Case series/case reports
In this paper, just published in the New England Journal of Medicine, the authors report neuropathological findings from autopsies of 18 consecutive patients with SARS-CoV-2 infection who died in a single teaching hospital between April 14 and April 29, 2020. All the patients had positive nasopharyngeal swab samples for SARS-CoV-2 on qualitative RT-PCR assays. Median age was 62 years, and 14 patients (78%) were men. Presenting neurological symptoms included myalgia (in 3 patients), headache (in 2), and decreased taste (in 1). Death occurred 0 to 32 days after the onset of symptoms (median 8 days; mean 10 days). Microscopic examination showed acute hypoxic injury in the cerebrum and cerebellum in all patients, with loss of neurons in the cerebral cortex, hippocampus, and cerebellar Purkinje cell layer, but no thrombi or vasculitis. Rare foci of perivascular lymphocytes were detected in 2 brain specimens, and focal leptomeningeal inflammation was detected in 1 brain specimen. No microscopic abnormalities were observed in the olfactory bulbs or tracts. The authors concluded that histopathological examination of brain specimens showed only hypoxic changes and did not show encephalitis or other specific brain changes referable to the virus. There was no cytoplasmic viral staining on immunohistochemical analysis. The virus was detected at low levels in 6 brain sections obtained from 5 patients; these levels were not consistently related to the interval from onset of symptoms to death. Positive tests may have been due to in situ virions or viral RNA from blood.
View Article: https://www.nejm.org/doi/full/10.1056/NEJMc2019373