A brief article from Henry Ford Health System in Detroit, published March 31 in Radiology, reports on the first presumptive case of COVID-19–associated acute necrotizing hemorrhagic encephalopathy. The patient, an airline worker in her 50s, presented with a 3-day history of cough, fever and altered mental status.
Acute necrotizing encephalopathy (ANE) is a rare complication of influenza and other viral infections and has been related to intracranial cytokine storms, which result in blood-brain barrier breakdown, but without direct viral invasion or parainfectious demyelination.
As described in the article, accumulating evidence suggests that a subgroup of patients with severe COVID-19 might have a cytokine storm syndrome. While predominantly described in the pediatric population, ANE is known to occur in adults as well.
The most characteristic imaging feature includes symmetric, multifocal lesions with invariable thalamic involvement. Other commonly involved locations include the brain stem, cerebral white matter, and cerebellum. Lesions appear hypoattenuating on CT images and MRI demonstrates T2 FLAIR hyperintense signal with internal hemorrhage. Postcontrast images may demonstrate a ring of contrast enhancement.
This is the first reported case of COVID-19–associated acute necrotizing hemorrhagic encephalopathy. As the number of patients with COVID-19 increases worldwide, doctors should be alert for patients presenting with COVID-19 and altered mental status.Back To Top
CT, MR Features of First Presumptive Case of COVID-19–Associated Acute Necrotizing Hemorrhagic Encephalopathy. Appl Radiol.