A, Image from noncontrast head CT demonstrates symmetric hypoattenuation within the bilateral medial thalami (arrows). B, Axial CT venogram demonstrates patency of the cerebral venous vasculature, including the internal cerebral veins (arrows). C, Coronal reformat of aCT angiogram demonstrates normal appearance of the basilar artery and proximal posterior cerebral arteries. Image courtesy of the Radiological Society of North America (RSNA)
March 31, 2020 — A brief article from Henry Ford Health System in Detroit, published today in Radiology, reports on the first presumptive case of COVID-19–associated acute necrotizing hemorrhagic encephalopathy. The patient, an airline worker in her 50s, presented with a 3-day history of cough, fever and altered mental status. Initial laboratory work-up was negative for influenza, with the diagnosis of COVID-19 made by detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral nucleic acid in a nasopharyngeal swab specimen using the U.S. Centers for Disease Control and Prevention (CDC) 2019-Novel Coronavirus (2019-nCoV) Real-Time Reverse Transcriptase-Polymerase Chain Reaction assay.
Acute necrotizing encephalopathy is a rare complication of influenza and other viral infections and has been related to intracranial cytokine storms, which result in blood-brain barrier breakdown.
Since its introduction to the human population in December 2019, the coronavirus disease 2019 (COVID-19) pandemic has spread across the world with over 330,000 reported cases in 190 countries. While patients typically present with fever, shortness of breath, and cough, neurologic manifestations have been reported, although to a much lesser extent. This is the first reported case of COVID-19–associated acute necrotizing hemorrhagic encephalopathy. As the number of patients with COVID-19 increases worldwide, doctors should be alert for patients presenting with COVID-19 and altered mental status.
Read the full article, COVID-19–associated Acute Hemorrhagic Necrotizing Encephalopathy: CT and MRI Features.
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