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Reply: studies to help clarify imaging findings and neurologic outcomes e thank the authors for their comments and for their interest in these patients. For example, the C-VASC COVID-19 study is a Win our paper. We completely agree that although the under- prospective, pragmatic, longitudinal multicenter Canadian cohort lying pathomechanism of hemorrhagic manifestations in critically ill study looking at stroke outcomes in these patients. Data sharing patients with coronavirus 2019 (COVID-19) remains uncertain, it is from many of these trials is also being harmonized through col- likely multifactorial. We have expanded on this series of patients in a laborations with organizations such as the Neurocritical Care larger cohort (currently under submission), and as the authors sug- Society and other international partners, pointing to the strengths gest, a few broad imaging themes have begun to allude to some of of the collaborations that arose as a result of the COVID-19 pan- these potential underlying mechanisms. These imaging features demic. It is becoming increasingly clear that far from being “just include cerebral microhemorrhages, venular thrombosis, arterial a respiratory disease,” COVID-19 is, in fact, a multisystem illness infarcts, subarachnoid hemorrhage, petechial or juxtacortical micro- that can have serious consequences for a certain subset of hemorrhages, leukoencephalopathy, and catastrophic large-volume patients. We therefore look forward to the results of these larger hemorrhages (including intraventricular hemorrhages). These myr- studies to help us to get a better picture regarding both short-and iad imaging findings could all result from downstream pathophysio- long-term neurologic outcomes in these patients. logical outcomes resulting from hypoxemia, hypercoagulability, and endotheliitis, all of which seem to be more common in patients with P. Nicholson COVID-19. As the authors have correctly stated, the addition of sys- Division of Neuroradiology temic anticoagulation may also be an additional factor leading to Joint Department of Medical Imaging Toronto Western Hospital hemorrhage in some of these patients. University Health Network, University of Toronto, Canada Although there is much uncertainty regarding the cause of L. Alshafai these findings at present, with the literature being populated Division of Neuroradiology withrelatively small-series single-center studies (such as our Joint Department of Medical Imaging own), we eagerly await the results of several ongoing large-cohort Mount Sinai Hospital University Health Network, University of Toronto, Canada T. Krings Indicates open access to non-subscribers at www.ajnr.org Division of Neuroradiology Joint Department of Medical Imaging Toronto Western Hospital http://dx.doi.org/10.3174/ajnr.A6827 University Health Network, University of Toronto, Canada AJNR Am J Neuroradiol 41:E91 Nov 2020 www.ajnr.org E91 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Neuroradiology American Journal of Neuroradiology

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Publisher
American Journal of Neuroradiology
Copyright
© 2020 by American Journal of Neuroradiology. Indicates open access to non-subscribers at www.ajnr.org
ISSN
0195-6108
eISSN
1936-959X
DOI
10.3174/ajnr.A6827
Publisher site
See Article on Publisher Site

Abstract

studies to help clarify imaging findings and neurologic outcomes e thank the authors for their comments and for their interest in these patients. For example, the C-VASC COVID-19 study is a Win our paper. We completely agree that although the under- prospective, pragmatic, longitudinal multicenter Canadian cohort lying pathomechanism of hemorrhagic manifestations in critically ill study looking at stroke outcomes in these patients. Data sharing patients with coronavirus 2019 (COVID-19) remains uncertain, it is from many of these trials is also being harmonized through col- likely multifactorial. We have expanded on this series of patients in a laborations with organizations such as the Neurocritical Care larger cohort (currently under submission), and as the authors sug- Society and other international partners, pointing to the strengths gest, a few broad imaging themes have begun to allude to some of of the collaborations that arose as a result of the COVID-19 pan- these potential underlying mechanisms. These imaging features demic. It is becoming increasingly clear that far from being “just include cerebral microhemorrhages, venular thrombosis, arterial a respiratory disease,” COVID-19 is, in fact, a multisystem illness infarcts, subarachnoid hemorrhage, petechial or juxtacortical micro- that can have serious consequences for a certain subset of hemorrhages, leukoencephalopathy, and catastrophic large-volume patients. We therefore look forward to the results of these larger hemorrhages (including intraventricular hemorrhages). These myr- studies to help us to get a better picture regarding both short-and iad imaging findings could all result from downstream pathophysio- long-term neurologic outcomes in these patients. logical outcomes resulting from hypoxemia, hypercoagulability, and endotheliitis, all of which seem to be more common in patients with P. Nicholson COVID-19. As the authors have correctly stated, the addition of sys- Division of Neuroradiology temic anticoagulation may also be an additional factor leading to Joint Department of Medical Imaging Toronto Western Hospital hemorrhage in some of these patients. University Health Network, University of Toronto, Canada Although there is much uncertainty regarding the cause of L. Alshafai these findings at present, with the literature being populated Division of Neuroradiology withrelatively small-series single-center studies (such as our Joint Department of Medical Imaging own), we eagerly await the results of several ongoing large-cohort Mount Sinai Hospital University Health Network, University of Toronto, Canada T. Krings Indicates open access to non-subscribers at www.ajnr.org Division of Neuroradiology Joint Department of Medical Imaging Toronto Western Hospital http://dx.doi.org/10.3174/ajnr.A6827 University Health Network, University of Toronto, Canada AJNR Am J Neuroradiol 41:E91 Nov 2020 www.ajnr.org E91

Journal

American Journal of NeuroradiologyAmerican Journal of Neuroradiology

Published: Nov 1, 2020

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