CASE REPORT   Free access

Journal of Radiological Review 2021 March;8(1):17-21

DOI: 10.23736/S2723-9284.20.00064-1

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Conventional and advanced MRI features of COVID-19-associated hemorrhagic necrotizing encephalopathy

Fabio LOMBARDO ¹ ✉, Alessandro ADAMI ², Eugenio S. OLIBONI ¹, Carmelo CICCIÒ ¹, Giuseppe SALA ¹, Zaira ESPOSITO ², Stefano FORLIVESI ², Giovanni CARBOGNIN ¹, Alberto BELTRAMELLO ¹

¹ Department of Radiology, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy; ² Department of Neurology, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy

We report the case of a 65 years-old female referred to our Emergency Department (ED) for acute onset of right hemiparesis-hypoesthesia with 7^th right cranial nerve involvement. After hospitalization, oropharyngeal and nasopharyngeal swabs, she resulted positive for SARS-CoV-2. Magnetic resonance (MR) examination showed heterogeneous enhancing lesions in the basal ganglia and in the left temporal lobe surrounded by vasogenic edema. Even if perfusion weighted imaging (PWI) and MR spectroscopy were inconclusive for a glial tumor, it was initially considered the most probable diagnosis along with atypical infectious process. After 14 days of i.v. antibiotic and corticosteroid therapy, a second MR examination showed a significant reduction of the enhancing areas and the surrounding edema alongside transient improving clinical conditions. Nevertheless, multiple hemorrhagic foci appeared in the affected regions and in the right cerebral pedicle. Eventually, the patient died due to the worsening of intracranial hemorrhage. These findings led to the presumptive diagnosis of COVID-19-associated hemorrhagic necrotizing encephalopathy (ANE).

KEY WORDS: Magnetic resonance imaging; Magnetic resonance spectroscopy; Perfusion imaging