Coronavirus 2019: clinical and neuropathological aspects

To understand the role of postinfectious autoimmune vascular inflammation in the pathogenesis of coronavirus disease 2019-related neurological illness caused by the novel severe acute respiratory syndrome coronavirus 2 virus and its effects on the brain in children and adults.

There are a very small number of postmortem neuropathological series of coronavirus disease 2019-related cerebrovascular and parenchymal disease. However, they fall into at least three major categories, with the majority manifesting those of terminal hypoxia, and others demonstrating inflammatory vascular leptomeningeal, cerebral and brainstem interstitial changes suspicious for encephalitis in a minority of cases. It remains uncertain whether these histopathological features have a relationship to post-infectious inflammatory immune mechanisms and microscopic vasculitis in adults as it appears to be in affected children with multisystem inflammatory syndrome.

The reasons for this dichotomy are unclear but may related to inherent and epigenetic factors that remain poorly understood. Treatment addressing postinfectious mechanisms of pulmonary, systemic, and nervous system injury may avert early mortality.