Here we present two previously unreported cases of bipallidal lesions found on MRI in COVID 19 positive patients as well as  four previously reported cases; to compare and contrast the underlying pathophysiology and disease courses in each one. Our objective is to better understand the effects of COVID 19 on the CNS and improve diagnosis and treatment of the neurological manifestations.

The SARS-Cov-2 virus may directly effect the central nervous system (CNS) via hematogenous or neuronal entry, the CNS may also be affected secondary to the systemic effects of the disease. MRI imaging has been found to be beneficial in determining the ways in which the virus effects the CNS.

The basal ganglia are highly metabolically active and have been found to be symmetrically affected by toxins, systemic/metabolic abnormalities, neurodegenerative disease, infections and vascular conditions. Our understanding of these disease processes and their imaging findings on MRI can potentially offer us insight into the imaging findings in our COVID-19 patients with bilateral Pallidal lesions.