Bipallidal lesions in COVID 19 patients: Case series and review of literature

Objective: Here we present two previously unreported cases of bipallidal lesions found on MRI in COVID 19 positive patients as well as four previously reported cases;to compare and contrast the underlying pathophysiology and disease courses in each one. Our objective is to better understand the effects of COVID 19 on the CNS and improve diagnosis and treatment of the neurological manifestations. Background: The SARS-Cov-2 virus may directly effect the central nervous system (CNS) via hematogenous or neuronal entry, the CNS may also be affected secondary to the systemic effects of the disease. MRI imaging has been found to be beneficial in determining the ways in which the virus effects the CNS. The basal ganglia are highly metabolically active and have been found to be symmetrically affected by toxins, systemic/metabolic abnormalities, neurodegenerative disease, infections and vascular conditions. Our understanding of these disease processes and their imaging findings on MRI can potentially offer us insight into the imaging findings in our COVID-19 patients with bilateral Pallidal lesions. Design/Methods: Reports of patients admitted to hospital in Austin, TX as well as review of literature through 10/9/20 using PUBMED. Results: 2 novel patients are described as well as 4 patients described in prior literature. A table was constructed comparing and contrasting each case and potential etiologies are proposed based on analysis of the cases. Conclusions: Bipallidal lesions are specific to a handful of conditions and their presence in patients with COVID 19 provides us with insight into how the virus can effect the brain. These findings may reflect liver damage in individuals and/or may be the result of chronic hypoxia, blood glucose variability or vasculitis. Damage to these areas of the brain may be irreversible and create long term disability due to neurological dysfunction of the individuals infected and therefore it is important to identify them early.