md-medicaldata

Authors

 

Igor Sekulić^1,2, Nemanja Rančić^1,2,3, Biljana Georgievski Brkić⁴, Miroslav Mišović^1,2, Smiljana Kostić^2,5, Jelena Bošković Sekulić⁶, Dejan Kostić<sup>1,2

1</sup>Institute of Radiology, Military Medical Academy, Belgrade, Serbia
²University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
³Centre for Clinical Pharmacology, Military Medical Academy, Belgrade, Serbia
⁴Special Hospital for Cerebrovascular Diseases „Sveti Sava”, Belgrade, Serbia
⁵Clinic for Neurology, Military Medical Academy, Belgrade, Serbia
⁶Clinic of Emergency Medicine, University Clinical Centre Kragujevac, Kragujevac, Serbia

 

UDK: 616.98-06:578.834 616.8

The paper was received / Rad primljen: 01.03.2023

Accepted / Rad prihvaćen: 21.03.2023.

 

Correspondence to:

Dejan Kostić,
Institute of Radiology,
Military Medical Academy,
Crnotravska 17, Belgrade, Serbia,
e-mail: drdkostic@gmail.

 

 

Abstract

 

 

Introduction: Neurological complications related to SARS-CoV-2 are increasingly recognized. In diffuse leukoencephalopathy with microhemorrhages, non-contrast computed tomography (CT) can initially demonstrate extensive, fairly symmetrical hypodense areas in the supratentorial white matter and corpus callosum, while magnetic resonance imaging (MRI) shows diffuse, confluent hyperintensities, scattered microhemorrhages predominantly in subcortical WM and the corpus callosum without diffusion restriction or abnormal enhancement. Case report: Initial imaging evaluation with non-contrast CT of the brain revealed multifocal non-hemorrhagic white matter lesions in both cerebral hemispheres and cerebellum. A contrast-enhanced brain MRI showed non-enhanced diffuse, bilateral, symmetric, confluent hyperintensities located in the deep and subcortical white matter with the involvement of the frontal, parietal, temporal and occipital lobes, as well as the brain stem, bilateral capsula interna and cerebellum, suggesting vasogenic edema. A microhemorrhage was found in corpus callosum, posterior limb of capsula interne of the left and basal ganglia on the right side. MRI showed non-diffusion restriction. The thalami showed no alterations. MRI angiogram and venogram of the brain were unremarkable. A definitive diagnosis of COVID-19-related diffuse leukoencephalopathy with callosal microhemorrhages has been made, given the rapid clinical deterioration, progression of imaging characteristics, and CSF imaging. Conclusion: Diffuse leukoencephalopathy with microhemorrhages is rare and often fatal neurological complication of COVID-19. Heightened clinical awareness and early imaging identification of diffuse leukoencephalopathy with microhemorrhages can provide clinicians with the opportunity to pursue more aggressive treatment options, thereby reducing fatal outcomes.

 

Key words:

COVID-19; leukoencephalopathy; microhemorrhages

 

 

 

Сажетак

 

Uvod: Sve više se uočavaju neurološke komplikacije povezane sa SARS-CoV-2 infekcijom. Kompjuterizovana tomografija (CT) bez aplikacije kontrastog sredstva može u početku, kod difuzne leukoencefalopatije sa mikrohemoragijama, da pokaže ekstenzivne, prilično simetrične hipodenzne oblasti u supratentorijalnoj beloj masi i corpus-u callosum-u, dok magnetna rezonanca (MRI) pokazuje difuzne, konfluentne T2 hiperintenzitete i brojne mikrohemoragije predominantno subkortikalno u beloj masi i corpus callosum-u, bez restriktivne difuzije i bez postkontrastnog pojačanja intenziteta signala. Prikaz slučaja: Inicijalna imidžing evaluacija, pomoć nekontrastnog CT endokranijuma, otkrila je multifokalne nehemoragične lezije bele mase u obe velikomoždane hemisfere i u malom mozgu. MRI endokranijuma sa i.v aplikovanim kontrastim sredstvom pokazao je difuzni, bilateralni, simetrični, konfluentni T2 hiperintenzitet bez postkontrastnog pojačanja intenziteta signala, lokalizovan u dubokoj beloj masi, subkortikalno sa zahvatanjem frontalnog, parijetalnog, temporalnog i okcipitalnog režnja, kao i moždanog stabla, capsula interna-e obostrano i malog mozga, što ukazuje na vazogeni edem. Viđena je mikrohemoragija u corpus callosum-u, posteriornom kraku capsula interna-e levo i bazalnim jedarima na desnoj strani. MRI nije pokazao restrikciju difuzije. U talamusu nisu registrovane nikakve promene.  MRI angiografija endokranijuma je bila nesignifikantna. Obzirom na brzo kliničko pogoršanje, progresiju imidžing nalaza i nalaza cerebrospinalne tečnosti, postavljena je definitivna dijagnoza difuzne leukoencefalopatije sa kaloznim mikrohemoragijama, povezane sa COVID-19. Zaključak: Difuzna leukoencefalopatija sa mikrohemoragijama je retka i često fatalna neurološka komplikacija COVID-19. Poremećaji svesti i rana identifikacija difuzne leukoencefalopatije sa mikrohemoragijama mogu pružiti kliničarima priliku da traže agresivnije opcije lečenja, čime se smanjuje mogućnost fatalnih ishoda.

 

Ključne reči:

COVID-19; leukoencefalopatija; mikrohemoragije

 

 

 

 

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PDF: 06-Sekulić I. et al. MD-Medical Data 2023;15(1-2) 031-034.pdf