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

BACKGROUND AND PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.