Abstract Coronavirus disease 19 (COVID‐19) is a rapidly evolving pandemic caused by the coronavirus Sars‐CoV‐2. Clinically manifest central nervous system symptoms have been described in COVID‐19 patients and could be the consequence of commonly associated vascular pathology, but the detailed neuropathological sequelae remain largely unknown. A total of six cases, all positive for Sars‐CoV‐2, showed evidence of cerebral petechial hemorrhages and microthrombi at autopsy. Two out of six patients showed an elevated risk for disseminated intravascular coagulopathy according to current criteria and were excluded from further analysis. In the remaining four patients, the hemorrhages were most prominent at the grey and white matter junction of the neocortex, but were also found in the brainstem, deep grey matter structures and cerebellum. Two patients showed vascular intramural inflammatory infiltrates, consistent with Sars‐CoV‐2‐associated endotheliitis, which was associated by elevated levels of the Sars‐CoV‐2 receptor ACE2 in the brain vasculature. Distribution and morphology of patchy brain microbleeds was clearly distinct from hypertension‐related hemorrhage, critical illness‐associated microbleeds and cerebral amyloid angiopathy, which was ruled out by immunohistochemistry. Cerebral microhemorrhages in COVID‐19 patients could be a consequence of Sars‐ CoV‐2‐induced endotheliitis and more general vasculopathic changes and may correlate with an increased risk of vascular encephalopathy.

中文翻译：

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脑内皮炎和微出血是 COVID-19 的神经病理学特征

摘要 冠状病毒病 19 (COVID-19) 是由冠状病毒 Sars-CoV-2 引起的一种迅速发展的大流行病。在 COVID-19 患者中已经描述了临床表现出的中枢神经系统症状，并且可能是常见的相关血管病理学的结果，但详细的神经病理学后遗症仍然很大程度上未知。共有 6 例 Sars-CoV-2 呈阳性，尸检显示脑出血和微血栓的证据。根据目前的标准，六分之二的患者出现播散性血管内凝血病的风险升高，因此被排除在进一步分析之外。其余 4 例患者中，出血以新皮质灰质和白质交界处最为突出，但也见于脑干、深部灰质结构和小脑。两名患者出现血管壁内炎症浸润，这与 Sars-CoV-2 相关内皮炎一致，这与脑血管系统中 Sars-CoV-2 受体 ACE2 水平升高有关。斑片状脑微出血的分布和形态明显不同于高血压相关的出血、危重病相关的微出血和脑淀粉样血管病，免疫组化已排除了这种情况。COVID-19 患者的脑微出血可能是由 Sars-CoV-2 诱导的内皮炎和更普遍的血管病变变化引起的，并且可能与血管性脑病的风险增加相关。这与脑血管系统中 Sars-CoV-2 受体 ACE2 水平升高有关。斑片状脑微出血的分布和形态明显不同于高血压相关的出血、危重病相关的微出血和脑淀粉样血管病，免疫组化已排除了这种情况。COVID-19 患者的脑微出血可能是由 Sars-CoV-2 诱导的内皮炎和更普遍的血管病变变化引起的，并且可能与血管性脑病的风险增加相关。这与脑血管系统中 Sars-CoV-2 受体 ACE2 水平升高有关。斑片状脑微出血的分布和形态明显不同于高血压相关的出血、危重病相关的微出血和脑淀粉样血管病，免疫组化已排除了这种情况。COVID-19 患者的脑微出血可能是由 Sars-CoV-2 诱导的内皮炎和更普遍的血管病变变化引起的，并且可能与血管性脑病的风险增加相关。