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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.

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. https://www.prnewswire.com/news-releases/large-international-study-reveals-spectrum-of-covid-19-brain-complications-301431751.html
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.