A 31-year-old male was admitted to the intensive care unit with respiratory failure due to SARS-CoV-2 infection. A persistent altered mental state, with agitation and subsequently persistent coma, was one of the complications he suffered during his illness. Brain MRI showed diffuse cerebral microbleeds (CMBs). The pattern of distribution resembled the CMBs that have been described earlier in critically ill patients. Post-mortem analysis of brain samples confirmed CMBs and additionally showed diffuse subcortical hypoxic white matter damage. We suggest that cerebral hypoxia may cause CMBs in COVID-19 patients in a similar way to other well-described causes of hypoxia. Furthermore, we want to bring to attention that coma in COVID-19 patients with CMBs may be associated with diffuse subcortical white matter injury not visible on brain MRI.
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