6. Case Series/Case Reports
In this paper, recently published in Lancet, the authors report the findings of autopsies of six patients (four men and two women, aged 58–82 years) who died from COVID-19 in April 2020 in Munich, Germany. The period from onset of symptoms to admission ranged from 2–10 days. Five patients were transferred to the ICU within the first 2 days of hospital admission. All patients eventually required ventilation or extracorporeal membrane oxygenation. The cause of death in the older patients (>65 years), all of whom were admitted with multiple comorbidities, was cardiorespiratory failure. By contrast, patients younger than 65 years died either of massive intracranial haemorrhage or pulmonary embolism, consistent with COVID-19-associated coagulopathy. These patients exhibited diffuse petechial haemorrhage throughout the entire brain. However, both groups showed lymphocytic pan-encephalitis and meningitis. The authors concluded that, in addition to viral pneumonia, pronounced CNS involvement with pan-encephalitis, meningitis, and brainstem neuronal cell damage were key events. Moreover, in patients younger than 65 years, CNS haemorrhage was a fatal complication of COVID-19.