Introduction
Although COVID-19 is primarily considered a respiratory disease, there are increasing reports of neurological effects that in some cases may be the first manifestation of the disease. Several reports of patients with COVID-19-related neurological disorders included encephalitis, Guillain-Barré syndrome, anosmia and ageusia, inflammatory CNS syndromes and acute cerebrovascular disease1,2.
Patient history
A 34-year-old male complaining of sore throat, headache, fever, dry cough, tiredness, difficulty breathing, chest pain and brain pain/pressure. Patient underwent thorax CT and PCR test, both positive for COVID-19.
Due to the complaint of severe headache and neck pain and pressure, the patient was referred by the neurology department for a brain and venography MR.
Technique
A non-contrast 2D TOF SPGR and fast T2 FRFSE and T2 FLAIR performed on a SIGNA™ Explorer 1.5T confirmed the presence of thrombosis. Patient was treated with anticoagulants. After the patient recovered from COVID-19 (negative PCR test), a follow up brain and venography MR was requested. Due to his recovery from COVID-19, the patient was evaluated on a SIGNA™ Pioneer 3.0T system at our non-pandemic section of the hospital campus. Non-contrast 3D Inhance along with fast acquisitions of T2 frFSE and T2 FLAIR were utilized.
Results
The follow-up brain and venography demonstrated the patient returned to normal (non-thrombosis) after anticoagulation therapy.
Discussion
Thrombotic events may be seen in patients positive for COVID-19. Therefore, radiologists should be careful to review venous sinus thrombosis while evaluating brain images in patients with neurological symptoms.
Figure 1.
CT exam results indicate patient is positive for COVID-19. Images acquired on GE Revolution™ A EVO 128-slice CT.
Figure 2.
Patient is referred for a brain and venography MR exam on SIGNA™ Explorer by neurologists because of severe headache and neck pain. Results indicate thrombosis. (A, B) Non-contrast 2D TOF SPGR, 5:13 min.
Figure 3.
T2 frFSE and T2 FLAIR images from initial SIGNA™ Explorer exam depict evidence of thrombosis (circles). (A) Axial T2 frFSE, 1:38 min.; (B) coronal T2 frFSE, 1:16 min.; and (C) axial T2 FLAIR, 2:16 min.
Figure 4.
Follow-up brain and venography exam on SIGNA™ Pioneer depicts non-thrombosis after treatment. (A, B) Non-contrast 3D Inhance.
Figure 5.
(A) Before and (B) after images of patient with thrombosis resulting from COVID-19. (A) Sagittal 3D Cube on SIGNA™ Explorer, 4:21 min. (B) Sagittal 3D Cube PROMO, 6:50 min. on SIGNA™ Pioneer.
