Nearly 10% of COVID-19 Patients Have Acute Findings on Neuroimaging, Study Finds


Data suggest that roughly 1 in 100 patients hospitalized with COVID-19 infection will develop central nervous system complications.

Scott H. Faro, MD, FASFNR, professor of radiology and neurology, and director, Division of Neuroradiology/Head & Neck Imaging, Thomas Jefferson University in Philadelphia

Scott H. Faro, MD, FASFNR

Data from a retrospective multicenter study suggests the overall incidence of central nervous system (CNS) complications in hospitalized patients with confirmed COVID-19 to be 1.2%, with those that underwent neuroimaging (NI) found to have a 10% incidence of complication (7.9% in the US vs 22.8% in the EU). Findings were presented at the 107th Scientific Assembly and Annual Meeting of the Radiological Society of North America (RSNA), November 28-December 2, 2021 in Chicago. 

Between September 2019 and June 2021, approximately 37,950 patients with COVID-19 were included from 11 centers in the US and Europe, making it the largest multi-institutional international study on brain complications associated with COVID-19 infection. Of these patients, 4342 underwent NI, with and acute findings identified in 442 patients (10%). This accounted for 294 of 3701 patients (7.9%) who underwent NI in the US and 148 of 647 patients (22.8%) who underwent NI in Europe. 

“Of all the inpatients who had imaging such as MRI or a CT scan of brain, the exam was positive approximately 10% of the time,” lead investigator Scott H. Faro, MD, FASFNR, professor of radiology and neurology, and director, Division of Neuroradiology/Head & Neck Imaging, Thomas Jefferson University in Philadelphia, said in a statement.1 "The incidence of 1.2% means that a little more than one in 100 patients admitted to the hospital with COVID-19 are going to have a brain problem of some sort.”

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“It is important to know an accurate incidence of all the major central nervous system complications,” Faro added. “There should probably be a low threshold to order brain imaging for patients with COVID-19.”

Of the COVID-19 complications reported by the 442 patients with acute NI findings, the most common were ischemic stroke, occurring in 276 patients (62.4%), intracranial hemorrhage (ICH) in 164 patients (37.1%), encephalitis in 25 patients (5.2%), deep sinus thrombosis in 10 patients (2.3%), acute disseminated encephalomyelitis (ADEM) in 8 patients (1.8%), posterior reversible encephalopathy syndrome in 7 patients (1.6%), and vasculitis in 2 patients (0.5%). There was a higher prevalence of ICH, encephalitis, and ADEM in Europe (4.7%) versus the US (0.3%), while ischemic stroke was more common in the US (74.1%) versus Europe (39.2%).2

Investigators observed white matter involvement in 252 of the NI-positive patients (57%). Distal unilateral was the most common distribution of lesions on neuroimaging, observed in 264 patients (59.7%), and the most affected lobes were the frontal in 244 patients (55.2%) and the parietal in 217 patients (49.1%). 

Patients were verified by board certified neuroradiologists and required to be 18 years or older, with a lab-confirmed diagnosis of COVID-19 infection. Also required were acute neuroimaging findings on a brain MRI or CT scan that were not attributable to any other cause other than COVID-19. Participants were an average age of 66 years (standard deviation, 12) with a 2:1 ratio of women versus men. 

“Much has been written about the overall pulmonary problems related to COVID-19, but we do not often talk about the other organs that can be affected," Faro said in a statement.1 "Our study shows that central nervous system complications represent a significant cause of morbidity and mortality in this devastating pandemic.”

1. Large international study reveals spectrum of COVID-19 brain complications. News release. Radiological Society of North America. November 29, 2021. Accessed December 2, 2021.
2. Faro SH, Manmatharayan A, Leiby B, et al. Retrospective multicenter study of the neuroimaging incidence of CNS complications in hospitalized COVID-19 positive patients. Presented at RSNA 2021; November 28-December 2, 2021. Chicago, IL and Virtual.
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