OBJECTIVES: 

Cerebrovascular injury associated with COVID-19 has been recognized, but the mechanisms remain uncertain. Acute respiratory distress syndrome (ARDS) is a severe pulmonary injury, which is associated with both ischemic and hemorrhagic stroke. It remains unclear if cerebrovascular injuries associated with severe COVID-19 are unique to COVID-19 or a consequence of severe respiratory disease or its treatment. The frequency and patterns of cerebrovascular injury on brain MRI were compared among patients with COVID-19 ARDS and non-COVID-19 ARDS.

DESIGN: 

A case-control study.

SETTING: 

A tertiary academic hospital system

PATIENTS: 

Adult patients (>18 yr) with COVID-19 ARDS (March 2020 to July 2021) and non-COVID-19 ARDS (January 2010-October 2018) who underwent brain MRI during their index hospitalization.

INTERVENTIONS: 

None.

MEASUREMENTS AND MAIN RESULTS: 

Cerebrovascular injury on MRI included cerebral ischemia (ischemic infarct or hypoxic ischemic brain injury) and intracranial hemorrhage (intraparenchymal, subarachnoid, or subdural, and cerebral microbleed [CMB]).

Twenty-six patients with COVID-19 ARDS and sixty-six patients with non-COVID ARDS underwent brain MRI during the index hospitalization, resulting in 23 age- and sex-matched pairs. The frequency of overall cerebrovascular injury (57% vs 61%), cerebral ischemia (35% vs 43%), intracranial hemorrhage (43% vs 48%), and CMB (52% vs 41%) between COVID-19 ARDS and non-COVID-19 ARDS patients was similar (all p values >0.05). However, four of 26 patients (15%) with COVID-19 and no patients with non-COVID-19 ARDS had disseminated leukoencephalopathy with underlying CMBs, an imaging pattern that has previously been reported in patients with COVID-19.

CONCLUSIONS: 

In a case-control study of selected ARDS patients with brain MRI, the frequencies of ischemic and hemorrhagic cerebrovascular injuries were similar between COVID-19 versus non-COVID-19 ARDS patients. However, the MRI pattern of disseminated hemorrhagic leukoencephalopathy was unique to the COVID-19 ARDS patients in this cohort.

中文翻译：

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与 COVID-19 和非 COVID-19 急性呼吸窘迫综合征相关的脑血管损伤的 MRI：匹配病例对照研究

目标： 

已认识到与 COVID-19 相关的脑血管损伤，但其机制仍不确定。急性呼吸窘迫综合征 (ARDS) 是一种严重的肺损伤，与缺血性和出血性中风有关。目前尚不清楚与严重 COVID-19 相关的脑血管损伤是 COVID-19 所特有的，还是严重呼吸系统疾病或其治疗的结果。比较了 COVID-19 ARDS 和非 COVID-19 ARDS 患者脑部 MRI 脑血管损伤的频率和模式。

设计： 

病例对照研究。

环境： 

三级学术医院系统

患者： 

患有 COVID-19 ARDS（2020 年 3 月至 2021 年 7 月）和非 COVID-19 ARDS（2010 年 1 月至 2018 年 10 月）的成年患者（>18 岁）在首次住院期间接受了脑部 MRI 检查。

干预措施： 

没有任何。

测量和主要结果： 

MRI 上的脑血管损伤包括脑缺血（缺血性梗死或缺氧缺血性脑损伤）和颅内出血（脑实质内、蛛网膜下腔或硬膜下和脑微出血 [CMB]）。

26 名 COVID-19 ARDS 患者和 66 名非 COVID-ARDS 患者在首次住院期间接受了脑部 MRI 检查，得到 23 对年龄和性别匹配的患者。COVID-19 ARDS 和非 COVID-19 ARDS 患者总体脑血管损伤（57% 对 61%）、脑缺血（35% 对 43%）、颅内出血（43% 对 48%）和 CMB（52% 对 41%）的频率-COVID-19 ARDS 患者相似（所有p值 > 0.05）。然而，26 名 COVID-19 患者中有 4 名 (15%) 而没有非 COVID-19 ARDS 患者患有播散性白质脑病并伴有潜在的 CMB，这是一种先前在 COVID-19 患者中报道过的影像学模式。

结论： 

在一项对选定的 ARDS 患者进行脑部 MRI 的病例对照研究中，COVID-19 与非 COVID-19 ARDS 患者的缺血性和出血性脑血管损伤的发生率相似。然而，弥漫性出血性脑白质病的 MRI 模式是该队列中 COVID-19 ARDS 患者所特有的。