Radiology of the central nervous system of patients in the acute phase of СOVID-19

Abstract

This article, being based on the analysis of literature and the author’s own materials, outlines the features of the lesion of the central nervous system in a new coronavirus infection. The main idea is that despite the primary damage to the respiratory tract, SARS-CoV-2 can be attributed to a number of signs as neurotropic viruses, which is ultimately realized by the transport of the pathogen COVID-19 from the place of primary localization — the respiratory tract to the human brain. The virus is capable of hitting all possible pathways of being transferred through tissues and within a short time appears in the brain, interacting with ACE2 receptors and co-receptors, which are expressed in almost all brain cells, neurons, astrocytes, oligodendrocytes, microgliocytes, which carry out the main functional tasks of the brain. The clinical part is devoted to radiation diagnosis of lesions of the nervous system caused by the SARS-CoV-2 coronavirus. Analysis of the literature has made it possible to identify radiation variants of CNS lesions in COVID-19, illustrating the main clinical manifestations of the disease. There are several main clinical and morphological variants of CNS damage in COVID-19 1: acute ischemic stroke, acute encephalopathy, due to massive diffuse damage to the endothelium against the background of vasculitis / endotheliitis, occurring both with and without signs of cerebral artery thrombosis, hemorrhages, primarily of the type of small petechiae, polyetiologic in nature (endothelial damage, acute hypoxia, microembolism). In addition, hemorrhages can be a consequence of venous infarction against the background of sinus thrombosis. Radiological methods can diagnose multi-step lesions of the supra- and subtentorial white matter, vasculitis, in particular Susak’s syndrome, posterior reversible leukoencephalopathy — PRES, leukoencephalopathy, delayed post-hypoxic leukoencephalopathy, Miller–Fischer’s polyneuropathy (Guillain-Barre syndrome), syndrome.