Department of Clinical Neuropathology, King's College Hospital NHS Foundation Trust, London, UK.
London Neurodegenerative Diseases Brain Bank, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
Neuropathol Appl Neurobiol. 2021 Feb;47(1):3-16. doi: 10.1111/nan.12667. Epub 2020 Oct 20.
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 summarize 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.
越来越多的证据表明，患有 19 型冠状病毒病（COVID-19）的患者会出现神经系统和精神症状。虽然有越来越多的临床报告表明出现了更严重和更特定的病症，如急性脑血管意外、脑炎和脱髓鞘疾病，但通常会描述嗅觉丧失、味觉减退、头痛、恶心和意识改变等症状。这些表现是否直接由于病毒侵犯中枢神经系统（CNS），还是由间接机制引起的，还有待确定。对尸检脑组织进行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，详细的研究很少。大脑中的病理变化可能代表 SARS-CoV-2 复制介导的直接细胞病变效应与呼吸衰竭、损伤性细胞因子反应、免疫反应减弱以及病毒感染引起的脑血管意外的间接效应的组合。需要进一步进行大规模的分子和细胞研究，以阐明 COVID-19 患者临床所见的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 COVID-19 患者神经病理学检查的现有报告，以及我们自己的经验，并讨论了它们对理解该疾病中 CNS 受累的贡献。
