Table 2.
Findings from neuropathological studies of patients with SARS-CoV-2 infection
| Aspect of study | Paniz-Mondolfi et al.40 | Schaller et al.41 | Puelles et al.43 | Solomon et al.44 | Reichard et al.60 | von Weyhern et al.61 |
|---|---|---|---|---|---|---|
| Number of patients | 1 | 10 | 27 | 18 | 1 | 6 |
| Neurological features | PD; hospitalized because of fever and confusion | Not reported | Brain involvement in 9 patients (no other clinical details available) | Myalgia (n = 3), headache (n = 2), decreased taste (n = 1), confusion and decreased arousal from sedation for ventilation (all patients) | None | Altered consciousness (n = 3), no neurological symptoms (n = 3) |
| Neuropathological findings | ||||||
| Histopathology | Not performed | No signs of CNS involvement | Not performed | Acute hypoxic ischaemic injury with neuronal loss, arteriolosclerosis with perivascular rarefaction, and perivascular inflammation with scattered microglia | Widespread haemorrhagic white matter lesions with surrounding axonal injury and macrophages, associated axonal injury, and a perivascular ADEM-like appearance; rare neocortical microscopic infarcts | Lymphocytic panencephalitis and meningitis; neuronal cell loss; axon degeneration |
| Electron microscopy | In frontal lobe brain sections: neural and capillary endothelial cells intracytoplasmic vacuoles containing virus-like particles | Not performed | Not performed | Not performed | Not performed | Not performed |
| Immunohistochemistry to detect SARS-CoV-2 | Not performed | Not performed | Not performed | No cytoplasmic viral staining in neurons, endothelium, or immune cells | Not performed | Not performed |
| Viral load quantification | Not performed | Not performed | High levels in the respiratory tract; low levels in the kidneys, liver, heart, brain and blood | Not performed | Not performed | Not performed |
| CSF findings | ||||||
| Standard examination | Not performed | Not performed | Not performed | Not performed | Not performed | Not performed |
| RT–PCR test for SARS-CoV-2 RNA | Negative (in post-mortem sample) | Negative (in post-mortem samples) | Not performed | Not performed | Not performed | Not performed |
ADEM, acute disseminated encephalomyelitis; CSF, cerebrospinal fluid; PD, Parkinson disease; RT–PCR, reverse transcription PCR; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.