Abstract
We document the neuropathologic findings of a 73-year old man who died from acute cerebellar hemorrhage in the context of relatively mild SARS-CoV2 infection. The patient developed sudden onset of headache, nausea, and vomiting, immediately followed by loss of consciousness on the day of admission. Emergency medical services found him severely hypoxemic at home, and the patient suffered a cardiac arrest during transport to the emergency department. The emergency team achieved return of spontaneous circulation after over 17 min of resuscitation. A chest radiograph revealed hazy bilateral opacities; and real-time-PCR for SARS-CoV-2 on the nasopharyngeal swab was positive. Computed tomography of the head showed a large right cerebellar hemorrhage, with tonsillar herniation and intraventricular hemorrhage. One day after presentation, he was transitioned to comfort care and died shortly after palliative extubation. Autopsy performed 3 h after death showed cerebellar hemorrhage and acute infarcts in the dorsal pons and medulla. Remarkably, there were microglial nodules and neuronophagia bilaterally in the inferior olives and multifocally in the cerebellar dentate nuclei. This constellation of findings has not been reported thus far in the context of SARS-CoV-2 infection.
Highlights
Symptomatic SARS-CoV-2 infection presents as a respiratory syndrome with upper and lower respiratory systems manifestations, characterized by cough, dyspnea, fever, chills, hyposmia, and ageusia [5, 20]
The unique findings we describe in this report revealed marked neuronophagia and microglial nodules in the inferior olives and to a lesser extent the dentate nuclei, and only mild perivascular lymphocytic infiltrates
Microglial nodules with white matter perivascular hemorrhages were described by Hart and Earle [13] and Russell [27] and designated as “perivenous encephalitis”, which is associated
Summary
Symptomatic SARS-CoV-2 infection presents as a respiratory syndrome with upper and lower respiratory systems manifestations, characterized by cough, dyspnea, fever, chills, hyposmia, and ageusia [5, 20]. A recent case report of neuropathologic findings in one case of SARS-CoV-2 documented a picture of multifocal white matter hemorrhages, axonal damage in a variable perivenular distribution, and no significant perivascular inflammation. While a cortical organizing infarct was noted, neuronal necrosis, neuronophagia, microglial nodules, and vascular necrosis were not identified [24].
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
