Department of Neuropathology, Institute of Psychiatry and Neurology, Warsaw, Poland.
Department of Forensic Medicine, Medical University of Warsaw, Warsaw, Poland.
Folia Neuropathol. 2021;59(3):219-231. doi: 10.5114/fn.2021.108829.
Coronavirus disease 2019 (COVID-19) poses a global challenge to healthcare and society in the early 21st century. We report neuropathological changes in 52 patients aged between 22 years and 88 years (median 58 years) who were infected with the CoV-2 coronavirus. Patients died under various circumstances and had various pre-existing diseases. The inclusion criteria for this study were: positive result for the nasopharyngeal swab for SARS-CoV-2 RNA, diagnosis of pneumonia of SARS-CoV-2 or nucleoproteins of SARS-CoV-2 in pulmonary tissue confirmed by immunohistochemical methods (IHC). Samples from all brain structures and lung specimens were taken for histopathological examinations. Brain and pulmonary samples were stained typically with histological and immunohistochemical methods and small tissue fragments were examined with the transmission electron microscope (TEM). The light and electron microscopy examination confirmed the numerous neuropathological changes in the brains of the patients infected with the CoV-2. Many of these changes were caused by pre-existing diseases of patients and/or by necessary treatment. However, vascular lesions and the inflammatory process seem to be characteristic of the CoV-2 infection. In all of the structures of 52 brains of patients, damage of the vessel walls and morphological feature of the damage to the blood-brain barrier were observed. Lymphocytic and microglial infiltrates, both perivascular and diffuse, were also observed. Hence, the brain changes due to COVID-19 infection, could be called COVID-19 cerebral angiopathy with diffuse inflammation.
2019 年冠状病毒病（COVID-19）对 21 世纪初的医疗保健和社会构成了全球性挑战。我们报告了 52 名年龄在 22 岁至 88 岁之间（中位数为 58 岁）的感染了 CoV-2 冠状病毒的患者的神经病理学变化。患者因各种情况死亡，并有各种先前存在的疾病。本研究的纳入标准为：鼻咽拭子 SARS-CoV-2 RNA 检测阳性，肺组织 SARS-CoV-2 肺炎或核衣壳蛋白的免疫组织化学方法（IHC）确诊为 SARS-CoV-2 肺炎，所有脑结构和肺标本均用于组织病理学检查。脑和肺标本通常用组织学和免疫组织化学方法染色，并通过透射电子显微镜（TEM）检查小块组织。光镜和电镜检查证实了感染 CoV-2 的患者大脑中存在许多神经病理学变化。这些变化中的许多是由患者的先前存在的疾病和/或必要的治疗引起的。然而，血管病变和炎症过程似乎是 CoV-2 感染的特征。在所有 52 例患者的大脑结构中，均观察到血管壁损伤和血脑屏障损伤的形态特征。还观察到血管周围和弥漫性的淋巴细胞和小胶质细胞浸润。因此，COVID-19 感染引起的脑改变可以称为 COVID-19 脑血管病伴弥漫性炎症。
