tetano
Editor, Senior Moderator
Neuropathol Appl Neurobiol
. 2020 Nov 29.
doi: 10.1111/nan.12677. Online ahead of print.
Intracerebral endotheliitis and microbleeds are neuropathological features of COVID-19
Daniel Kirschenbaum[SUP] 1 [/SUP], Lukas L Imbach[SUP] 2 [/SUP], Elisabeth Jane Rushing[SUP] 1 [/SUP], Katrin B M Frauenknecht[SUP] 1 [/SUP], Dominic Gascho R T[SUP] 3 [/SUP], Benjamin Victor Ineichen[SUP] 4 [/SUP], Emanuela Keller[SUP] 5 [/SUP], Sibylle Kohler[SUP] 6 [/SUP], Mona Lichtblau[SUP] 7 [/SUP], Regina R Reimann[SUP] 1 [/SUP], Katharina Schreib[SUP] 6 [/SUP], Silvia Ulrich[SUP] 7 [/SUP], Peter Steiger[SUP] 8 [/SUP], Adriano Aguzzi[SUP] 1 [/SUP], Karl Frontzek[SUP] 1 [/SUP]
Affiliations
Abstract
Coronavirus disease 19 (COVID-19), caused by infection with the severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2), has become a worldwide pandemic (1). Symptoms of COVID-19 vary widely and range from asymptomatic disease to severe pneumonia and multiorgan failure (2). A severe disease course is more likely in older patients and patients with pre-existing respiratory and cardiovascular conditions (2). Patients with severe Sars-CoV-2 infection may present with ischaemic stroke (3, 4) or even fatal intracerebral haemorrhage (5). To date, little is known about the neuropathological sequelae of COVID-19. The largest published autopsy series of COVID-19 neuropathology reported microthrombi and acute haemorrhagic infarction in a significant number of patients (6), while another more recent study found evidence of lymphocytic encephalitis and meningitis (7). Endotheliitis of the brain and extraneural organs has been shown in Sars-CoV infected patients (8). Similarly, it is a recurrent feature in the lungs and other peripheral organs of Sars-CoV-2 infected patients (9) but has not yet been reported in the central nervous system. We speculated that cerebrovascular pathology in COVID-19 patients could be a direct consequence of hitherto unidentified cerebral endotheliitis caused by Sars-CoV-2.
. 2020 Nov 29.
doi: 10.1111/nan.12677. Online ahead of print.
Intracerebral endotheliitis and microbleeds are neuropathological features of COVID-19
Daniel Kirschenbaum[SUP] 1 [/SUP], Lukas L Imbach[SUP] 2 [/SUP], Elisabeth Jane Rushing[SUP] 1 [/SUP], Katrin B M Frauenknecht[SUP] 1 [/SUP], Dominic Gascho R T[SUP] 3 [/SUP], Benjamin Victor Ineichen[SUP] 4 [/SUP], Emanuela Keller[SUP] 5 [/SUP], Sibylle Kohler[SUP] 6 [/SUP], Mona Lichtblau[SUP] 7 [/SUP], Regina R Reimann[SUP] 1 [/SUP], Katharina Schreib[SUP] 6 [/SUP], Silvia Ulrich[SUP] 7 [/SUP], Peter Steiger[SUP] 8 [/SUP], Adriano Aguzzi[SUP] 1 [/SUP], Karl Frontzek[SUP] 1 [/SUP]
Affiliations
- PMID: 33249605
- DOI: 10.1111/nan.12677
Abstract
Coronavirus disease 19 (COVID-19), caused by infection with the severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2), has become a worldwide pandemic (1). Symptoms of COVID-19 vary widely and range from asymptomatic disease to severe pneumonia and multiorgan failure (2). A severe disease course is more likely in older patients and patients with pre-existing respiratory and cardiovascular conditions (2). Patients with severe Sars-CoV-2 infection may present with ischaemic stroke (3, 4) or even fatal intracerebral haemorrhage (5). To date, little is known about the neuropathological sequelae of COVID-19. The largest published autopsy series of COVID-19 neuropathology reported microthrombi and acute haemorrhagic infarction in a significant number of patients (6), while another more recent study found evidence of lymphocytic encephalitis and meningitis (7). Endotheliitis of the brain and extraneural organs has been shown in Sars-CoV infected patients (8). Similarly, it is a recurrent feature in the lungs and other peripheral organs of Sars-CoV-2 infected patients (9) but has not yet been reported in the central nervous system. We speculated that cerebrovascular pathology in COVID-19 patients could be a direct consequence of hitherto unidentified cerebral endotheliitis caused by Sars-CoV-2.