Neuroimaging findings in 4342 hospitalized COVID-19 subjects: A multicenter report from the United States and Europe

J Neuroimaging. 2023 Sep-Oct;33(5):752-763. doi: 10.1111/jon.13140. Epub 2023 Jun 28.


Background and purpose: To determine the incidence of acute neuroimaging (NI) findings and comorbidities in the coronavirus disease of 2019 (COVID-19)-infected subjects in seven U.S. and four European hospitals.

Methods: This is a retrospective study of COVID-19-positive subjects with the following inclusion criteria: age >18, lab-confirmed COVID-19 infection, and acute NI findings (NI+) attributed to COVID-19 on CT or MRI brain. NI+ and comorbidities in total hospitalized COVID-19-positive (TN) subjects were assessed.

Results: A total of 37,950 COVID-19-positive subjects were reviewed and 4342 underwent NI. NI+ incidence in subjects with NI was 10.1% (442/4342) including 7.9% (294/3701) in the United States and 22.8% (148/647) in Europe. NI+ incidence in TN was 1.16% (442/37,950). In NI (4342), incidence of ischemic stroke was 6.4% followed by intracranial hemorrhage (ICH) (3.8%), encephalitis (0.5%), sinus venous thrombosis (0.2%), and acute disseminated encephalomyelitis (ADEM) (0.2%). White matter involvement was seen in 57% of NI+. Hypertension was the most common comorbidity (54%) before cardiac disease (28.8%) and diabetes mellitus (27.7%). Cardiac disease (p < .025), diabetes (p < .014), and chronic kidney disease (p < .012) were more common in the United States.

Conclusion: This multicenter, multinational study investigated the incidence and spectrum of NI+ in 37,950 hospitalized adult COVID-19 subjects including regional differences in incidences of NI+, associated comorbidities, and other demographics. NI+ incidence in TN was 1.16% including 0.95% in the United States and 2.09% in Europe. ICH, encephalitis, and ADEM were common in Europe, while ischemic strokes were more common in the United States. In this cohort, incidence and distribution of NI+ helped characterize the neurological complications of COVID-19.

Keywords: COVID-19; brain; neuroimaging.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • COVID-19* / diagnostic imaging
  • COVID-19* / epidemiology
  • Encephalitis*
  • Encephalomyelitis, Acute Disseminated*
  • Europe / epidemiology
  • Heart Diseases*
  • Humans
  • Intracranial Hemorrhages
  • Ischemic Stroke*
  • Neuroimaging / methods
  • Retrospective Studies
  • United States / epidemiology