We evaluated the incidence, distribution, and histopathologic correlates of microvascular brain lesions in patients with severe COVID-19. Sixteen consecutive patients admitted to the intensive care unit with severe COVID-19 undergoing brain MRI for evaluation of coma or neurologic deficits were retrospectively identified. Eleven patients had punctate susceptibility-weighted imaging (SWI) lesions in the subcortical and deep white matter, eight patients had >10 SWI lesions, and four patients had lesions involving the corpus callosum. The distribution of SWI lesions was similar to that seen in patients with hypoxic respiratory failure, sepsis, and disseminated intravascular coagulation. 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. Collectively, these radiologic and histopathologic findings add to growing evidence 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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磁敏感加权成像显示严重 COVID-19 的脑微血管损伤

我们评估了严重 COVID-19 患者脑微血管病变的发生率、分布和组织病理学相关性。回顾性确定了连续 16 名因严重 COVID-19 入住重症监护病房接受脑 MRI 评估昏迷或神经功能缺损的患者。11 名患者在皮层下和深部白质中有点状磁敏感加权成像 (SWI) 病变，8 名患者有 >10 个 SWI 病变，4 名患者有累及胼胝体的病变。SWI 病灶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。一名患者的脑解剖显示 SWI 病变对应于广泛的微血管损伤，以血管周围和实质点状出血和微观缺血性病变为特征。总的来说，这些放射学和组织病理学发现增加了越来越多的证据，表明严重 COVID-19 患者有皮层下和深部白质中多灶性微血管出血和缺血性病变的风险。