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Intracerebral endotheliitis and microbleeds are neuropathological features of COVID‐19
- Source :
- Neuropathology and Applied Neurobiology
- Publication Year :
- 2020
- Publisher :
- John Wiley and Sons Inc., 2020.
-
Abstract
- Coronavirus disease 19 (COVID‐19) is a rapidly evolving pandemic caused by the coronavirus Sars‐CoV‐2. Clinically manifest central nervous system symptoms have been described in COVID‐19 patients and could be the consequence of commonly associated vascular pathology, but the detailed neuropathological sequelae remain largely unknown. A total of six cases, all positive for Sars‐CoV‐2, showed evidence of cerebral petechial hemorrhages and microthrombi at autopsy. Two out of six patients showed an elevated risk for disseminated intravascular coagulopathy according to current criteria and were excluded from further analysis. In the remaining four patients, the hemorrhages were most prominent at the grey and white matter junction of the neocortex, but were also found in the brainstem, deep grey matter structures and cerebellum. Two patients showed vascular intramural inflammatory infiltrates, consistent with Sars‐CoV‐2‐associated endotheliitis, which was associated by elevated levels of the Sars‐CoV‐2 receptor ACE2 in the brain vasculature. Distribution and morphology of patchy brain microbleeds was clearly distinct from hypertension‐related hemorrhage, critical illness‐associated microbleeds and cerebral amyloid angiopathy, which was ruled out by immunohistochemistry. Cerebral microhemorrhages in COVID‐19 patients could be a consequence of Sars‐ CoV‐2‐induced endotheliitis and more general vasculopathic changes and may correlate with an increased risk of vascular encephalopathy.<br />Clinically manifest central nervous system symptoms are common in COVID‐19 patients but their causes are still unknown. We present here four patients who tested positive for Sars‐CoV‐2 with cerebral haemorrhages which were most prominent at the grey and white matter junction of the neocortex and the brainstem. We present evidence of intracerebral endotheliitis in COVID‐19 patients which could predispose to more general vasculopathic changes and may correlate with an increased risk of vascular encephalopathy.
- Subjects :
- 0301 basic medicine
Male
Pathology
Neurology
COVID19
ACE2
medicine.disease_cause
2722 Histology
Covid
2737 Physiology (medical)
0302 clinical medicine
Coronavirus
Aged, 80 and over
Sars‐CoV‐2
10218 Institute of Legal Medicine
endotheliitis
2728 Neurology (clinical)
Female
10023 Institute of Intensive Care Medicine
10178 Clinic for Pneumology
medicine.symptom
Meningitis
Encephalitis
Scientific Correspondence
medicine.medical_specialty
Histology
10208 Institute of Neuropathology
Clinical Neurology
610 Medicine & health
Neuropathology
Asymptomatic
Pathology and Forensic Medicine
10180 Clinic for Neurosurgery
03 medical and health sciences
10043 Clinic for Neuroradiology
Physiology (medical)
medicine
Humans
Vasculitis, Central Nervous System
Endotheliitis
Aged
Cerebral Hemorrhage
Retrospective Studies
business.industry
SARS-CoV-2
COVID-19
Endothelial Cells
medicine.disease
2734 Pathology and Forensic Medicine
Pneumonia
030104 developmental biology
2808 Neurology
570 Life sciences
biology
Neurology (clinical)
business
030217 neurology & neurosurgery
Subjects
Details
- Language :
- English
- ISSN :
- 13652990 and 03051846
- Database :
- OpenAIRE
- Journal :
- Neuropathology and Applied Neurobiology
- Accession number :
- edsair.doi.dedup.....e12f7a67459fc9ef719cf5326bf4a506