Article Figures & Data
Figures
- Figure 1 PRISMA Flow Diagram Demonstrating Case Selection Methodology
PRISMA flow diagram illustrating source information used, the screening process used and its effects on excluded articles, and final articles and cases selected for study inclusion.
- Figure 2 Neuroimaging Examples From the MGB Case Series
Axial brain MRI sequences of patients with post-COVID ADEM from the MGB case series. (A–C) Axial brain MRI sequences from case 1 display FLAIR hyperintensities in the bilateral frontal lobes, anterior temporal lobes, and cerebellum. (D and E) Axial brain MRI sequences from case 2 show bilateral FLAIR hyperintensities with a prominent right parietal lesion that enhances, as well as nodular enhancement of the right corona radiata and occipital horn of the right lateral ventricle. (F) Sagittal postcontrast T1 sequence of the cervical spine MRI from case 2 displays a focus of intramedullary enhancement at C4-5 (red box). (G–I) Axial brain MRI sequences from case 3 show diffuse, multifocal T2 FLAIR lesions (G and I) and a predominant open-ring contrast enhancement pattern of several lesions in the T1 postcontrast sequence (H). ADEM = acute disseminated encephalomyelitis; MGB = Massachusetts General Brigham.
- Figure 3 Neuropathology Examples of Post–COVID-19 ADEM
Brain pathology from case 2 of the MGB series (case details provided in the supplementary files, links.lww.com/NXI/A584). Low-power images (A–D) demonstrate markedly cellular brain parenchyma with prominent perivascular inflammation and reduced myelinated fibers (A, Luxol–H&E stain), with relative preservation of axons (B, neurofilament immunohistochemistry). The cellular population is composed largely of macrophages (C, CD68 immunohistochemistry), whereas the perivascular infiltrates are predominantly T cells (D, CD3 immunohistochemistry). Higher-power views (E–H) characterize the perivascular infiltrates as composed of small mature lymphocytes and focally prominent plasma cells (E, H&E, open arrows), whereas the surrounding tissue is composed of numerous foamy macrophages (solid arrows) and reactive astrocytes. Immunohistochemistry demonstrates scattered perivascular and parenchymal plasma cells (F, CD138), numerous parenchymal foamy macrophages (G, CD68), and marked perivascular T cells (H, CD3). ADEM = acute disseminated encephalomyelitis; MGB = Massachusetts General Brigham.
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