0:01

This is another example of

0:03

a leukoencephalopathy,

0:05

a white matter disease that has become better

0:09

understood in the past two years.

0:13

This patient had severe pulmonary distress and Covid,

0:19

and was identified to have left-sided

0:23

Horner syndrome dysmetria.

0:27

The patient had a background history of diabetes

0:30

and diabetic neuropathy and nephropathy,

0:33

and also had end-stage renal disease.

0:36

So a lot going on,

0:38

and the study was done because of the patient's

0:41

neurologic deficits and change in mental status.

0:45

I have here the T2-weighted scan

0:49

and FLAIR scan.

0:50

Unfortunately,

0:51

the patient was on a ventilator, and therefore,

0:53

there's a lot of motion artifact,

0:55

as you can see on the FLAIR scan.

0:57

But what the study does show is a central

1:01

leukoencephalopathy that is bright on the FLAIR,

1:06

and which extends, as you can see,

1:08

into the posterior limbs of the internal capsule.

1:12

On the fast T2-weighted scan, again,

1:15

you get the sense of the extent into the

1:17

posterior limbs of the internal capsule

1:20

with widening and bright signal,

1:22

and then the involvement of the corona radiata.

1:25

And then above the corona radiata,

1:27

you have the centrum semiovale

1:29

with somewhat sparing of the periphery.

1:32

Now, in Covid leukoencephalopathy,

1:35

which this is a case of,

1:37

you generally do see microbleeds.

1:39

This is the susceptibility-weighted

1:41

scan on this individual.

1:44

And this patient was spared of the microbleeds

1:47

that one might see on patients with white matter

1:51

disease from COVID.

1:53

You might also see

1:54

superimposed strokes and ischemic injuries on

1:58

the basis of the hypercoagulability

2:00

that may occur with COVID.

2:03

Note that on the ADC map,

2:07

the areas of the white matter disease do show

2:12

reduction in ADC centrally here on either side

2:16

of the ventricular system, which, again,

2:18

is not uncommon with COVID leukoencephalopathy.

2:24

Your differential diagnosis includes hypoxic

2:27

ischemic leukoencephalopathy,

2:30

which may also occur in patients who have COVID,

2:34

and that's more of a

2:37

different mechanism where the patient may have

2:40

had a respiratory arrest,

2:42

as opposed to the more insidious onset of the

2:47

Covid leukoencephalopathy.