Coronavirus 2019: clinical and neuropathological aspects

Area of Science:

• Neurology
• Immunology
• Pathology

Background:

• Coronavirus disease 2019 (COVID-19) can cause neurological illness.
• The precise mechanisms underlying COVID-19 neurological complications are not fully understood.
• Postinfectious autoimmune processes are being investigated as potential contributors.

Purpose of the Study:

• To investigate the role of postinfectious autoimmune vascular inflammation in COVID-19 neurological illness.
• To examine the effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on the brain in children and adults.
• To explore potential links between observed neuropathological findings and immune-mediated mechanisms.

Main Methods:

• Review of postmortem neuropathological studies of COVID-19 patients.
• Analysis of cerebrovascular and parenchymal changes in the brain.
• Comparison of findings in adults and children with multisystem inflammatory syndrome.

Main Results:

• Postmortem findings in COVID-19 brains include terminal hypoxia, inflammatory vascular changes, and encephalitis-like features.
• A minority of cases show inflammatory vascular leptomeningeal, cerebral, and brainstem interstitial changes.
• The relationship between these histopathological features and post-infectious immune mechanisms, including microscopic vasculitis, remains uncertain, particularly in adults.

Conclusions:

• The exact reasons for differing neuropathological presentations in COVID-19 are unclear, potentially involving inherent and epigenetic factors.
• Understanding postinfectious inflammatory mechanisms is crucial for developing effective treatments.
• Interventions targeting postinfectious mechanisms may help prevent mortality from pulmonary, systemic, and nervous system injury in COVID-19.