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. 2020 Dec 16;5(3):167–177. doi: 10.1016/S2352-4642(20)30362-X

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Vasculitic and thrombotic findings

(A, B) A 15-year-old girl (case 12) presented 27 weeks pregnant with fever, seizures, and hypertension, and COVID-19 pneumonia. Her CT at presentation (A) showed low-density areas in multiple locations (arrows). MRI 7 days later (B) showed small focal infarcts and a larger left occipital infarct (arrows) on diffusion trace imaging, findings compatible with unusually severe posterior reversible encephalopathy syndrome. (C, D) A 15-year-old girl (case 20) with subacute COVID-19 and no classical respiratory symptoms presented with fever, confusion, and headache. Complete occlusive thrombosis of the superior sagittal sinus was shown by the large filling defect in the postcontrast sagittal T1-weighted image (C; arrowheads), with resultant bilateral haemorrhagic venous infarcts on axial FLAIR images (D; arrows). (E) A 15-year-old girl (case 27) with multisystem inflammatory syndrome in children who also developed multiple microthrombi, as shown on SWI. The microthrombi were relatively clinically silent and showed partial resolution at 3 weeks with full clinical resolution of symptoms at 3 months after presentation. (F–I) A 2-year-old girl (case 32, indeterminate category) presented with fever and pharyngeal pain with an acute left midbrain infarction (arrow) shown on the apparent diffusion coefficient map (F; arrow). She had a thrombus in the feeding anterior perforator vessel on SWI (G; arrow) and marked associated vessel wall enhancement on postcontrast T1 arterial wall imaging (H, arrow; I, circle). FLAIR=fluid-attenuated inversion recovery. SWI=susceptibility-weighted imaging.