Neuroradiological Features of Mild and Severe SARS-CoV-2 Infection

Acad Radiol. 2020 Nov;27(11):1507-1514. doi: 10.1016/j.acra.2020.08.026. Epub 2020 Aug 29.


Rationale and objectives: An increasing number of neurological complications and corresponding radiological findings have been reported in patients with COVID-19 infection. The purpose of this study is to systematically review the current literature on COVID-19-associated neuroradiological findings and examine the prevalence of different findings in patients with both severe and mild COVID-19 infection.

Materials and methods: A comprehensive literature search of the PubMed and Embase databases was performed. Any studies reporting CT or MRI neuroimaging findings in patients with confirmed COVID-19 infection were included. Patient demographics, main radiological findings, neurological symptoms, and severity of COVID-19 infection were tabulated and quantified according to infection severity.

Results: Sixty-one studies published between 2019 and 2020 comprising 711 patients were analyzed according to severity of respiratory symptoms. The main neuroradiological findings for patients with mild classification were cranial nerve abnormalities, ischemic infarction, and white matter abnormalities, while the main findings in patients with severe classification were white matter abnormalities, ischemic infarction, and hemorrhagic events.

Conclusion: Neuroradiological manifestations in COVID-19 infection are highly heterogeneous and differ based on the severity of COVID-19 infection. Cranial nerve abnormalities appear exclusive to mild infection, with a high degree of olfactory tract involvement, while hemorrhagic events are more common in severe infection. Notably, ischemic infarction was equally prevalent in both mild and severe COVID-19 infection. Healthcare providers treating COVID-19 patients should be aware of these potential complications and consider neurological assessment and neuroimaging studies when indicated.

Keywords: COVID-19; MRI; Neuroimaging; Neuroradiology; SARS-CoV-2.

Publication types

  • Systematic Review

MeSH terms

  • Betacoronavirus*
  • COVID-19
  • Coronavirus Infections* / complications
  • Humans
  • Nervous System Diseases* / virology
  • Pandemics*
  • Pneumonia, Viral* / epidemiology
  • SARS-CoV-2