E1338. Neuroradiological Findings in Mild and Severe COVID-19 Infection
  1. Simon Pan; University of California, San Francisco
  2. William Chen; University of California, San Francisco
  3. Joe Baal; University of California, San Francisco
  4. Leo Sugrue; University of California, San Francisco
In 2019, the novel SARS-CoV-2 coronavirus emerged from Wuhan, China and commenced a global pandemic that has resulted in over 18,380,616 confirmed cases and 696,389 deaths as of August 2020. Although the major cause of morbidity and mortality in COVID-19 infection is respiratory failure, a surprising number of patients have been reported to exhibit neurological symptoms, ranging from acute cerebrovascular insults, encephalitis, inflammatory demyelination, to isolated sensorineural deficits. It is poorly understood how presentation of neurological symptoms can vary in patients with different severities of COVID-19 infection. The purpose of this study is to systematically review the current literature on COVID-19-associated neuroradiological findings and examine the prevalence of different findings in patients with severe and mild COVID-19 infection.

Materials and Methods:
A comprehensive literature search of the PubMed and Embase databases was performed with the following search terms: “((brain or neurological or neurology or neuropsychiatric or neuroimaging or anosmia or neuroradiological or neuroradiology) AND (MRI or magnetic resonance imaging or CT or computerized tomography or radiology or radiological or imaging) AND (COVID-19 or novel coronavirus or SARS-COV-2 or 2019-nCoV)).” Any studies reporting CT or MRI neuroimaging findings in patients with confirmed COVID-19 infection were included. Patient demographics, main radiological findings, neurological symptoms, and severity of COVID-19 infection were systematically tabulated and quantified. Any mention of admission to the ICU for respiratory illness, ARDS, or invasive respiratory support was classified as severe infection.

61 studies published between 2019 to 2020 comprising 711 patients were analyzed according to severity of respiratory symptoms. The main neuroradiological findings for patients with mild classification were cranial nerve abnormalities, ischemic infarction, and white matter abnormalities, while the main findings in patients with severe classification were white matter abnormalities, ischemic infarction, and hemorrhagic events. Cranial nerve abnormalities were exclusively reported in mild COVID-19 infection, while ischemic infarction was equally prevalent between the two populations.

These data suggest that neuroradiological manifestations in COVID-19 infection are highly heterogeneous and differ based on the severity of COVID-19 infection. Ischemic infarction was highly prevalent even in mild COVID-19 infection, suggesting that SARS-CoV-2 induces a hypercoaguable state. Healthcare providers treating COVID-19 patients should be aware of these potential complications and consider neurological assessment and neuroimaging studies when indicated.