key: cord-0860781-vxt1d1ld
authors: Sabino, João Vitor; Gonçales, Eduardo Sellan Lopes; Reis, Fabiano
title: COVID-19-associated leukoencephalopathy and brain microhemorrhages
date: 2021-09-24
journal: Revista da Sociedade Brasileira de Medicina Tropical
DOI: 10.1590/0037-8682-0469-2021
sha: 068ae7a8ae8e7a9a6f8d59d7fbe6187db64e8c9b
doc_id: 860781
cord_uid: vxt1d1ld

nan

João Vitor Sabino [1] , Eduardo Sellan Lopes Gonçales [2] and Fabiano Reis [2] [1]. The dissemination and persistence of coronavirus disease 2019 (COVID-19) worldwide have increased recognition of the ability of this disease to cause brain lesions. Herein, we describe a patient with COVID-19-associated leukoencephalopathy with microhemorrhages, a pattern that has been previously described 1,2 .

A 62-year-old male patient with hypertension (managed with losartan, 100 mg/day) presented with upper respiratory symptoms that persisted for seven days, along with myalgia. Real-time reversetranscription polymerase chain reaction testing of a nasopharyngeal swab sample confirmed SARS-CoV-2 infection. The patient was on mechanical ventilation for 37 days, and the lowest recorded blood oxygen saturation level was 90%. The platelet count was normal (311,000/mL). A brain magnetic resonance imaging (MRI) scan showed confluent symmetric T2 hyperintensity and restricted diffusion in the subcortical white matter of the precentral gyrus and the centrum semiovale, with small punctate hemorrhagic foci in the posterior limb of the left internal capsule and the subcortical white matter (Figure 1 A-E) . Chest computed tomography revealed ground-glass opacities and consolidations in both lungs ( Figure 1F) . The patient died three days after MRI.

Although the findings in this case were nonspecific and may be observed in vasculitides 1,3 , acute hemorrhagic encephalomyelitis 1 and delayed post-hypoxic leukoencephalopathy 2 , leukoencephalopathy, and microhemorrhages in critically ill patients with COVID-19 may be related to demyelination, endothelial lesions, and cytokine release syndrome 1,2 . These lesions may be viewed as potential late brain complications of COVID-19 in patients with a diminished mental status, and these patients usually have a poor prognosis 1,2 .

COVID-19-associated leukoencephalopathy

COVID-19-associated diffuse leukoencephalopathy and microhemorrhages

Mimickers of neuropsychiatric manifestations in systemic lupus erythematosus

We offer our deepest thanks to the institutions that provided technical support for the development and implementation of this study.