Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts.
Harvard Medical School, Boston, Massachusetts.
Semin Neurol. 2023 Apr;43(2):195-204. doi: 10.1055/s-0043-1767716. Epub 2023 Apr 6.
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, 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.
神经病理学研究结果已经发表，涉及约 900 名死于或因严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 感染的患者，这不到 640 万例据世界卫生组织报告的 COVID-19 大流行 2 年来的死亡人数的 0.01%。在这篇综述中，我们扩展了之前总结 COVID-19 神经病理学的工作，纳入了截至 2022 年 6 月发表的尸检信息，以及儿童 COVID-19、COVID-19 变体、继发性脑部感染、脑部影像学和美国或欧洲以外国家进行的尸检方面的神经病理学研究。我们还总结了研究非人类灵长类动物和其他模型中神经发病机制的研究。虽然脑血管病理学和小胶质细胞主导的炎症模式仍然是 COVID-19 相关神经病理学的主要发现，但对于急性 COVID-19 或 COVID-19 后条件下导致神经症状的机制，尚无单一的理解。因此，至关重要的是，我们将脑组织的微观和分子发现纳入我们对临床疾病的了解，以便我们获得 COVID-19 神经发病率研究的最佳实践指导和直接研究重点。
