Leukoencephalopathy Associated with Severe COVID-19 Infection: Sequela of Hypoxemia?

Brain MR images of a critically ill patient (Patient 2) with COVID-19 infection exhibiting impaired arousal, aphasia, and lethargy. A and B, Paired axial DWI and ADC map show symmetric foci of restricted diffusion involving the deep white matter of both cerebral hemispheres. C, Axial T2/FLAIR image through the same level shows associated increased T2/FLAIR hyperintensity corresponding to the regions of restricted diffusion. D, Axial fractional anisotropy map shows focal disruption of white matter tracts in the regions of diffusion restriction (white arrows). E and F, Paired axial DWI and ADC map show restricted diffusion of the body of the corpus callosum (arrow). G and H, Paired axial DWI and ADC map show restricted diffusion of the splenium of the corpus callosum (arrow).

Brain MR images of a critically ill patient (patient 1) with COVID-19 infection exhibiting altered mental status. A and B, Paired axial DWI and ADC map show symmetric restricted diffusion of the deep white matter of both cerebral hemispheres. C, Axial T2 FLAIR image through the same level shows associated increased T2 FLAIR hyperintensity corresponding to the regions of restricted diffusion.

Brain MR images of a critically ill patient (patient 5) with COVID-19 infection exhibiting impaired arousal and diffuse hypertonicity. A, Axial FLAIR image shows increased T2 FLAIR signal in the bilateral middle cerebellar peduncles (arrows). B, Contrast-enhanced T1-weighted image shows absence of abnormal enhancement of the bilateral middle cerebellar peduncles (arrows). C and D, Paired axial DWI and ADC map show corresponding restricted diffusion of bilateral middle cerebellar peduncles (arrows).