We describe the case of a COVID-19 patient with severely impaired consciousness after sedation hold, showing magnetic resonance imaging (MRI) findings of (i) acute bilateral supratentorial ischemic lesions involving the fronto-parietal white matter and the corpus callosum and (ii) multiple diffuse susceptibility weighted imaging (SWI) hypointense foci, infra and supratentorial, predominantly bithalamic, suggestive of microhemorrhage or alternatively microthrombi. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) RNA was detected in the cerebrospinal fluid. Our findings suggest the occurrence of vascular damage, predominantly involving microvessels. The underlying mechanisms, which include direct and indirect penetration of the virus to the central nervous system and systemic cardiorespiratory complications, are yet to be elucidated, and a direct correlation with SARS-CoV-2 infection remains uncertain.

我们描述了一名在镇静后意识严重受损的 COVID-19 患者的病例，显示磁共振成像 (MRI) 结果：(i) 涉及额顶叶白质和胼胝体的急性双侧幕上缺血性病变，以及 (ii)幕下和幕上多个弥漫性磁敏感加权成像 (SWI) 低信号灶，主要是双丘脑，提示微出血或微血栓。在脑脊液中检测到严重急性呼吸综合征冠状病毒-2 (SARS-CoV-2) RNA。我们的研究结果表明血管损伤的发生，主要涉及微血管。其潜在机制，包括病毒直接和间接渗透到中枢神经系统以及全身性心肺并发症，尚未阐明，并且与 SARS-CoV-2 感染的直接相关性仍不确定。