Letter by Uchino and Cho Regarding Article, "Infarction of the Splenium of the Corpus Callosum in the Age of COVID-19: A Snapshot in Time".

To the Editor:

Among the many reports on complications of coronavirus disease 2019 (COVID-19), we read the report by Sparr and Bieri[1] with interest. They report 4 patients with infarcts in the splenium of the corpus callosum and tested positive for COVID-19 (2 diagnosed with computed tomography only and 2 with magnetic resonance imaging). The authors report that splenial infarcts are uncommon, and these 4 might represent a unique feature of COVID-19. Three of 4 had severe respiratory disease and were supported with mechanical ventilation and dialysis. The authors suggest that the strokes might reflect underlying “hypoxia, release of inflammatory cytokines, effects of the virus on clotting, viral invasion of blood vessels causing angitis…”

Radiological studies of patients with COVID-19, essentially all with respiratory failure with mechanical ventilation and encephalopathy, have reported frequent occurrences of cerebral infarcts and microhemorrhages on magnetic resonance imaging. In 1 study, among 73 COVID-19 patients with magnetic resonance imaging of the brain, there were 3 with restricted diffusion in splenium of corpus callosum and 5 with microhemorrhages in corpus callosum.[2] Other reports also noted frequent observation of microhemorrhages in corpus callosum and juxtacortical white matter.[3] Over the past several years, this pattern of microhemorrhages in juxtacortical white matter and corpus callosum has been reported among critically ill patients with acute respiratory distress syndrome, mechanical ventilation, or extracorporeal membrane oxygenation support.[4,5] Although we agree that these infarcts and microhemorrhages might reflect a COVID-19–specific process, it is also possible that a microangiopathic process might be common among patients with critical illness regardless of COVID-19 status.

Disclosures

Dr Uchino has received compensation from Ono Pharmaceutical, Co, Ltd, Portola, Inc, Abbott Laboratories, and Genentech, Inc, unrelated to this work. The other author reports no conflicts.