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Cerebral vasculitis of medium-sized vessels as a possible mechanism of brain damage in COVID-19 patients #MMPMID33340640
Lersy F; Anheim M; Willaume T; Chammas A; Brisset JC; Cotton F; Kremer S
J Neuroradiol 2021[May]; 48 (3): 141-146 PMID33340640show ga
BACKGROUND AND PURPOSE: Cerebral complications related to COVID-19 were recently reported, and the underlying mechanisms of brain damage remain uncertain, probably multifactorial. Among various hypotheses suggested, a possible vasculitis was issued but never confirmed. Herein, we aimed to describe brain MRIs focused on the intracranial vessel wall in a population of COVID-19 patients with neurologic manifestations. MATERIALS AND METHODS: Between March 1 and May 31, 2020, 69 consecutive COVID-19 patients with neurologic manifestations underwent a brain MRI allowing the study of the intracranial vessel wall at Strasbourg University hospitals and were retrospectively included. During the same period, 25 consecutive patients, without suspicion of SARS-CoV-2 infection, underwent a brain MRI urgently, with the same imaging protocols. A vasculitis seemed likely when imaging demonstrated vessel wall thickening with homogeneous and concentric enhancement. RESULTS: Among the 69 COVID-19 patients included, 11 (16%) presented arterial vessel wall thickening with homogeneous and concentric enhancement, compatible with cerebral vasculitis. These neuroimaging findings were not found among the 25 patients without SARS-CoV-2 infection, and the difference was statistically significant (p?=?0.03). Middle cerebral arteries, basilar artery, and posterior cerebral arteries were the most frequent vessels involved. For nine of them, imaging demonstrated ischemic or hemorrhagic complications. CONCLUSION: Cerebral vasculitis of medium-sized vessels seems to be one of the mechanisms at the origin of brain damage related to COVID-19.
|Adult[MESH]
|Aged[MESH]
|Aged, 80 and over[MESH]
|Brain/*diagnostic imaging[MESH]
|COVID-19/*complications/diagnostic imaging[MESH]
|Female[MESH]
|Humans[MESH]
|Magnetic Resonance Angiography[MESH]
|Magnetic Resonance Imaging[MESH]
|Male[MESH]
|Middle Aged[MESH]
|Neuroimaging[MESH]
|Retrospective Studies[MESH]
|Vasculitis, Central Nervous System/diagnostic imaging/*etiology[MESH]