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Semin Neurol 2023; 43(02): 195-204
DOI: 10.1055/s-0043-1767716
Review Article

What Can We Still Learn from Brain Autopsies in COVID-19?

Isaac H. Solomon
1   Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
2   Harvard Medical School, Boston, Massachusetts
,
Arjun Singh
3   Division of Neuroimmunology and Neuro-Infectious Diseases, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
4   Healing Hospital, Chandigarh, India
,
Rebecca D. Folkerth
5   Office of Chief Medical Examiner and Department of Forensic Medicine, New York University School of Medicine, New York, New York
,
Shibani S. Mukerji
2   Harvard Medical School, Boston, Massachusetts
3   Division of Neuroimmunology and Neuro-Infectious Diseases, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
6   Division of Infectious Diseases, Vaccine and Immunotherapy Center, Massachusetts General Hospital, Charlestown, Massachusetts
› Institutsangaben Funding S.S.M. is supported by the National Institute of Mental Health at the National Institutes of Health (grant number K23MH115812, R01MH131194), James S. McDonnell Foundation, and Rappaport Fellowship. I.H.S. is supported by the National Institute of Neurological Disorders and Stroke at the National Institutes of Health (grant number R21NS119660).
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Abstract

Neuropathological findings have been published from ∼900 patients who died with or from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, representing less than 0.01% of the close to 6.4 million deaths reported to the World Health Organization 2 years into the coronavirus disease 2019 (COVID-19) pandemic. In this review, we extend our prior work summarizing COVID-19 neuropathology by including information on published autopsies up to June 2022, and neuropathological studies in children, COVID-19 variants, secondary brain infections, ex vivo brain imaging, and autopsies performed in countries outside of the United States or Europe. We also summarize research studies that investigate mechanisms of neuropathogenesis in nonhuman primates and other models. While a pattern of cerebrovascular pathology and microglial-predominant inflammation remains the primary COVID-19-associated neuropathological finding, there is no singular understanding of the mechanisms that underlie neurological symptoms in acute COVID-19 or the post-acute COVID-19 condition. Thus, it is paramount that we incorporate microscopic and molecular findings from brain tissue into what we know about the clinical disease so that we attain best practice guidance and direct research priorities for the study of the neurological morbidity of COVID-19.

Keywords

COVID-19 - severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) - brain autopsies - neuropathological findings - children with COVID-19 - Rhino-orbito-cerebral mucormycosis COVID-19 Neuropathogenesis

Author Contributions

I.H.S. was involved in the conceptualization, writing, reviewing, and editing of the manuscript, and figure generation. A.S. was involved in the writing and editing of the manuscript. R.D.F. was involved in the editing of the manuscript and figure generation. S.S.M. was involved in the conceptualization, writing, reviewing, and editing of the manuscript, and supervision.




Publikationsverlauf

Artikel online veröffentlicht:
06. April 2023

© 2023. Thieme. All rights reserved.

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