Abstract
Background: Neuroinvasive properties of SARS-CoV-2 have allowed the hypothesis of several pathogenic mechanisms related to acute and chronic neurological sequelae. However, neuropathological correlates have been poorly systematically investigated, being retrieved from reports of single case or limited case series still. Methods: A PubMed search was carried out to review all publications on autopsy in subjects with “COronaVIrus Disease-19” (COVID-19). Among them, we focused on histological findings of the brain, which were compared with those from the authors’ autoptic studies performed in some COVID-19 patients. Results: Only seven studies reported histological evidence of brain pathology in patients deceased for COVID-19, including three with reverse transcription–quantitative polymerase chain reaction evidence of viral infection. All these studies, in line with our experience, showed vascular-related and infection-related secondary inflammatory tissue damage due to an abnormal immune response. It is still unclear, however, whether these findings are the effect of a direct viral pathology or rather reflect a non-specific consequence of cardiovascular and pulmonary disease on the brain. Conclusions: Notwithstanding the limited evidence available and the heterogeneity of the studies, we provide a preliminary description of the relationship between SARS-CoV-2 and brain sequelae. Systematic autoptic investigations are needed for accurate detection and adequate management of these patients.
Highlights
The recently emerged Severe Acute Respiratory Syndrome-Coronavirus-2 (SARSCoV-2) has shown several neuroinvasive properties that have allowed the hypothesis of different pathogenic mechanisms related to both acute and chronic neurological sequelae of the “COronaVIrus Disease-19” (COVID-19)
Neurological complications may arise from a direct effect of SARS-CoV-2, they usually reflect a systemic response to the infection, with severe cases of COVID-19 more often producing central nervous system (CNS) complications with respect to mild forms (45.5% vs. 30%) [21]
We excluded the following items: all publications not dealing with COVID-19 autopsy or neuropathology; all studies different from original articles; all preclinical studies or research performed on animals or cell cultures; non-English written papers; any other publication that did not comply with the goal of the present review
Summary
Francesco Fisicaro 1,† , Mario Di Napoli 2,†,‡ , Aldo Liberto 1 , Martina Fanella 2 , Flavio Di Stasio 3 , Manuela Pennisi 1 , Rita Bella 4 , Giuseppe Lanza 5,6, *,§ and Gelsomina Mansueto 7,§. Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affil-
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