TABLE 1.
Clinical and neuropathological characteristics of 15 patients who died with SARS‐CoV‐2 infection
| Case ID | Gender | Age at death | Covid swab positivity | Neurological symptoms | Brain weight (g) | Gross findings | Neuropathological findings | Lung pathology | Olfactory bulbs | Other CNS areas | IHC | Other organs with RT‐PCR positivity | Other organ findings | |||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| E‐gene | RdRp gene | N1 gene | N1 gene quantification (copies/μl) | N2 gene | N2 gene quantification (copies/μl) | |||||||||||||
| 1 | M | 56 | + | 0 | 1300 | Subarachnoid and cerebellar parenchymal haemorrhage | Medulla: moderate gliosis; cortical white matter: mild gliosis and microglial activation; subarachnoid and cerebellar parenchymal haemorrhage | DAD (all phases) and diffuse microthrombi | − | − | − | − | − | − | 0 | np | Lung, heart | Myocarditis |
| 2 | M | 70 | + | 0 | 1260 | 0 | Cerebellum: plurifocal red neurons (Purkinje cells) | Proliferative and organising DAD | − | − | − | − | − | − | 0 | np | Heart, lung | Myocardiosclerosis, small vessels pulmonary thromboembolism |
| 3 | F | 73 | + | Tetraparesis, ataxia, dysautonomia, ophthalmoplegia | 1260 | 0 | Brainstem: mild gliosis, microglial activation; cerebellum: microglial activation; CA1: focal red neurons | Focal exudative DAD | − | − | 24.74 | 508 | 24.25 | 1798 | 0 | Olfactory bulbs | 0 | Small vessel pulmonary thromboembolism |
| 4 | M | 51 | + | 0 | 1410 | Petechiae in corpus callosum | Cerebellum: focal red neurons (Purkinje cells); corpus callosum: microhaemorrhages; prefrontal cortex, left: focal ferruginized neurons | Exudative and proliferative DAD; focal microthrombi | − | 34.5 | − | − | − | − | 0 | 0 | Lung, kidney | None |
| 5 | M | 67 | + | 0 | 1390 | Parenchymal cerebral haemorrhage, cingulate gyrus and parietal lobe, right | Parietal cortex and cingulate gyrus: left microhaemorrhages; basal ganglia, left: leptomeningeal thrombus; middle cerebral arteries: thrombi | Exudative and proliferative DAD; diffuse microthrombi | 30.2 | 29.7 | 31.81 | 2 | 30.5 | 15 | 0 | 0 | Lung, kidney, liver | Myocardiosclerosis, small vessels pulmonary thromboembolism |
| 6 | F | 97 | + | Dementia | 1050 | Atrophy | Midbrain: focal red neurons | Focal exudative and proliferative DAD | − | − | − | − | 34.17 | 1 | Midbrain: E‐gene: 34.9 | 0 | Lung, liver, kidney, heart | Chronic ischaemic cardiomyopathy, myocardialamyloidosis |
| 7 | F | 74 | + | Seizures, aphasia | 1150 | 0 | Brainstem, cerebellum: focal red neurons; hippocampus and amygdala, left: mild gliosis and microglial activation; amygdala, left: necrosis with neutrophilic infiltrate; middle cerebral arteries: thrombi | Aspergillus pneumonia and plurifocal microthrombi | − | − | 26.85 | 94 | 26.53 | 315 | 0 | Lung, heart, kidney | Myocardiosclerosis, small vessels pulmonary thromboembolism | |
| 8 | M | 62 | + | 0 | 1420 | Parenchymal plurifocal haemorrhages, cerebral and cerebellar, inundation of third ventricle | Pons, midbrain, cerebellum, cerebral hemispheres: microhaemorrhages | DAD (all phases) and diffuse microthrombi | − | − | − | − | − | − | 0 | np | Lung, heart, liver | Small vessel pulmonary thromboembolism, lymphocytic myocarditis |
| 9 | M | 51 | + | 0 | 1220 | 0 | 0 | Proliferative DAD and plurifocal microthrombi | 33 | 32.7 | − | − | 30.95 | 11 | 0 | 0 | Lung, heart, kidney, liver | Myocardiosclerosis |
| 10 | M | 47 | − | Seizures | 1420 | White matter discoloration; cerebellar petechiae | Grey and white matter, diffuse: plurifocal petechial haemorrhages, moderate gliosis, microglial activation, necrosis, neutrophilic infiltrate | Focal exudative DAD | − | − | − | − | − | − | 0 | np | Lung, heart, kidney, liver | None |
| 11 | F | 4 | + | 0 | 1340 | Plurifocal parenchymal haemorrhages, cerebral and cerebellar; marked oedema | Cerebellum: focal red neurons (Purkinje cells) and microhaemorrhages; cerebral cortex and brainstem: focal red neurons, microhaemorrhages and diffuse, marked oedema | Exudative DAD | − | − | − | − | − | − | Midbrain: E‐gene 33.5 | 0 | Lung, intestine | Intestinal infarction, MIS‐C |
| 12 | M | 62 | + | 0 | 1180 | Brain stem and cerebellar haemorrhage | Brainstem, cerebellum, cerebral cortex: plurifocal red neurons; cerebellum: microhaemorrhages | DAD (all phases) | 30.7 | 32.2 | 29.46 | 12 | 29.19 | 41 | 0 | 0 | Lung | None |
| 13 | F | 85 | + | Dementia | 880 | Marked atrophy, midbrain haemorrhage | Cerebellum and midbrain: microhaemorrhages | Focal proliferative DAD | − | − | − | − | − | − | 0 | np | 0 | None |
| 14 | F | 17 | Not performed | 0 | 1230 | Cerebellar tonsil herniation | Prefrontal cortex, left: calcifications | Mild interstitial pneumonia oedema, haemorrhage | 33.2 | 30.68 | 32.47 | 1 | 31.31 | 8 | 0 | 0 | 0 | Severe acute pyelonephritis |
| 15 | M | 57 | + | 0 | 1250 | 0 | Medulla: focal perivascular lymphocytic cuffing; cerebral cortex and brainstem: mild gliosis, plurifocal microhaemorrhages | Oedema, haemorrhage | − | − | HK Neg | HK Neg | HK Neg | HK Neg | 0 | np | 0 | Acute myocardial infarction |
Abbreviations: CNS, central nervous system; DAD, diffuse alveolar damage; MIS‐C, multisystem inflammatory syndrome in children; HK, housekeeping gene; IHC, immunohistochemistry; NA, not available; np, not performed.