COVID-19-Associated Cytotoxic Lesions of the Corpus Callosum in Chinese Patients: A Retrospective Study.

Cytotoxic lesions of the corpus callosum (CLOCCs) are a rare brain condition that can occur with COVID-19. Among eight patients with confirmed COVID-19 who had brain MRIs, most had fever before neurological symptoms appeared. Neurological findings included altered consciousness, headache, cognitive and behavioral disturbances, ataxia, dysarthria, pyramidal signs, and visual impairments. Blood markers of inflammation and cell damage changed with disease progression. One patient had elevated cerebrospinal fluid protein. Treatment with glucocorticoids and antivirals led to complete recovery, and follow-up MRIs in seven patients showed radiological improvement within days to weeks. The condition has a favorable prognosis and distinct MRI features, emphasizing the need to consider CLOCCs in COVID-19 patients.

Study at a glance

Abstract

Cytotoxic lesions of the corpus callosum (CLOCCs) are a rare clinicoradiologic syndrome, exceptionally rare in association with coronavirus disease (COVID-2019). This study aimed to investigate the neurological features of COVID-19-associated CLOCCs and gain insights into their underlying pathophysiology. A retrospective evaluation was conducted on patients with COVID-19-associated CLOCCs admitted to our neurological diseases unit. The evaluation included comprehensive analysis of clinical presentations, laboratory findings, and radiological data. From December 17, 2022, to December 31, 2023, our center identified CLOCCs in eight individuals with clinically established COVID-19 who underwent brain magnetic resonance imaging (MRI). The majority of patients (7/8) presented with fever preceding neurological symptoms. The spectrum of neurological findings encompassed altered consciousness (5/8), headache (4/8), cognitive and behavioral disturbances (4/8), ataxia (2/8), dysarthria (2/8), pyramidal signs (2/8), and visual impairments (2/8). Peripheral blood markers of inflammation and cytolysis revealed trends that paralleled disease progression. Elevated cerebrospinal fluid protein levels were observed in a single patient, whereas cell counts, glucose, and chloride levels were unremarkable. Treatment with glucocorticoids and antiviral medications led to complete clinical remission, with subsequent MRIs (7/8) showing radiological improvements within 3 days to 2 weeks posttreatment. Our study shows that CLOCCs associated with COVID-19 are characterized by a favorable prognosis and distinct MRI features, similar to those observed in other clinical contexts. This underscores the importance of including CLOCCs in the differential diagnosis of COVID-19 and highlights the need for ongoing research to address the neurological condition of SARS-CoV-2 infections and to inform preventive and therapeutic strategies.