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AJNR Awards, New Junior Editors, and more. Read the latest AJNR updates

Research ArticleAdult Brain
Open Access

Neurovascular Complications in COVID-19 Infection: Case Series

A.M. Franceschi, R. Arora, R. Wilson, L. Giliberto, R.B. Libman and M. Castillo
American Journal of Neuroradiology September 2020, 41 (9) 1632-1640; DOI: https://doi.org/10.3174/ajnr.A6655
A.M. Franceschi
aFrom the Neuroradiology Section (A.M.F.)
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R. Arora
bDepartments of Radiology and Neurology (R.A., L.G., R.B.L.), Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Manhasset, New York
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R. Wilson
cNeuroradiology Section (R.W., M.C.), Department of Radiology, The University of North Carolina School of Medicine, Chapel Hill, North Carolina.
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L. Giliberto
bDepartments of Radiology and Neurology (R.A., L.G., R.B.L.), Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Manhasset, New York
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R.B. Libman
bDepartments of Radiology and Neurology (R.A., L.G., R.B.L.), Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Manhasset, New York
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M. Castillo
cNeuroradiology Section (R.W., M.C.), Department of Radiology, The University of North Carolina School of Medicine, Chapel Hill, North Carolina.
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Figures

  • FIG 1.
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    FIG 1.

    Axial noncontrast head CT demonstrates focal low attenuation in the left posterior frontal/anterior parietal lobes in the region consistent with an acute infarction.

  • FIG 2.
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    FIG 2.

    Axial (A) and coronal (B) noncontrast CT demonstrates diffuse cerebral edema. There are horizontally oriented intra-axial hemorrhages (arrows) in the cerebellar hemispheres on the coronal view.

  • FIG 3.
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    FIG 3.

    Axial noncontrast CT demonstrates acute infarctions in the right frontal and parietal regions. There is a subcentimeter hemorrhage (arrow) in the right parietal region.

  • FIG 4.
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    FIG 4.

    Axial noncontrast CT demonstrates acute infarctions in the left frontal, parietal, and temporal lobes extending to the left basal ganglia and insular cortex, with additional small infarcts in the right anterior limb of the internal capsule and right frontal subcortical white matter.

  • FIG 5.
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    FIG 5.

    Noncontrast CT (A) demonstrates low attenuation in the parietal and temporal lobes compatible with acute infarctions. Head CTV (B) demonstrates occlusion of the cavernous segment of the right internal carotid artery (arrow). Neck CTA (C and D) shows extensive intraluminal thrombi (arrows) in the distal common carotid arteries, extending to the carotid bulbs and external carotid arteries.

  • FIG 6.
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    FIG 6.

    Coronal and sagittal neck CTA (A) demonstrates nonocclusive intraluminal thrombus (arrows) extending from the left common carotid artery to the proximal internal carotid artery. Axial DWI (B) demonstrates acute infarcts in the left frontal and parietal regions.

  • FIG 7.
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    FIG 7.

    Noncontrast CT demonstrates focal low attenuation in the right frontal centrum semiovale and right frontal subcortical region (A) and a wedge-shaped area of low attenuation in the right parietal region (B). DWI demonstrate small infarcts in the frontal lobes (C), both occipital lobes (D), and the left cerebellum (E).

  • FIG 8.
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    FIG 8.

    Noncontrast CT (A) demonstrates low attenuation in the left occipital lobe. DWI (B) confirms a left occipital infarction. Corresponding SWI (C) shows confluent hemorrhages in the region of the acute infarction. SWI through the centrum semiovale (D) shows numerous bilateral microhemorrhages. Postcontrast T1-weighted image (E) shows leptomeningeal enhancement overlying the left occipital infarction and diffuse dural enhancement.

  • FIG 9.
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    FIG 9.

    Non-contrast CT axial (A) and coronal (B) views demonstrate focal low attenuation in the parietal and right frontal lobes compatible with acute infarctions.

  • FIG 10.
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    FIG 10.

    Non-contrast CT demonstrates low attenuation suggestive of an acute right MCA territory infarction (A). There is subtle high attenuation (arrow) in the right Sylvian fissure suggesting thrombus (B). Coronal and sagittal CTA views demonstrate long-segment thrombus resulting in occlusion (arrow) of the right internal carotid artery (C). Head view (D) demonstrates occlusion of the right middle cerebral artery. Follow-up head CT obtained on the same day as CTA reveals a right middle cerebral artery territory acute infarction and possible infarctions in the left parietal lobe and left temporal region (E and F). Cerebellar infarctions were also present (G).

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American Journal of Neuroradiology: 41 (9)
American Journal of Neuroradiology
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Cite this article
A.M. Franceschi, R. Arora, R. Wilson, L. Giliberto, R.B. Libman, M. Castillo
Neurovascular Complications in COVID-19 Infection: Case Series
American Journal of Neuroradiology Sep 2020, 41 (9) 1632-1640; DOI: 10.3174/ajnr.A6655

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Neurovascular Complications in COVID-19 Infection: Case Series
A.M. Franceschi, R. Arora, R. Wilson, L. Giliberto, R.B. Libman, M. Castillo
American Journal of Neuroradiology Sep 2020, 41 (9) 1632-1640; DOI: 10.3174/ajnr.A6655
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