Neuropathological findings in fatal COVID-19 and their associated neurological clinical manifestations
Authors
Pablo Sánchez, Raúl De; Ruz-Caracuel, L.; Pian Arias, Hector; Corral Corral, Iñigo; Carretero-Barrio, Irene; [et al.]Identifiers
Permanent link (URI): http://hdl.handle.net/10017/59526DOI: 10.1016/j.pathol.2022.03.006
ISSN: 0031-3025
Date
2022Affiliation
Universidad de Alcalá. Departamento de Medicina y Especialidades Médicas. Unidad Docente de Medicina.Funders
Instituto de Salud Carlos III
CIBERONC
Instituto Ramón y Cajal de Investigación Sanitaria
Merck, Sharp & Dohme (MSD)
Bibliographic citation
Pathology, 2022, v. 54, n. , p. 738-745
Keywords
COVID-19
Autopsy
Encephalopathy
Neuroinflammation
Neuropathology
Description / Notes
9 p.
Project
info:eu-repo/grantAgreement/ISCIII//PI
19%01331/ES//
info:eu-repo/grantAgreement/CIBERONC// CB16%12%00316/ES//
info:eu-repo/grantAgreement/IRYCIS// 2020%0290/ES//
info:eu-repo/grantAgreement/IRYCIS// 2020%154/ES//
Document type
info:eu-repo/semantics/article
Version
info:eu-repo/semantics/publishedVersion
Rights
©2022 TheAuthor(s). Published by ElsevierB.V. on behalf of Royal College of Pathologists of Australasia
Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)
Access rights
info:eu-repo/semantics/openAccess
Abstract
Severe cases of Coronavirus Disease 2019 (COVID-19) can present with multiple neurological symptoms. The available neuropathological studies have described different lesions; the most frequent was the presence of neuroinflammation and vascular-related lesions. The objective of this study was to report the neuropathological studies performed in a medical institution, with abundant long intensive care unit stays, and their associated clinical manifestations. This is a retrospective monocentric case series study based on the neuropathological reports of 13 autopsies with a wide range of illness duration (13-108 days). A neuroinflammatory score was calculated based on the quantification of CD8- and CD68-positive cells in representative areas of the central nervous system. This score was correlated afterwards with illness duration and parameters related to systemic inflammation. Widespread microglial and cytotoxic T-cell activation was found in all patients. There was no correlation between the neuroinflammatory score and the duration of the illness; nor with parameters of systemic inflammation such as the peak of IL-6 or the HScore (a parameter of systemic macrophage activation syndrome). Two patients had global hypoxic ischaemic damage and five patients had subacute infarcts. One patient had many more brain vascular microthrombi compared to the others and multiple subacute pituitary infarcts. SARS-CoV-2 RNA was not detected with qRT-PCR. The proportion of brain lesions in severe COVID-19 patients could be related to illness duration. In our series, with abundant long hospitalisation stays, neuroinflammation was present in all patients and was more prominent between day 34 and day 45 after onset of symptoms. Clinical correlation showed that two patients with the highest neuroinflammatory scores had severe encephalopathies that were not attributable to any other cause. The second most frequent lesions were related to vascular pathology.
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