IMPORTANCE: Microvascular lesions are common in patients with severe COVID-19. Radiologic-pathologic correlation in one case suggests a combination of microvascular hemorrhagic and ischemic lesions that may reflect an underlying hypoxic mechanism of injury, which requires validation in larger studies. OBJECTIVE: To determine the incidence, distribution, and clinical and histopathologic correlates of microvascular lesions in patients with severe COVID-19. DESIGN: Observational, retrospective cohort study: March to May 2020. SETTING: Single academic medical center. PARTICIPANTS: Consecutive patients (16) admitted to the intensive care unit with severe COVID-19, undergoing brain MRI for evaluation of coma or focal neurologic deficits. EXPOSURES: Not applicable. MAIN OUTCOME AND MEASURES: Hypointense microvascular lesions identified by a prototype ultrafast high-resolution susceptibility-weighted imaging (SWI) MRI sequence, counted by two neuroradiologists and categorized by neuroanatomic location. Clinical and laboratory data (most recent measurements before brain MRI). Brain autopsy and cerebrospinal fluid PCR for SARS-CoV 2 in one patient who died from severe COVID-19. RESULTS: Eleven of 16 patients (69%) had punctate and linear SWI lesions in the subcortical and deep white matter, and eight patients (50%) had >10 SWI lesions. In 4/16 patients (25%), lesions involved the corpus callosum. Brain autopsy in one patient revealed that SWI lesions corresponded to widespread microvascular injury, characterized by perivascular and parenchymal petechial hemorrhages and microscopic ischemic lesions. CONCLUSIONS AND RELEVANCE: SWI lesions are common in patients with neurological manifestations of severe COVID-19 (coma and focal neurologic deficits). The distribution of lesions is similar to that seen in patients with hypoxic respiratory failure, sepsis, and disseminated intravascular coagulation. Collectively, these radiologic and histopathologic findings suggest that patients with severe COVID-19 are at risk for multifocal microvascular hemorrhagic and ischemic lesions in the subcortical and deep white matter.

中文翻译：

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严重 COVID-19 中的脑微血管损伤。

重要性：微血管病变在重症 COVID-19 患者中很常见。一个病例的放射学-病理学相关性表明微血管出血性和缺血性病变的组合可能反映了潜在的缺氧损伤机制，这需要在更大规模的研究中进行验证。目的：确定重症 COVID-19 患者微血管病变的发生率、分布以及临床和组织病理学相关性。设计：观察性回顾性队列研究：2020 年 3 月至 2020 年 5 月。设置：单一学术医疗中心。参与者：连续患者 (16) 因严重 COVID-19 入住重症监护病房，接受脑部 MRI 评估昏迷或局灶性神经功能缺损。暴露：不适用。主要成果和措施：通过原型超快高分辨率磁敏感加权成像 (SWI) MRI 序列识别的低信号微血管病变，由两名神经放射科医师计数并按神经解剖位置分类。临床和实验室数据（脑 MRI 前的最新测量值）。一名死于严重 COVID-19 的患者的脑尸检和脑脊液 PCR 检测 SARS-CoV 2。结果：16 名患者中有 11 名（69%）在皮层下和深部白质有点状和线状 SWI 病灶，8 名患者（50%）有 >10 个 SWI 病灶。在 4/16 患者 (25%) 中，病变累及胼胝体。一名患者的脑尸检显示，SWI 病变对应于广泛的微血管损伤，其特征是血管周围和实质点状出血以及显微镜下缺血性病变。结论和相关性：SWI 病变在具有严重 COVID-19 神经系统表现（昏迷和局灶性神经功能缺损）的患者中很常见。病变的分布与缺氧性呼吸衰竭、败血症和弥散性血管内凝血的患者相似。总的来说，这些放射学和组织病理学发现表明，重症 COVID-19 患者在皮层下和深部白质中存在多灶性微血管出血性和缺血性病变的风险。