Cerebral microvascular injuries in severe COVID-19 infection: progression of white matter hyperintensities post-infection. Issue 9 (13th September 2022)

• Record Type: Journal Article
• Authors: Petersson, Ida; Hansen, Bjorn M; Svenningsson, Anders; Lundstrom, Annika
• Is Part Of: BMJ case reports. Volume 15:Issue 9(2022)
• Publication Date: 2022-09-13
• Subjects: neurology -- stroke -- COVID-19 -- radiology -- adult intensive care; Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr-2022-249156
• Languages: English
• ISSNs: 1757-790X

Abstract

Abstract : A range of neuroradiological findings has been reported in patients with COVID-19, some mimicking cerebral small vessel disease (CSVD). We present a case of a man in his 50s with severe COVID-19, who was Glasgow Coma Scale 3 and tetraparetic after sedation was ceased in the intensive care unit. Return of consciousness and motor activity was slow. An MRI 1 month after debut of symptoms demonstrated white matter hyperintensities on T2-weighted Fluid Attenuated Inversion Recovery (T2-FLAIR) and many small areas with impaired diffusion in primarily supratentorial and infratentorial white matter on Diffusion-Weighted Imaging (DWI). In the following months, the patient made a remarkable clinical recovery. Despite clinical improvement, an MRI after 7 months showed that white matter hyperintensities had progressed and become confluent. Both MRIs demonstrated findings resembling CSVD, which could relate to a COVID-19-specific process affecting cerebral microvasculature.