Pearls & Oy-sters: Leukoencephalopathy in critically ill patients with COVID-19

Coronavirus disease 2019 (COVID-19) can cause diffuse leukoencephalopathy. cAlthough the pathophysiology of leukoencephalopathy due to COVID-19 is unclear, there are myriad possible mechanisms for this finding, including hypoxic-ischemic injury, microvascular thrombosis secondary to hypercoagulability, and endothelial damage. Oy-sters cDo not assume that critically ill patients with COVID-19 who are on sedation for a protracted period will be neurologically intact when sedation is discontinued and wears off.cIn critically ill patients with COVID-19 who have encephalopathy, before attributing prolonged coma to infection and toxic-metabolic conditions, obtain an MRI.The neurologic manifestations of coronavirus disease 2019 (COVID-19) have been increasingly documented. 1 However, severe encephalopathy with white matter changes on imaging has not been well-described.We present 4 patients with leukoencephalopathy following COVID-19 infection who were evaluated by the neurology team at New York University Langone Health-associated hospitals between April 2 and April 29, 2020.Select clinical data and laboratory values are found in table 1 and table e-1 (links.lww.com/WNL/B187),respectively.All 4 cases were positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nasopharyngeal PCR on admission.