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 summarise 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.

中文翻译：

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COVID-19 中的神经病理学谱

越来越多的证据表明，患有冠状病毒病 19 (COVID-19) 的患者会出现神经和精神症状。嗅觉丧失、味觉减退、头痛、恶心和意识改变是常见的描述，尽管有新出现的更严重和特定情况的临床报告，如急性脑血管意外、脑炎和脱髓鞘疾病。这些表现是直接由于病毒入侵中枢神经系统 (CNS) 还是由间接机制引起的尚未确定。尸检时脑组织的神经病理学检查对于确定 SARS-CoV-2 病毒的神经侵袭潜力至关重要，但迄今为止，很少有详细的研究。大脑的病理变化可能是由 SARS-CoV-2 复制介导的直接细胞病变效应或由呼吸衰竭、有害细胞因子反应、免疫反应降低和病毒感染引起的脑血管意外引起的间接效应的组合。有必要进行进一步的大规模分子和细胞研究，以阐明 COVID-19 临床上所见神经和精神特征的神经病理学相关性。在这篇综述中，我们总结了目前关于 COVID-19 患者神经病理学检查的报告，以及我们自己的经验，并讨论了它们对理解 CNS 参与这种疾病的贡献。病毒感染引起的免疫反应降低和脑血管意外。有必要进行进一步的大规模分子和细胞研究，以阐明 COVID-19 临床上所见神经和精神特征的神经病理学相关性。在这篇综述中，我们总结了目前关于 COVID-19 患者神经病理学检查的报告，以及我们自己的经验，并讨论了它们对理解 CNS 参与这种疾病的贡献。病毒感染引起的免疫反应降低和脑血管意外。有必要进行进一步的大规模分子和细胞研究，以阐明 COVID-19 临床上所见神经和精神特征的神经病理学相关性。在这篇综述中，我们总结了目前关于 COVID-19 患者神经病理学检查的报告，以及我们自己的经验，并讨论了它们对理解 CNS 参与这种疾病的贡献。