PMC7577845_01
CT scan in a 77-year-old COVID-19 patient. An acute infarct is present in the right MCA territory
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Fig1
Computerized tomography (CT) scan revealed a large acute right middle cerebral artery (MCA) infarction involving the right basal ganglia, insula, and frontal, parietal, and temporal lobes (Fig. 1).
PMC7577845_02
CT scan in a 62-year-old COVID-19 patient. Multiple acute parenchymal hemorrhages involving both cerebral hemispheres, leading to marked swelling, mass effect, and brain herniation
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Fig2
Due to persistent encephalopathy over the next week, a CT scan of the head was performed and showed (Fig. 2) multiple acute intraparenchymal hemorrhages involving both cerebral hemispheres, with marked edema, mass effect, and herniation.
PMC7577845_03
MRI in a 72-year-old COVID-19 patient. Diffusion-weighted imaging shows a large acute infarction in the right MCA territory
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Fig3
Magnetic resonance imaging (MRI) showed acute infarction within the right MCA territory (Fig. 3).
PMC7577845_04
CT scan in a 40-year-old COVID-19 patient. A large acute infarct in the left MCA territory involves a large part of the left cerebral hemisphere with associated swelling, mass effect, and mild midline shift. Also noted is a small acute infarct in the right temporal lobe
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Fig4
CT scan showed early ischemic changes in the left insula and frontal operculum and hyperdensity involving the distal M1 and proximal M2 segments of the left MCA, concerning for acute thrombus (Fig. 4).
PMC7577845_05
CT scan in a 7-year-old COVID-19 patient. Non-contrast images show diffuse loss of gray-white matter differentiation and diffuse cerebral edema
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Fig5
Head CT at that time demonstrated diffuse cerebral edema with loss of gray-white differentiation (Fig. 5).
a Lymphocytes and histiocytes in the leptomeninges. b, c Perivascular infiltrates of lymphocytes and histiocytes in the right superior frontal cortex. d Shrunken and hyperchromatic pyramidal neurons in an edematous neuropil (hematoxylin and eosin; original magnification a, c, d x 400, b x 200)
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Fig6
Pathological evaluation showed a mixed mononuclear inflammatory infiltrate in leptomeningeal space and cortical tissue (Figs. 6 and 7).
a Perivascular inflammatory infiltrates composed partly of CD3-immunopositive lymphocytes in the cerebral cortex. b Lymphocytes are also immunopositive for CD5. c Leptomeningeal infiltrates of CD3-immunopositive lymphocytes. d Lymphocytes are also immunopositive for CD5. e, f Leptomeningeal infiltrate of mostly perivascular CD163-immunopositive histiocytes. g, h Perivascular infiltrate of CD163-immunopositive histiocytes and numerous microglia in the cerebral cortex. (a and c CD3 immunostains, b and d CD5 immunostains, e-h CD163 immunostains; original magnification a and h x 400; b x 800; c, d, and f x 200; e x 40; g x 100)
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Fig7
Pathological evaluation showed a mixed mononuclear inflammatory infiltrate in leptomeningeal space and cortical tissue (Figs. 6 and 7).