Importance: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is considered to have potential neuro-invasiveness that might lead to acute brain disorders or contribute to respiratory distress in patients with coronavirus disease 2019 (COVID-19). Brain magnetic resonance imaging (MRI) data in COVID-19 patients are scarce due to difficulties to obtain such examination in infected unstable patients during the COVID-19 outbreak. Objective: To investigate the occurrence of structural brain abnormalities in non-survivors of COVID-19 in a virtopsy framework. Design: Prospective, case series study with postmortem brain MRI obtained early (<24h) after death. Setting: Monocentric study. Participants: From 31/03/2020 to 24/04/2020, consecutive decedents who fulfilled the following inclusion criteria were included: death <24 hours, SARS-CoV-2 detection on nasopharyngeal swab specimen, chest computerized tomographic (CT) scan suggestive of COVID-19, absence of known focal brain lesion, and MRI compatibility. Main Outcome(s) and Measure(s): Signs of acute brain injury and MRI signal abnormalities along the olfactory tract and brainstem were searched independently by 3 neuroradiologists, then reviewed with neurologists and clinicians. Results: Among the 62 patients who died from COVID-19 during the inclusion period, 19 decedents fulfilled inclusion criteria. Subcortical micro- and macro-bleeds (2 decedents), cortico-subcortical edematous changes evocative of posterior reversible encephalopathy syndrome (PRES, one decedent), and nonspecific deep white matter changes (one decedent) were observed. Asymmetric olfactory bulbs were found in 4 other decedents without downstream olfactory tract abnormalities. No brainstem MRI signal abnormality. Conclusions and Relevance: Postmortem brain MRI demonstrates hemorrhagic and PRES-related brain lesions in non-survivors of COVID-19 that might be triggered by the virus-induced endothelial disturbances. SARS-CoV-2-related olfactory impairment seems to be limited to olfactory bulbs. The absence of brainstem MRI abnormalities does not support a brain-related contribution to respiratory distress in COVID-19.

中文翻译：

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COVID-19非幸存者的早期死后脑MRI发现

重要性：严重急性呼吸系统综合症冠状病毒2（SARS-CoV-2）被认为具有潜在的神经侵袭性，可能导致2019年冠状病毒病（COVID-19）患者出现急性脑部疾病或导致呼吸窘迫。由于在COVID-19爆发期间受感染的不稳定患者难以进行此类检查，因此COVID-19患者的脑磁共振成像（MRI）数据稀缺。目的：研究在虚拟框架下非COVID-19幸存者脑结构异常的发生情况。设计：死后早期（<24h）进行死后脑MRI的前瞻性病例系列研究。地点：单中心研究。参加者：从31/03/2020到24/04/2020，符合以下纳入标准的连续死者包括：死亡<24小时，鼻咽拭子标本的SARS-CoV-2检测，胸部计算机断层扫描（CT）扫描提示COVID-19，缺乏已知的局灶性脑病灶和MRI兼容性。主要结果和措施：由3位神经放射科医生独立搜索嗅觉和脑干的急性脑损伤迹象和MRI信号异常，然后与神经科医生和临床医生进行审查。结果：在入选期间死于COVID-19的62例患者中，有19名死者符合入选标准。观察到皮层下微出血和大出血（2例），皮质-皮层下水肿性变化（可唤起后可逆性脑病综合征）（PRES，1例）和非特异性深部白质变化（1例）。在其他4名死者中发现不对称嗅球，没有下游嗅觉异常。无脑干MRI信号异常。结论和相关性：死后脑部MRI显示非COVID-19幸存者的出血性和PRES相关性脑部病变可能是由病毒引起的内皮功能紊乱触发的。SARS-CoV-2相关的嗅觉障碍似乎仅限于嗅球。没有脑干MRI异常不支持COVID-19中与脑相关的呼吸窘迫相关因素。SARS-CoV-2相关的嗅觉障碍似乎仅限于嗅球。没有脑干MRI异常不支持COVID-19中与脑相关的呼吸窘迫相关因素。SARS-CoV-2相关的嗅觉障碍似乎仅限于嗅球。没有脑干MRI异常不支持COVID-19中与脑相关的呼吸窘迫相关因素。