Spectrum of common and uncommon neurovascular and neurological manifestations of COVID-19 on cross-sectional imaging

Abstract

COVID-19 is an emerging and re-emerging disease that is caused by SARS CoV-2, a neurotropic virus that frequently involves the central nervous system in addition to the lungs. Findings on neuroimaging can be observed in a significant percentage of active COVID-19 and post-COVID patients, especially those who are/have been critically ill. Accurate diagnosis of such cases on imaging aids in appropriate patient management and prevention of permanent neurological deficits. The features of CNS involvement in COVID-19 can be broadly categorized as the more common neurovascular and relatively uncommon neurological manifestations. Several pathophysiological mechanisms have been proposed for the patterns of CNS involvement and corresponding neuroimaging features in COVID-19. We have outlined the pathophysiology and indications for neuroimaging in COVID-19 and extensively discussed the neuroimaging features of the entire spectrum of neurovascular and neurological manifestations, including the rare and diagnostically challenging ones, through case-based illustrations. As new strains of COVID-19 continue to emerge, radiologists need to be aware of the imaging features of various neurological and neurovascular manifestations of CNS involvement in COVID-19 as timely diagnosis is vital in preventing or limiting permanent neurological deficits in such cases.