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Radiology from Brain Team

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PDF - RADIOLOGY, from Brain Team

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RADIOLOGY from Brain Team

by Anne G. Osborn, MD, FACR and Miral D. Jhaveri, MD, MBA

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Autopsied case of acute necrotizing encephalopathy (ANE) shows bilateral hemorrhagic necrosis in the medial thalami. (Courtesy R. Hewlett, MD).
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Virus-associated ANE in an obtunded 5-year-old girl shows bilateral medial thalamic hyperintensities on T2WI. T2* GRE shows hemorrhagic foci. DWI shows restricted diffusion in the lesions. In this case, the etiology was influenza A, but the pathology is identical to ANE caused by SARS-CoV-2.
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Coronal autopsied case of acute hemorrhagic leukoencephalopathy (AHLE) shows innumerable petechial hemorrhages in the subcortical and deep white matter (WM) extending into the subcortical U-fibers. Note striking sparing of the cortex and basal ganglia. Findings are identical in critical illness-associated cerebral microbleeds.
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Axial T2* SWI in a case of viral infection and acute clinical deterioration show multiple tiny WM microbleeds. AHLE was confirmed by biopsy.
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Gross autopsy shows 2 areas of gross hemorrhagic necrosis in the left hemispheric WM. Findings and clinical history of prior flu-like illness with a rapidly progressive clinical course are characteristic of a viral exanthem with AHLE. (Courtesy R. Hewlett, MD.)
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Axial T2* GRE in a patient with rapid decline after a flu-like viral illness shows a large left frontal hemorrhage with numerous blooming foci in multiple subcortical WM lesions. This is AHLE. (Courtesy R. Ramakantan, MD).
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Axial FLAIR MR in a 32-year-old man with COVID-19 on intubation who developed altered mental status shows symmetric hyperintensity in the globi pallidi.
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Axial DWI in the same patient shows mild restricted diffusion in the outer margins of both globi pallidi. Hypoxic-ischemic encephalopathy (HIE) is common in patients with severe COVID-19, and the globus pallidi are commonly affected.
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Axial NECT scan in a 42-year-old man with COVID-19 was obtained shortly before the patient expired. Severe cerebral edema is present, seen here as diffuse low-density brain with effacement of all basilar cisterns. Both hemispheres and the cerebellum are affected.
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More cephalad NECT shows the gray matter-WM interfaces are completely effaced. The lateral ventricles are small, and the surface sulci are obliterated. The patient was pronounced brain dead shortly after the scan was obtained.
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Axial FLAIR in a 47-year-old woman with COVID-19 and altered mental status shows bilateral, nearly symmetric patchy perirolandic hyperintensities.
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Axial DWI in the same patient shows restricted diffusion in the perirolandic areas of both hemispheres, mild HIE.

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