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Research ArticleHead and Neck Imaging
Open Access

Olfactory Bulb Signal Abnormality in Patients with COVID-19 Who Present with Neurologic Symptoms

S.B. Strauss, J.E. Lantos, L.A. Heier, D.R. Shatzkes and C.D. Phillips
American Journal of Neuroradiology August 2020, DOI: https://doi.org/10.3174/ajnr.A6751
S.B. Strauss
aFrom the Department of Radiology (S.B.S., J.E.L., L.A.H., C.D.P.), Weill Cornell Medical College, New York-Presbyterian, New York, New York
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J.E. Lantos
aFrom the Department of Radiology (S.B.S., J.E.L., L.A.H., C.D.P.), Weill Cornell Medical College, New York-Presbyterian, New York, New York
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L.A. Heier
aFrom the Department of Radiology (S.B.S., J.E.L., L.A.H., C.D.P.), Weill Cornell Medical College, New York-Presbyterian, New York, New York
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D.R. Shatzkes
bDepartment of Radiology (D.R.S.), Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital and The New York Head and Neck Institute, New York, New York.
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C.D. Phillips
aFrom the Department of Radiology (S.B.S., J.E.L., L.A.H., C.D.P.), Weill Cornell Medical College, New York-Presbyterian, New York, New York
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  • FIG 1.
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    FIG 1.

    Quantitative assessment of OB signal intensity. For each patient, the ROI is drawn at the mid segment of the OB and within the left superior frontal WM to calculate normalized values.

  • FIG 2.
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    FIG 2.

    Normalized OB T2 FLAIR signal intensity in patients and controls. Box-and-whisker plots show median and interquartile ranges for each group. There was a significant difference in mean signal intensity between the patients and the controls (P = .003). Findings remain significant even with the exclusion of the COVID-19 high outlier depicted at a mean normalized OB T2 FLAIR signal intensity of 3.1.

  • FIG 3.
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    FIG 3.

    A 48-year-old woman positive for COVID-19 who presented with weakness and unsteady gait of 1 week’s duration. Neurologic examination was significant for truncal ataxia, dysarthria, and left-sided dysmetria. A, Coronal high-resolution T2WI demonstrates normal OB morphology and signal intensity. B, Coronal and (C) sagittal postcontrast T2 FLAIR images demonstrate an increased T2 signal within the OB (red arrows). Note relative increased signal compared with (D) coronal T2WI at the level of the intracisternal segment of the trigeminal nerve (red arrow).

  • FIG 4.
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    FIG 4.

    A 52-year-old woman positive for COVID-19 and with a history of major depressive disorder, was found to be catatonic. A, Coronal and (B) sagittal postcontrast 3D T2 FLAIR demonstrates increased intraneural signal within the OBs (red arrows) relative to (C) coronal postcontrast 3D T2 FLAIR images of the trigeminal nerve (red arrow).

  • FIG 5.
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    FIG 5.

    A 74-year-old woman (in the control group) with decreased sense of smell of several months’ duration. Coronal postcontrast 3D T2 FLAIR of (A) the OB (red arrow) and (B) the trigeminal nerve (red arrow) demonstrate isointense signal.

Tables

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    Table 1:

    Kennedy staging

    StageDescription
    0Normal
    IAnatomic abnormalities, unilateral sinus disease, bilateral disease limited to ethmoid sinuses
    IIBilateral ethmoid disease with involvement of 1 dependent sinus
    IIIBilateral ethmoidal disease with involvement of 2 or more dependent sinuses on each side
    IVDiffuse sinonasal polyposis
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    Table 2:

    Demographic and clinical characteristics of patients and controls

    CharacteristicPatients (n = 12)Controls (n = 12)
    Age, mean ± standard deviation, y58.25 ± 14.85258.00 ± 13.824
    Sex at birth6 women, 6 men9 women, 3 men
    Indication for study (n/N)Altered mental status (9/12); ataxia, dysarthria (1/12); status epilepticus (1/12); paresthesia, anosmia (1/12)Anosmia (7); phantosmia (2); hyposmia (3)
    Kennedy staging score, n/N
        037
        I42
        II00
        III20
        IV33
    Olfactory recess involvement, n/N01
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    Table 3:

    Severity of chronic microvascular ischemic disease in patients and controls

    SubjectsNoneMildModerateSevere
    Patients with COVID-190.500.250.1670.83
    Controls with anosmia0.3330.4170.250.00
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Cite this article
S.B. Strauss, J.E. Lantos, L.A. Heier, D.R. Shatzkes, C.D. Phillips
Olfactory Bulb Signal Abnormality in Patients with COVID-19 Who Present with Neurologic Symptoms
American Journal of Neuroradiology Aug 2020, DOI: 10.3174/ajnr.A6751

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Olfactory Bulb Signal Abnormality in Patients with COVID-19 Who Present with Neurologic Symptoms
S.B. Strauss, J.E. Lantos, L.A. Heier, D.R. Shatzkes, C.D. Phillips
American Journal of Neuroradiology Aug 2020, DOI: 10.3174/ajnr.A6751
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