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Brain imaging COVID-19 and pneumonia with worsening respiratory status and altered mental state

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Brain imaging in a 76-year-old man with COVID-19 and pneumonia with worsening respiratory status and altered mental state. Because his drowsy mental state persisted, a brain MRI was performed 23 days after onset. (A) The MRI revealed symmetrical high-signal-intensity lesions in the bilateral globus pallidus on a fluid-attenuation inversion recovery image. (B, C) These lesions did not show restricted diffusion on DWI and the apparent diffusion coefficient map. (D-H) Multiple punctate lesions with high DWI signal intensity were noted in the bilateral cerebral white matter. The distribution of these lesions did not correspond to typical watershed territories but was more consistent with an embolic infarction pattern. (I) There were no hemorrhagic changes observed in the globus pallidus on susceptibility-weighted imaging, apart from dark signal intensity due to iron deposition. Abbreviations: COVID-19 = coronavirus disease 2019, DWI = diffusion-weighted imaging, MRI = magnetic resonance imaging. (From: Park JH, Yi KS, Choi CH, Kim Y, Lee J. Bilateral globus pallidus lesions associated with COVID-19: mimicking acute carbon monoxide poisoning. Medicine (Baltimore) 2025;104(35):e44183. Creative Commons Attribution 4.0 International [CC BY 4.0] license, creativecommons.org/licenses/by/4.0.)