Early postmortem brain MRI findings in COVID-19 non-survivor
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The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is considered to have potential neuro-invasiveness that might lead to acute brain disorders or contribute to respiratory distress in patients with COVID-19. This study investigates the occurrence of structural brain abnormalities in non-survivors of COVID-19 in a virtopsy framework.

In this prospective, monocentric, case series study, consecutive patients who fulfilled the following inclusion criteria benefited from an early postmortem structural brain MRI: death <24 hours, SARS-CoV-2 detection on nasopharyngeal swab specimen, chest computerized tomographic (CT) scan suggestive of COVID-19, absence of known focal brain lesion, and MRI compatibility.

- Among the 62 patients who died from COVID-19, 19 decedents fulfilled the inclusion criteria.
- Parenchymal brain abnormalities were observed in 4 decedents: subcortical micro- and macro-bleeds (2 decedents), cortico-subcortical edematous changes evocative of posterior reversible encephalopathy syndrome (PRES, one decedent), and nonspecific deep white matter changes (one decedent).
- Asymmetric olfactory bulbs were found in 4 other decedents without downstream olfactory tract abnormalities.
- No brainstem MRI signal abnormality was observed.

Conclusively, Postmortem brain MRI demonstrates hemorrhagic and PRES-related brain lesions in non-survivors of COVID-19. SARS-CoV-2-related olfactory impairment seems to be limited to olfactory bulbs. Brainstem MRI findings do not support a brain-related contribution to respiratory distress in COVID-19.

Source: https://n.neurology.org/content/early/2020/06/16/WNL.0000000000010116