Images from brain MRI demonstrated hemorrhagic rim enhancing lesionswithin the bilateral thalami, medial temporal lobes, and subinsular regions (Fig 2).


Smith College

- The first presumptive case of COVID-19 associated acute necrotizing hemorrhagic (ANE)—related to intracranial cytokine storms, which result in BBB breakdown.
- 3-day history of cough, fever, and altered mental status 
- Testing for the presence of SARSCoV-2 in the CSF was unable to be performed
- Evidence of ANE:
- CT images demonstrated symmetric hypoattenuation within the bilateral medial thalami with a normal CT angiogram and CT venogram (Fig 1).
- Images from brain MRI demonstrated hemorrhagic rim enhancing lesionswithin the bilateral thalami, medial temporal lobes, and subinsular regions (Fig 2).


Case Study: COVID-19–associated Acute Hemorrhagic Necrotizing Encephalopathy: CT and MRI Features

Poyiadji, N., Shahin, G., Noujaim, D., Stone, M., Patel, S., & Griffith, B. (2020). COVID-19–associated acute hemorrhagic necrotizing encephalopathy: CT and MRI features. Radiology, 201187.
https://pubs.rsna.org/doi/full/10.1148/radiol.2020201187


COVID-19–associated Acute Hemorrhagic Necrotizing Encephalopathy: CT and MRI Features


CT images demonstrated symmetric hypoattenuation within the bilateral medial thalami with a normal CT angiogram and CT venogram (Fig 1).


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