Clinical and Radiological Profiles of COVID-19 Patients with Neurological Symptomatology: A Comparative Study

  1. Maria Aragao
  2. Mariana Leal
  3. Pedro Andrade
  4. Ocelio Cartaxo Filho
  5. Lucas Aragao
  6. Tatiana Fonseca
  7. Marcelo Valenca
  8. Maria Leao
  9. Joao Aragao
  10. Maria Soares
  11. Mirelle Lima
  12. Silvio Caldas
  13. Marcelo Valenca

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Abstract

Patients with COVID-19 can require radiological examination, with chest CT being more frequent than neuro-imaging. The objective is to identify epidemiological, clinical and radiological factors considered as predictors of neurological involvement in patients with COVID-19 assessed by neuroimaging and to describe the neuroimaging findings. This retrospective study was performed with 232 consecutive confirmed COVID-19 patients, from two radiological units, which were divided into two groups: (1) those who underwent a brain CT/MRI scan (n = 35) versus (2) those who did not undergo the brain CT/MRI scan, but underwent only chest CT (n = 197). There was a statistically significant difference with associations regarding the COVID-19 brain scan group for: admission to ICU, greater severity of lung injuries, the use of a mechanical ventilator and sepsis. Statistical tendency was found for chronic renal failure and systemic arterial hypertension. Forty-percent of COVID-19 patients from the brain scan group were abnormal on brain CT and/or brain MRI (22.9% of the cases with bleeding or microbleeding, 8.6% with restricted diffusion lesions). One ischemic stroke case was associated with irregularity at the M1 segment of the right middle cerebral artery. There was a case of left facial nerve palsy with enhancement of the left geniculate ganglia. An analysis of the olfactory bulbs was possible in 12 brain MRIs and 100% had enhancement and/or microbleeding. In conclusion, a more severe COVID-19 disease from ICU, a more severe form of lung disease, the use of mechanical ventilator and sepsis were associated to the COVID-19 patients with neurological involvement who had undergone brain scans. Microvascular phenomenon was a frequent finding in the brain and olfactory bulbs evaluated by neuroimaging.

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  1. Version published to 10.3390/v13050845
  2. ScreenIT

    SciScore for 10.1101/2020.12.28.20248957: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: The Institutional Review Board approved this retrospective study of the Ethics Committee.
    Consent: Informed consent was waived.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Statistical Analysis: Softwares SPSS 13.0 (Statistical Package for the Social Sciences) for Windows and Excel 2010 were used; all tests were applied with 95% confidence.
    SPSS
    suggested: (SPSS, RRID:SCR_002865)
    Statistical Package for the Social Sciences
    suggested: (SPSS, RRID:SCR_002865)
    Excel
    suggested: None

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    The limitation of our study is that it is a retrospective study. The variables analyzed were not always noted in the medical records of all patients. Patients underwent brain scans because of major neurological complications and not for anosmia. For this reason, the MRI of most patients did not have an adequate sequence to evaluate the olfactory bulbs. Despite the anterior fossa region being analyzed with coronal fat suppression T1WI can have susceptibility artifacts between the interface with the air, these artifacts are generally well recognized by radiologists and did not hinder the investigation and the analysis.40 However, future anatomopathological studies are necessary to confirm our finding. In conclusion, in COVID-19 patients, the impact of major neurological complication to indicate brain scans was much less frequent than respiratory complication to need chest CT. The profile of COVID-19 patients group which needed to undergo brain scans were statistically associated with the more severe COVID-19 disease, located at ICU, a more severe form of lung disease, use of of mechanical ventilator, complaints of dyspnea (less frequent), seizure, stroke and sepsis. There was a statistical tendency to chronic renal failure and systemic arterial hypertension. Regarding brain imaging findings, less than half of patients had abnormal imaging scans with all of them showing vascular brain injury lesion, being more frequently microbleeding or bleeding, followed by restricted diffusio...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.12.28.20248957v1 on medRxiv