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

Research ArticleAdult Brain
Open Access

Serial Imaging of Virus-Associated Necrotizing Disseminated Acute Leukoencephalopathy (VANDAL) in COVID-19

S. Agarwal, J. Conway, V. Nguyen, S. Dogra, P. Krieger, D. Zagzag, A. Lewis, K. Melmed, S. Galetta and R. Jain
American Journal of Neuroradiology February 2021, 42 (2) 279-284; DOI: https://doi.org/10.3174/ajnr.A6898
S. Agarwal
aFrom the Department of Neurology (S.A., J.C., A.L., K.M., S.G.)
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J. Conway
aFrom the Department of Neurology (S.A., J.C., A.L., K.M., S.G.)
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V. Nguyen
bRadiology (V.N., S.D., P.K., R.J.)
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S. Dogra
bRadiology (V.N., S.D., P.K., R.J.)
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P. Krieger
bRadiology (V.N., S.D., P.K., R.J.)
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D. Zagzag
cPathology (D.Z.)
dNeurosurgery (D.Z., A.L., K.M., R.J.), NYU Langone Health, New York, New York
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A. Lewis
aFrom the Department of Neurology (S.A., J.C., A.L., K.M., S.G.)
dNeurosurgery (D.Z., A.L., K.M., R.J.), NYU Langone Health, New York, New York
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K. Melmed
aFrom the Department of Neurology (S.A., J.C., A.L., K.M., S.G.)
dNeurosurgery (D.Z., A.L., K.M., R.J.), NYU Langone Health, New York, New York
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S. Galetta
aFrom the Department of Neurology (S.A., J.C., A.L., K.M., S.G.)
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R. Jain
bRadiology (V.N., S.D., P.K., R.J.)
dNeurosurgery (D.Z., A.L., K.M., R.J.), NYU Langone Health, New York, New York
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    FIG 1.

    Axial DWI (A) and T2-weighted imaging (B) showing disseminated leukoencephalopathy with associated microhemorrhages (C) seen on the susceptibility-weighted imaging. D, Postcontrast T1-weighted imaging shows patchy enhancement of most WM lesions, with the larger lesion in the left cerebral hemisphere also showing central nonenhancement, suggestive of breakdown of the BBB and WM necrosis.

  • FIG 2.
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    FIG 2.

    A and B, Axial FLAIR and coronal T2-weighted images at baseline MR imaging (day 25) showing multiple confluent areas of leukoencephalopathy. C and D, These lesions progressed to show development of cystic cavitations in the WM (arrows) as well as interval prominence of the lateral and third ventricles, suggesting brain atrophy on follow-up MR imaging on day 75.

  • FIG 3.
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    FIG 3.

    Axial DWI, T2-weighted, FLAIR (A–C), and coronal T2-weighted images (D) at baseline MR imaging (day 10) showing multiple patchy areas of restricted diffusion/cytotoxic edema in the WM. E–H, Axial corresponding follow-up MR imaging (day 75) demonstrates development of cystic cavitations in the previous patchy cytotoxic WM lesions (arrows) as well as interval prominence of the lateral and third ventricles, suggesting brain atrophy. Follow-up MR imaging also showed marked progression of more confluent WM lesions surrounding the patchy cystic lesions.

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American Journal of Neuroradiology: 42 (2)
American Journal of Neuroradiology
Vol. 42, Issue 2
1 Feb 2021
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Cite this article
S. Agarwal, J. Conway, V. Nguyen, S. Dogra, P. Krieger, D. Zagzag, A. Lewis, K. Melmed, S. Galetta, R. Jain
Serial Imaging of Virus-Associated Necrotizing Disseminated Acute Leukoencephalopathy (VANDAL) in COVID-19
American Journal of Neuroradiology Feb 2021, 42 (2) 279-284; DOI: 10.3174/ajnr.A6898

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Serial Imaging of Virus-Associated Necrotizing Disseminated Acute Leukoencephalopathy (VANDAL) in COVID-19
S. Agarwal, J. Conway, V. Nguyen, S. Dogra, P. Krieger, D. Zagzag, A. Lewis, K. Melmed, S. Galetta, R. Jain
American Journal of Neuroradiology Feb 2021, 42 (2) 279-284; DOI: 10.3174/ajnr.A6898
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