopathy and widespread microbleeds, and subcortical white matter hyperintensities. Occasionally, gray matter hyperintensity, similar to those observed seen in autoimmune encephalitis, has been noted. In many cases, white matter lesions similar to that in acute disseminated encephalomyelitis have been described. Acute disseminated encephalomyelitis in COVID-19 seems to be a parainfectious event and autoimmune in origin. Many cases of acute necrotizing encephalitis resulting in extensive damage to thalamus and brain stem have been described; cytokine storm has been considered a pathogenic mechanism behind this. None of the neuroimaging abnormalities can provide a clue to the possible pathogenic mechanism.
Periventricular white-matter MR hyperintensity, microbleeds, arterial and venous infarcts, and hemorrhages are apparently distinctive neuroimaging abnormalities in patients with COVID-19.
COVID-19 存在多种神经影像学异常。
本文综述了 COVID-19 相关神经并发症患者的各种神经影像学表现。
我们检索了 PubMed、Google Scholar、Scopus 和预印本数据库（medRxiv 和 bioRxiv）。使用的检索词是“COVID-19 与脑炎、脑病、神经影像学或神经放射学”和“SARS-CoV-2 与脑炎、脑病、神经影像学或神经放射学”。
神经影像学异常在老年和合并症患者中常见。神经影像学异常主要为血管源性。COVID-19 相关凝血功能障碍导致大血管闭塞和脑静脉血栓形成。COVID-19 相关脑出血类似于抗凝相关脑出血。神经影像学上，缺氧缺血损伤以及针对 SARS-CoV-2 病毒的超免疫反应表现为小血管疾病。小血管疾病表现为弥漫性白质脑病和广泛微出血以及皮质下白质高信号。偶尔也会出现类似自身免疫性脑炎所见的灰质高信号。在许多情况下，都描述了类似于急性播散性脑脊髓炎的白质病变。COVID-19 中的急性播散性脑脊髓炎似乎是一种副感染性事件，其发病机制为自身免疫。许多急性坏死性脑炎导致丘脑和脑干广泛损伤的病例也有报道；细胞因子风暴被认为是这种疾病的一种发病机制。没有任何神经影像学异常能提供可能的发病机制线索。
脑室周围白质磁共振高信号、微出血、动脉和静脉梗死及出血是 COVID-19 患者明显的神经影像学异常。
