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Neuropathological Findings in Two Patients with Fatal COVID-19
Neuropathology and Applied Neurobiology ( IF 4.0 ) Pub Date : 2020-09-24 , DOI: 10.1111/nan.12662 M P Jensen 1 , J Le Quesne 2, 3 , L Officer-Jones 2 , A Teodòsio 2 , J Thaventhiran 2 , C Ficken 2 , M Goddard 4 , C Smith 5 , D Menon 6 , K S J Allinson 7
Neuropathology and Applied Neurobiology ( IF 4.0 ) Pub Date : 2020-09-24 , DOI: 10.1111/nan.12662 M P Jensen 1 , J Le Quesne 2, 3 , L Officer-Jones 2 , A Teodòsio 2 , J Thaventhiran 2 , C Ficken 2 , M Goddard 4 , C Smith 5 , D Menon 6 , K S J Allinson 7
Affiliation
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AIMS
To describe the neuropathological findings in two cases of fatal Coronavirus Disease 2019 (COVID-19) with neurological decline. METHODS
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection was confirmed in both patients by reverse transcription polymerase chain reaction (RT-PCR) from nasopharyngeal swabs antemortem. Coronial autopsies were performed on both patients and histological sampling of the brain was undertaken with a variety of histochemical and immunohistochemical stains. RNAscope® in situ hybridisation (ISH) using the V-nCoV2019-S probe and RT-PCR SARS-CoV-2 ribonucleic acid (RNA) was performed in paraffin-embedded brain tissue sampled from areas of pathology. RESULTS
Case 1 demonstrated severe multifocal cortical infarction with extensive perivascular calcification and numerous megakaryocytes, consistent with a severe multi-territorial cerebral vascular injury. There was associated cerebral thrombotic microangiopathy. Case 2 demonstrated a brainstem encephalitis centred on the dorsal medulla and a subacute regional infarct involving the cerebellar cortex. In both cases ISH and RT-PCR for SARS-CoV-2 RNA were negative in tissue sampled from the area of pathology. CONCLUSIONS
Our case series adds calcifying cerebral cortical infarction with associated megakaryocytes and brainstem encephalitis to the spectrum of neuropathological findings that may contribute to the neurological decompensation seen in some COVID-19 patients. Viral RNA was not detected in post-mortem brain tissue, suggesting that these pathologies may not be a direct consequence of viral neuroinvasion and may represent para-infectious phenomena, relating to the systemic hyperinflammatory and hypercoagulable syndromes that both patients suffered.
中文翻译：
两名致命 COVID-19 患者的神经病理学发现
目的 描述两例致命的 2019 年冠状病毒病 (COVID-19) 病例的神经病理学结果，并伴有神经功能衰退。方法 死前鼻咽拭子的逆转录聚合酶链反应 (RT-PCR) 证实两名患者均感染了严重的急性呼吸综合征冠状病毒 2 (SARS-CoV-2)。对两名患者进行了冠状位尸检，并用各种组织化学和免疫组织化学染色对大脑进行了组织学取样。使用 V-nCoV2019-S 探针和 RT-PCR 的 RNAscope® 原位杂交 (ISH) 对取自病理区域的石蜡包埋脑组织进行了 SARS-CoV-2 核糖核酸 (RNA)。结果 病例 1 显示严重的多灶性皮质梗死伴广泛的血管周围钙化和大量巨核细胞，符合严重的多区域脑血管损伤。有相关的脑血栓性微血管病。病例 2 显示以背侧髓质为中心的脑干脑炎和累及小脑皮质的亚急性区域性梗死。在这两种情况下，从病理区域取样的组织中，针对 SARS-CoV-2 RNA 的 ISH 和 RT-PCR 均为阴性。结论 我们的病例系列将钙化性脑皮质梗塞与相关的巨核细胞和脑干脑炎添加到可能导致某些 COVID-19 患者出现神经功能失代偿的神经病理学发现谱中。在死后脑组织中未检测到病毒 RNA，这表明这些病理可能不是病毒神经侵袭的直接后果，可能代表副感染现象，
更新日期：2020-09-24
中文翻译：
两名致命 COVID-19 患者的神经病理学发现
目的 描述两例致命的 2019 年冠状病毒病 (COVID-19) 病例的神经病理学结果，并伴有神经功能衰退。方法 死前鼻咽拭子的逆转录聚合酶链反应 (RT-PCR) 证实两名患者均感染了严重的急性呼吸综合征冠状病毒 2 (SARS-CoV-2)。对两名患者进行了冠状位尸检，并用各种组织化学和免疫组织化学染色对大脑进行了组织学取样。使用 V-nCoV2019-S 探针和 RT-PCR 的 RNAscope® 原位杂交 (ISH) 对取自病理区域的石蜡包埋脑组织进行了 SARS-CoV-2 核糖核酸 (RNA)。结果 病例 1 显示严重的多灶性皮质梗死伴广泛的血管周围钙化和大量巨核细胞，符合严重的多区域脑血管损伤。有相关的脑血栓性微血管病。病例 2 显示以背侧髓质为中心的脑干脑炎和累及小脑皮质的亚急性区域性梗死。在这两种情况下，从病理区域取样的组织中，针对 SARS-CoV-2 RNA 的 ISH 和 RT-PCR 均为阴性。结论 我们的病例系列将钙化性脑皮质梗塞与相关的巨核细胞和脑干脑炎添加到可能导致某些 COVID-19 患者出现神经功能失代偿的神经病理学发现谱中。在死后脑组织中未检测到病毒 RNA，这表明这些病理可能不是病毒神经侵袭的直接后果，可能代表副感染现象，
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