Invited Review: The spectrum of neuropathology in COVID‐19

• Published in: Neuropathology and applied neurobiology Vol. 47; no. 1; pp. 3 - 16
• Main Authors: Al‐Sarraj, S., Troakes, C., Hanley, B., Osborn, M., Richardson, M. P., Hotopf, M., Bullmore, E., Everall, I. P.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.02.2021
• Subjects: Anosmia; Autopsy; Brain; Central nervous system; cerebrovascular accident (CVA); Coronaviruses; COVID-19; COVID-19 - complications; COVID-19 - pathology; Cytokines; Demyelinating diseases; Demyelination; Encephalitis; Female; Humans; Immune response; Male; microglia cells; Nausea; Nervous System Diseases - pathology; Nervous System Diseases - virology; Neuropathology; Olfaction disorders; pathology; Respiratory failure; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Stroke; T lymphocytes; COVID-19; T lymphocytes; Brain; SARS-CoV-2; pathology; encephalitis; cerebrovascular accident (CVA); microglia cells
• ISSN: 0305-1846; 1365-2990
• DOI: 10.1111/nan.12667

There is increasing evidence that patients with Coronavirus disease 19 (COVID‐19) present with neurological and psychiatric symptoms. Anosmia, hypogeusia, headache, nausea and altered consciousness are commonly described, although there are emerging clinical reports of more serious and specific conditions such as acute cerebrovascular accident, encephalitis and demyelinating disease. Whether these presentations are directly due to viral invasion of the central nervous system (CNS) or caused by indirect mechanisms has yet to be established. Neuropathological examination of brain tissue at autopsy will be essential to establish the neuro‐invasive potential of the SARS‐CoV‐2 virus but, to date, there have been few detailed studies. The pathological changes in the brain probably represent a combination of direct cytopathic effects mediated by SARS‐CoV‐2 replication or indirect effects due to respiratory failure, injurious cytokine reaction, reduced immune response and cerebrovascular accidents induced by viral infection. Further large‐scale molecular and cellular investigations are warranted to clarify the neuropathological correlates of the neurological and psychiatric features seen clinically in COVID‐19. In this review, we summarize the current reports of neuropathological examination in COVID‐19 patients, in addition to our own experience, and discuss their contribution to the understanding of CNS involvement in this disease.