Multifocal transient cortical brain lesions: a consistent MRI finding in neuro-COVID-19 patients

We report four cases of subacute encephalopathy occurring in patients with SARS-CoV-2 infection. All patients have been intubated in the first week from onset of ARDS and presented neurological signs of agitation and spatial disorientation after weaning from mechanical ventilation. The MRI picture and the clinical features are described. MRI lesions characteristics are unusual but demonstrate a highly consistent pattern through all the four patients with similar neurological symptoms. They do not fulfill any typical criteria for a definite neuroradiological entity. Their predominantly parieto-occipital distribution recalls posterior reversible encephalopathy syndrome (PRES), although the prevalent cortical involvement and diffusion MRI pattern are not typical of PRES. We speculate that this pattern may be related to a possible transient dysregulation of vasomotor reactivity.