Neuropathological findings in two patients with fatal COVID‐19

Abstract

Case 1 demonstrated multi‐territorial cerebral vascular injury with associated cerebral thrombotic microangiopathy; case 2 demonstrated a brainstem encephalitis centred on the dorsal medulla and a subacute regional infarct involving the cerebellar cortex. Viral RNA was not detected in post‐mortem brain tissue, suggesting that these pathologies may not be a direct consequence of viral neuroinvasion and may represent para‐infectious phenomena, relating to the systemic hyperinflammatory and hypercoagulable syndromes that both patients suffered.

Evidence of central nervous system infection and neuroinvasive routes, as well as neurological involvement, in the lethality of SARS‐CoV‐2 infection

“…A total of 14 COVIID patients were included in the three autopsy studies mentioned above. Detection of SARS‐CoV‐2 by RT‐PCR and/or immunostaining was performed in two studies, but the results did not support the infection of CNS in four COVID‐19 patients 42,43 …”

“…Up to September 14, 2020, a total of 20 autopsy studies on neuropathology were retrieved, among which CNS detection of SARS‐CoV‐2 was negative in 12 (of 12) cases from three studies, 36,42,43 and positive in 58 (of 87) cases (66.7%) from nine studies, 46‐54 and unavailable for 109 cases in eight studies 35,37‐41,44,45 …”

“…On September 8, 2020, Jensen et al 43 reported neuropathological findings in two patients with fatal COVID‐19. The first case showed pathological changes consistent with severe multiterritorial cerebral vascular injury.…”

Olfactory transmucosal SARS-CoV-2 invasion as a port of central nervous system entry in individuals with COVID-19

“…Several recent tissue-based studies assessing CNS alterations in fatal COVID-19 have provided the first hints at histopathological changes occurring in COVID-19 such as hypoxia-related pathology including CNS infarction due to cerebral thromboembolism and signs of a CNS-intrinsic myeloid cell response [32][33][34][35][36][37][38] and/or have presented data on the presence of viral RNA in the CNS 4,39 .…”

Brain ischemic injury in COVID‐19‐infected patients: a series of 10 post‐mortem cases

“…At present, data on SARS-CoV-2 neuropathological features are limited (4,5,8,10) and most frequently focused on cases presenting neurological symptoms.…”