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Intracerebral endotheliitis and microbleeds are neuropathological features of COVID‐19
Author(s) -
Kirschenbaum Daniel,
Imbach Lukas L.,
Rushing Elisabeth J.,
Frauenknecht Katrin B. M.,
Gascho Dominic,
Ineichen Benjamin V.,
Keller Emanuela,
Kohler Sibylle,
Lichtblau Mona,
Reimann Regina R.,
Schreib Katharina,
Ulrich Silvia,
Steiger Peter,
Aguzzi Adriano,
Frontzek Karl
Publication year - 2021
Publication title -
neuropathology and applied neurobiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.538
H-Index - 95
eISSN - 1365-2990
pISSN - 0305-1846
DOI - 10.1111/nan.12677
Subject(s) - cerebral amyloid angiopathy , medicine , pathology , intracerebral hemorrhage , autopsy , grey matter , encephalopathy , angiopathy , white matter , hypertensive encephalopathy , disease , magnetic resonance imaging , dementia , subarachnoid hemorrhage , radiology , blood pressure , diabetes mellitus , endocrinology
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.