New research suggests pneumonia in COVID-19 patients is linked to viral-induced changes in the brain. MRI scans revealed 57.9% of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected patients had recent brain lesions.
About 29 patients had focal neurological manifestations. The other 17 patients had nonfocal neurological manifestations. The most significant lesions came from territorial infarcts or cerebral hemorrhaging.
“Brain MRI is a feasible and important imaging modality in selected patients with SARS-CoV-2 pneumonia on developing neurological manifestations, suggestive of brain involvement, particularly in patients with nonfocal manifestations and decline in [Glasgow Coma Scale],” concluded the team.
The study “Brain MRI in SARS-CoV-2 pneumonia patients with newly developed neurological manifestations suggestive of brain involvement” was recently published in the journal Scientific Reports.
Patient characteristics
A total of 46 patients, 33 females and 13 males tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and later developed pneumonia. Their SARS-CoV-2 infection suggested neurological manifestations, and they were invited to take an MRI scan of their brain.
About 78.3% of patients had a secondary health condition, with 23.9% reporting over 3 comorbidities. On average, patients were 51.3 years old.
Results
MRI scans showed brain lesions in 82.6% of patients. Additionally, about 57.9% of the identified brain legions were recent, suggesting the lesions were linked to SARS-CoV-2 infection. Only 41.1% of brain lesions were considered old.
Of the 57.9% with recent brain legions, 77.3% of these lesions were deemed “clinically significant.” These patients were the ones who had a stroke. Eight experienced a recent infarct, and five patients had a recent cerebral hemorrhage. In addition, four patients showed signs of global hypoxic-ischemic encephalopathy.
Five patients had MRI scans positive for nonspecific subcortical changes, suggesting white matter microangiopathy. Of these 5 patients, 2 were below the age of 50 and had nonfocal neurological manifestations and microangiopathic lesions. Laboratory evidence showed these patients had a history of viral infections, including MERS-CoV infection. The remaining 3 patients were older than 50 and had microangiopathic lesions associated with lacunar Infarcts.
Differences in COVID-19 patients with or without recent lesions
Based on the MRI scans, the 46 patients were categorized into several groups.
Group A composed of 63% of patients who had presented with neurological manifestations.
Of the 22 patients in Group A, ten had recent infarcts and seven had territorial infarcts. In addition, three patients had lacunar or microangiopathic infarcts in three patients, four with recent cerebral hemorrhage, three with old territorial infarcts, and five patients with variable sized old lacunar infarcts.
Group B had the remaining 37% who did not have neurological manifestations at the time of the MRI scan.
About 4 out of 5 patients in Group B who had severe SARS-CoV-2 pneumonia underwent cardiac arrest. From this, brain MRI scans depicted signs of global hypoxic-ischemic encephalopathy. These five patients were eventually intubated from severe COVID-19–induced pneumonia. Therefore, this group was designated as group C.
Group D consisted of patients who did not have a cardiac arrest and had no signs of global hypoxic-ischemic encephalopathy.
Group A and Group B showed a significant difference in the Glasgow Coma Scale (GCS) — used to measure a person’s consciousness level after trauma. Group C also had a low GCS score
The MRI findings provide further evidence that SARS-CoV-2 affects the brain and generates neurological manifestations, including lesions.
Study limitations
The current research is a retrospective study, indicating a small number of patients were non-randomized. Age, gender, and the type of comorbidity presented in each patient may weaken the association between SARS-CoV-2 and cerebrovascular disease.
To the research team’s knowledge, there is no prior brain MRI study on SARS-CoV-2 infection. The lack of a baseline may decrease the accurateness in patterns between brain lesions and SARS-CoV-2 infection.
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