• Tim Coolen, Valentina Lolli, Niloufar Sadeghi, Antonin Rovai, Nicola Trotta, Fabio Silvio Taccone, Jacques Creteur, Sophie Henrard, Jean-Christophe Goffard, Olivier Dewitte, Gilles Naeije, Serge Goldman, and Xavier De Tiège.
• From the Department of Radiology (T.C., V.L., N.S.), Department of Nuclear Medicine (A.R., N.T., S.G., X.D.T.), Intensive Care Unit (F.S.T., J.C.), Department of Internal Medicine (S.H., J.-C.G.), Department of Neurosurgery (O.D.W.), and Department of Neurology (G.N.), CUB Hôpital Erasme, and Laboratoire de Cartographie fonctionnelle du Cerveau (T.C., V.L., A.R., N.T., S.G., X.D.T.), UNI-ULB Neuroscience Institute, Université libre de Bruxelles, Brussels, Belgium.
• Neurology. 2020 Oct 6; 95 (14): e2016-e2027.

ObjectivesThe severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is considered to have potential neuroinvasiveness that might lead to acute brain disorders or contribute to respiratory distress in patients with coronavirus disease 2019 (COVID-19). This study investigates the occurrence of structural brain abnormalities in non-survivors of COVID-19 in a virtopsy framework.MethodsIn this prospective, monocentric, case series study, consecutive patients who fulfilled the following inclusion criteria benefited from an early postmortem structural brain MRI: death <24 hours, SARS-CoV-2 detection on nasopharyngeal swab specimen, chest CT scan suggestive of COVID-19, absence of known focal brain lesion, and MRI compatibility.ResultsAmong the 62 patients who died of COVID-19 from March 31, 2020, to April 24, 2020, at our institution, 19 decedents fulfilled the inclusion criteria. Parenchymal brain abnormalities were observed in 4 decedents: subcortical microbleeds and macrobleeds (2 decedents), cortico-subcortical edematous changes evocative of posterior reversible encephalopathy syndrome (PRES; 1 decedent), and nonspecific deep white matter changes (1 decedent). Asymmetric olfactory bulbs were found in 4 other decedents without downstream olfactory tract abnormalities. No brainstem MRI signal abnormality was observed.ConclusionsPostmortem brain MRI demonstrates hemorrhagic and PRES-related brain lesions in non-survivors of COVID-19. SARS-CoV-2-related olfactory impairment seems to be limited to olfactory bulbs. Brainstem MRI findings do not support a brain-related contribution to respiratory distress in COVID-19.© 2020 American Academy of Neurology.

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