Brain MRI findings in neurologically symptomatic COVID-19 patients: a systematic review and meta-analysis

• Published in: Journal of neurology 2023-11, Vol.270 (11), p.5131-5154
• Main Authors: Afsahi, Amir Masoud, Norbash, Alexander M., Syed, Shahla F., Sedaghat, Maya, Afsahi, Ghazaleh, Shahidi, Ramin, Tajabadi, Zohreh, Bagherzadeh-Fard, Mahsa, Karami, Shaghayegh, Yarahmadi, Pourya, Shirdel, Shabnam, Asgarzadeh, Ali, Baradaran, Mansoureh, Khalaj, Fattaneh, Sadeghsalehi, Hamidreza, Fotouhi, Maryam, Habibi, Mohammad Amin, Jang, Hyungseok, Alavi, Abass, Sedaghat, Sam
• Format: Article
• Language: English
• Subjects: Basal ganglia; Coronaviruses; Corpus callosum; COVID-19; Cytotoxicity; Encephalitis; Encephalomyelitis; Encephalopathy; Hypoxia; Ischemia; Lesions; Magnetic resonance imaging; Medicine; Medicine & Public Health; Meninges; Meta-analysis; Nervous system; Neurology; Neuropathy; Neuroradiology; Neurosciences; Olfactory bulb; Review; Substantia alba; Substantia grisea; Systematic review; Thrombosis
• ISSN: 0340-5354; 1432-1459
• DOI: 10.1007/s00415-023-11914-9

Background Coronavirus disease 2019 (COVID-19) has been associated with nervous system involvement, with more than one-third of COVID-19 patients experiencing neurological manifestations. Utilizing a systematic review, this study aims to summarize brain MRI findings in COVID-19 patients presenting with neurological symptoms. Methods Systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) checklist. The electronic databases of PubMed/MEDLINE, Embase, Scopus, and Web of Science were systematically searched for literature addressing brain MRI findings in COVID-19 patients with neurological symptoms. Results 25 publications containing a total number of 3118 COVID-19 patients with neurological symptoms who underwent MRI were included. The most common MRI findings and the respective pooled incidences in decreasing order were acute/subacute infarct (22%), olfactory bulb abnormalities (22%), white matter abnormalities (20%), cerebral microbleeds (17%), grey matter abnormalities (12%), leptomeningeal enhancement (10%), ADEM (Acute Disseminated Encephalomyelitis) or ADEM-like lesions (10%), non-traumatic ICH (10%), cranial neuropathy (8%), cortical gray matter signal changes compatible with encephalitis (8%), basal ganglia abnormalities (5%), PRES (Posterior Reversible Encephalopathy Syndrome) (3%), hypoxic-ischemic lesions (4%), venous thrombosis (2%), and cytotoxic lesions of the corpus callosum (2%). Conclusion The present study revealed that a considerable proportion of patients with COVID-19 might harbor neurological abnormalities detectable by MRI. Among various findings, the most common MRI alterations are acute/subacute infarction, olfactory bulb abnormalities, white matter abnormalities, and cerebral microbleeds.