Neuropathological Features of #Covid-19 | NEJM
▻https://www.nejm.org/doi/10.1056/NEJMc2019373
Pas de lésions cérébrales inflammatoires ou d’autres types de lésions pouvant être attribuées au #sars-cov2
Présence du virus incertaine.
In conclusion, histopathological examination of brain specimens obtained from 18 patients who died 0 to 32 days after the onset of symptoms of Covid-19 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 the onset of symptoms to death. Positive tests may have been due to in situ virions or viral RNA from blood.
Neuropathology of patients with COVID-19 in Germany : a post-mortem case series - The Lancet Neurology
▻https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(20)30308-2/abstract
Ici des lésions inflammatoires sont retrouvées et la présence du virus semble indiscutable mais ne semble pas augmenter les lésions
43 patients were included in our study. Patients died in hospitals, nursing homes, or at home, and were aged between 51 years and 94 years (median 76 years [IQR 70–86]).
We detected fresh territorial ischaemic lesions in six (14%) patients.
37 (86%) patients had astrogliosis in all assessed regions.
Activation of microglia and infiltration by cytotoxic T lymphocytes was most pronounced in the brainstem and cerebellum, and meningeal cytotoxic T lymphocyte infiltration was seen in 34 (79%) patients.
SARS-CoV-2 could be detected in the brains of 21 (53%) of 40 examined patients, with SARS-CoV-2 viral proteins found in cranial nerves originating from the lower brainstem and in isolated cells of the brainstem. The presence of SARS-CoV-2 in the CNS was not associated with the severity of neuropathological changes.
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In summary, our results show that SARS-CoV-2 RNA and proteins can be detected in the CNS. The brain shows mild neuropathological changes with pronounced neuroinflammation in the brainstem being the most common finding. However, the presence of SARS-CoV-2 in the CNS was not associated with the severity of neuropathological changes.16, 17 Careful neuropathological interpretation will be essential to disentangle which changes are attributable to SARS-CoV-2. All such changes must be mapped against neuropathological changes caused by pre-existing medical conditions often present in patients with COVID-19, as well as neuropathological changes caused by invasive treatments that are used in severe cases of COVID-19.35