Abstract
BackgroundBrain abnormalities are a concern in COVID-19, so we used minimally invasive autopsy (MIA) to investigate it, consisting of brain 7T MR and CT images and tissue sampling via transethmoidal route with at least three fragments: the first one for reverse transcription polymerase chain reaction (RT-PCR) analysis and the remaining fixed and stained with hematoxylin and eosin. Two mouse monoclonal anti-coronavirus (SARS-CoV-2) antibodies were employed in immunohistochemical (IHC) reactions.ResultsSeven deceased COVID-19 patients underwent MIA with brain MR and CT images, six of them with tissue sampling. Imaging findings included infarcts, punctate brain hemorrhagic foci, subarachnoid hemorrhage and signal abnormalities in the splenium, basal ganglia, white matter, hippocampi and posterior cortico-subcortical. Punctate brain hemorrhage was the most common finding (three out of seven cases). Brain histological analysis revealed reactive gliosis, congestion, cortical neuron eosinophilic degeneration and axonal disruption in all six cases. Other findings included edema (5 cases), discrete perivascular hemorrhages (5), cerebral small vessel disease (3), perivascular hemosiderin deposits (3), Alzheimer type II glia (3), abundant corpora amylacea (3), ischemic foci (1), periventricular encephalitis foci (1), periventricular vascular ectasia (1) and fibrin thrombi (1). SARS-CoV-2 RNA was detected with RT-PCR in 5 out of 5 and IHC in 6 out 6 patients (100%).ConclusionsDespite limited sampling, MIA was an effective tool to evaluate underlying pathological brain changes in deceased COVID-19 patients. Imaging findings were varied, and pathological features corroborated signs of hypoxia, alterations related to systemic critically ill and SARS-CoV-2 brain invasion.
Highlights
Brain abnormalities are a concern in COVID-19, so we used minimally invasive autopsy (MIA) to inves‐ tigate it, consisting of brain 7T MR and computed tomography (CT) images and tissue sampling via transethmoidal route with at least three fragments: the first one for reverse transcription polymerase chain reaction (RT-PCR) analysis and the remaining fixed and stained with hematoxylin and eosin
The aim of the present study is to describe imaging and histopathological findings in deceased COVID-19 patients whose brains were assessed with this approach
Severe illness was defined as acute respiratory distress syndrome with computed tomography characteristic findings of COVID-19 involvement, hypoxemia requiring supplementary oxygen and patients with comorbidities
Summary
Brain abnormalities are a concern in COVID-19, so we used minimally invasive autopsy (MIA) to inves‐ tigate it, consisting of brain 7T MR and CT images and tissue sampling via transethmoidal route with at least three fragments: the first one for reverse transcription polymerase chain reaction (RT-PCR) analysis and the remaining fixed and stained with hematoxylin and eosin. Neuropsychiatric symptoms are an important concern in COVID-19 patients. Neurological symptoms in COVID-19 include headache, dizziness, seizures, anosmia, ageusia, focal deficits (quadriparesis, hemiparesis, aphasia), confusion and post-extubation delayed awakening. The proposed mechanisms include direct nervous tissue viral aggression, host response, hypoxia, stroke, critically ill patients’ related injuries, treatment side effects or a combination of these factors
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