QJM: An International Journal of Medicine. 2022, 115 (8), 539journal articl

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30104

40398152

60911732

Imoto, Waki

Kakeya, Hiroshi

Yamada, Koichi

井本, 和紀

掛屋, 弘

English

Osaka Metropolitan University Repository Education and Research Archives

Long COVID with intracranial microangiopathy言語: English出版者: Oxford University Press公開日: 2025-05-26キーワード (Ja): キーワード (En): 作成者: 井本, 和紀, Yamada, Koichi, 掛屋, 弘メールアドレス: 所属: メタデータhttp://hdl.handle.net/10466/0002003059URLClinical Picture Long COVID with intracranial microangiopathy  Waki Imoto1,2,3, Koichi Yamada1,2,3, Hiroshi Kakeya1,2,3*  1 Department of Infection Control Science, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan 2 Department of Infectious Disease Medicine, Osaka Metropolitan University Hospital, Osaka 545-8586, Japan 3 Department of Infection Control and Prevention, Osaka Metropolitan University Hospital, Osaka 545-8586, Japan  Address correspondence to: Dr Hiroshi Kakeya, Department of Infection Control Science, Osaka Metropolitan University, Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan; E-mail: kakeya-ngs@umin.ac.jp/kakeya@omu.ac.jp  A 56-year-old woman with a history of hypertension was diagnosed with coronavirus disease 2019 (COVID-19). On the fourth illness day, her condition became severe, and she was admitted to the intensive care unit and treated with high-flow oxygen via a mask. She recovered and was discharged on day 11 of hospitalization (the 14th day of COVID-19). One week after discharge (three weeks after onset), she noticed pain in the muscles of her right limbs. The pain in her right limbs persisted and 12 months after COVID-19 onset she consulted her primary care doctor and was referred to us because of suspected long COVID. On neurological examination, although spontaneous pain was noted, no grasping pain or paresthesia were observed. Apart from the pain in her right arm, no abnormal neurological findings were detected. Brain magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) were performed. Susceptibility-weighted MRI revealed a linear hypo-intensity inside the postcentral gyrus, surrounded by atrophy (figure 1a, red arrow). No abnormal findings were observed on MRA (figure 1b).  Various neurological events and abnormal brain MRI findings have been reported in patients with acute COVID-19.1 Myalgia is a common symptom of long COVID2 but to our knowledge, no cases of cerebral microangiopathy have been reported in patients with long COVID who did not experience neurological symptoms in the acute phase. In this case, the symptoms appeared approximately 3 weeks after the onset of COVID-19, without any obvious signs of cerebral infarction. If a patient with a history of COVID-19 presents with a microangiopathy that cannot be confirmed by MRA, it is possible that they have a microangiopathy triggered by COVID-19. As myalgia is a common symptom in long COVID,2 it is possible that other cases of microangiopathy, similar to this case, have been overlooked. In patients with long COVID, it is essential to rule out organic diseases that may contribute to the patients’ symptoms. In cerebral microangiopathy due to COVID-19, there may be a slight time lag between the onset of the illness and the onset of symptoms, as in this case.  Acknowledgments We would like to thank Editage (www.editage.com) for their assistance with English language editing.  Conflict of interest: None.  Consent for publication Written informed consent was obtained from the patient for publication of this case report and the accompanying images. A copy of the written consent is available for review upon request.  References 1. Sawlani V, Scotton S, Nader K, Jen JP, Patel M, Gokani K, et al. COVID-19-related intracranial imaging findings: a large single-centre experience. Clin Radiol 2021; 76:108–116. 2. Aiyegbusi OL, Hughes SE, Turner G, Rivera SC, McMullan C, Chandan JS, et al; TLC Study Group. Symptoms, complications and management of long COVID: a review. J R Soc Med 2021; 114:428–442.  Figure legend Figure 1. Cranial magnetic resonance imaging. (a) Susceptibility-weighted magnetic resonance imaging of brain, showing a small area of microangiopathy in the postcentral gyrus (red arrow); (b) Magnetic resonance angiography showing no obvious abnormalities. 

Long COVID with intracranial microangiopathy

https://omu.repo.nii.ac.jp/record/2003059/files/2025000216.pdf

Long COVID with intracranial microangiopathy

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