Neuropathological findings in COVID-19: an autopsy cohort

• Published in: Journal of neuropathology and experimental neurology 2023-01, Vol.82 (1), p.21-28
• Main Authors: Eschbacher, Kathryn L, Larsen, Rachel A, Moyer, Ann M, Majumdar, Ramanath, Reichard, Robert Ross
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Autopsy; Causes of; Child; Child, Preschool; COVID-19; Diagnosis; Female; Humans; Infant; Infant, Newborn; Male; Middle Aged; Nervous system diseases; Neurodegenerative Diseases; Neuropathology; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Young Adult
• ISSN: 0022-3069; 1554-6578
• DOI: 10.1093/jnen/nlac101

Abstract The literature regarding the neuropathological findings in cases of SARS-CoV-2 infection, which causes coronavirus disease 2019 (COVID-19), is expanding. We identified 72 patients who died of COVID-19 (n = 48) or had recovered shortly before death (n = 24) and had autopsies performed at our institution (49 males, 23 females; median age at death 76.4 years, range: 0.0–95.0 years). Droplet digital polymerase chain reaction (ddPCR) for the detection of SARS-CoV-2 was performed (n = 58) in multiple brain regions. In cases the assay was successfully completed (n = 50), 98.0% were negative (n = 49) and 2% were indeterminate (n = 1). Most histologic findings were typical of the patient age demographic, such as neurodegenerative disease and arteriolosclerosis. A subset of cases demonstrated findings which may be associated with sequelae of critical illness. We identified 3 cases with destructive perivascular lesions with axonal injury, one of which also harbored perivascular demyelinating lesions. These rare cases may represent a parainfectious process versus sequelae of vascular injury. The lack of detectable SARS-CoV-2 by ddPCR or significant histologic evidence of direct infection suggests that active encephalitis is not a feature of COVID-19.