Magnetic Resonance Imaging Alteration of the Brain in a Patient With Coronavirus Disease 2019 (COVID-19) and Anosmia | Global Health | JAMA Neurology | JAMA Network
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Images in Neurology
May 29, 2020

Magnetic Resonance Imaging Alteration of the Brain in a Patient With Coronavirus Disease 2019 (COVID-19) and Anosmia

Author Affiliations
  • 1Department of Neuroradiology, IRCCS Istituto Clinico Humanitas and Humanitas University, Milan, Italy
  • 2Department of Radiology and Hematology & Oncology Division, Boston Children’s Hospital, Boston, Massachusetts
  • 3Department of Radiology and Advanced MRI Center, University of Massachusetts Medical School and Medical Center, Worcester, Massachusetts
  • 4UOC Malattie Neurodegenerative e Neurometaboliche Rare, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
JAMA Neurol. 2020;77(8):1028-1029. doi:10.1001/jamaneurol.2020.2125

The neurotropism of human coronaviruses has already been demonstrated in small animals, and in autoptic studies the severe acute respiratory syndrome coronavirus (SARS-CoV), which was responsible for the SARS outbreak during 2002 to 2003, was found in the brains of patients with infection.1 It has been proposed that the neuroinvasive potential of the novel SARS-CoV-2, responsible for coronavirus disease 2019 (COVID-19), may be at least partially responsible for the respiratory failure of patients with COVID-19.2 In this article, we share the magnetic resonance imaging (MRI) evidence of in vivo brain alteration presumably due to SARS-CoV-2 and demonstrate that anosmia can represent the predominant symptom in COVID-19.

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    1 Comment for this article
    UFPs Could Be a Carrier for SARS-CoV-2 to Brain Structures via the Olfactory Pathway
    Giovanni Ghirga, Pediatrician, Italy |
    Ultrafine particles (<100 nm, UFPs) comprise more than 90% of the total concentration of submicron particles in urban areas, and 70%–80% in suburban areas (1). Nose-to-brain transport of airborne ultrafine particles (UFPs) via the olfactory pathway has been verified as a possible route for particle translocation into the brain (2). Particulate matter represents an effective carrier for virus transport (3). UFPs could be a carrier for SARS-CoV-2 to the brain structures via the olfactory pathway, and pathologic studies of the olfactory pathway aimed to observe or exclude the role of UFPs as a carrier for SARS-CoV-2 transportation from the nose to the brain are needed.


    1) Manigrasso M, Protano C, Martellucci S, Mattei V, Vitali M, Avino P. International Journal of Environmental Research and Public Health. Evaluation of the Submicron Particles Distribution Between Mountain and Urban Site: Contribution of the Transportation for Defining Environmental and Human Health Issues. Int. J. Environ. Res. Public Health 2019, 16, 1339.
    2) Tian L, Shang Y, Chen R, Bai R, Chen C, et al. Correlation of regional deposition dosage for inhaled nanoparticles in human and rat olfactory. Particle and Fibre Toxicology (2019) 16:6.
    3) SIMA, University of Bologna, and University of Bari, Italy. Evaluation of the potential relationship between Particulate Matter (PM) pollution and COVID-19 infection spread in Italy. Position Paper. Accessed 29 May 2020.