In this article, the authors evaluated the incidence, distribution, and histopathological correlates of microvascular brain lesions in patients with severe COVID-19. Sixteen consecutive patients admitted to the intensive care unit with severe COVID-19 undergoing brain MRI for evaluation of coma or neurological deficits were retrospectively identified. Eleven patients had punctate susceptibility-weighted imaging (SWI) lesions in the subcortical and deep white matter, eight patients had >10 SWI lesions, and four patients had lesions involving the corpus callosum. The distribution of SWI lesions was similar to that seen in patients with hypoxic respiratory failure, sepsis, and disseminated intravascular coagulation. Brain autopsy in one patient revealed that SWI lesions corresponded to widespread microvascular injury, characterised by perivascular and parenchymal petechial hemorrhages and microscopic ischaemic lesions. Collectively, these radiologic and histopathological findings add to growing evidence that patients with severe COVID-19 are at risk for multifocal microvascular haemorrhagic and ischaemic lesions in the subcortical and deep white matter.
DOI: 10.1016/j.jns.2021.117308