While neuroimaging is not frequently performed in patients with coronavirus disease 2019 (COVID-19), acute stroke is the most common COVID-19–related neuroimaging finding, according to study results published in the Journal of the Neurological Sciences.
Previous studies have reported that severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the pathogen that causes COVID-19, can involve the nervous system but limited data are available on the incidence of neurological complications based on neuroimaging and its prognostic role. The goal of the current study was to assess the incidence, spectrum, and prognostic role of neuroimaging findings in hospitalized patients with COVID-19 in New York City.
The retrospective cohort study included 3218 patients with confirmed COVID-19 confirmed who were hospitalized from March 1, 2020, to April 13, 2020. Of these, 454 patients (14.1%) underwent neuroimaging and 38 of them had acute neuroimaging findings: ischemic stroke (n=26), hemorrhagic stroke (n=9), hypoxic anoxic brain injury (n=2), and encephalitis (n=1).
The data showed that 16 of 37 (42%) patients with acute neuroimaging findings died during hospitalization, including 47% of patients with large vessel acute ischemic stroke and 55.5% of those with hemorrhagic stroke. Mortality risk was significantly higher for patients with COVID-19 with neuroimaging findings, compared with patients without acute neuroimaging findings (odds ratio, 6.02, 95% CI, 2.6-15.6; P <.001) and the risk remained significant using a competing risk model (hazard ratio 2.28, 95% CI, 1.35-3.85).
However, patients with no acute neuroimaging findings did not have significantly increased mortality compared with patients who were never imaged.
The researchers acknowledged the limitations of the study and the difficulties to ascertain the true incidence of COVID-19–related neurological manifestations, including the fact that neurological complications may be present with no abnormalities on neuroimaging, limited ability to complete neurological examination and obtain neuroimaging as a result of the extreme infection control measures and inability to transport critically ill patients.
“The discovery of acute stroke by neuroimaging is a strong prognostic marker of poor outcome,” concluded the researchers.
Jain R, Young M, Dogra S, et al. COVID-19 related neuroimaging findings: a signal of thromboembolic complications and a strong prognostic marker of poor patient outcome [published online May 19, 2020]. J Neurol Sci. doi:10.1016/j.jns.2020.116923