Fig. 6

Inflammatory vasculopathy. A 45-year-old SARS-CoV-2-positive man presented chiefly with encephalopathy and aphasia, without concurrent respiratory or any other systemic symptoms. Serum levels of inflammatory makers (CRP; 152.4 mg/dl, ESR; 91 mm/h) and D-Dimer (464 mg/dl) were elevated. Anticardiolipin IgM antibodies were 52.3 (normal range 0–12.5). Past medical history is notable for diabetes and hypertension. Axial FLAIR (1, 4) MR images show gyriform signal hyperintensity of the left paramedian frontal lobe and genu of the corpus callosum with corresponding high signal intensity on DWI (2, 5) and low signal intensity on ADC (3, 6) compatible with an acute ischemia. The maximum intensity projection (MIP) of CT angiogram demonstrates irregular areas of narrowing of the left A1 and M1 segments. These findings are consistent with inflammatory vasculopathy, likely related to the interplay among systemic inflammation, immune dysregulation, and anticardiolipin antibodies. Direct infection of the endothelial cells and its contribution to the vascular irregularity of the affected vascular segments cannot be excluded. The patient received tocilizumab 8 mg/kg intravenously and a 5-day course of intravenous pulse methylprednisolone (1000 mg/day). He was discharged to a subacute rehabilitation facility with mild improvement of aphasia and cognitive deficit