Introduction: SARS-CoV-2 might spread through the nervous system, reaching respiratory centers in the brainstem. Because we recently reported neurophysiological brainstem reflex abnormalities in COVID-19 patients, we here neuropathologically assessed structural brainstem damage in two COVID-19 patients. Materials and methods: We assessed neuropathological features in two patients who died of COVID-19 and in two COVID-19 negative patients as controls. Neuronal damage and corpora amylacea (CA) numbers /mm2 were histopathologically assessed. Other features studied were the immunohistochemical expression of the SARS-CoV-2 nucleoprotein (NP) and the Iba-1 antigen for glial activation. Results: Autopsies showed normal gross brainstem anatomy. Histopathological examination demonstrated increased neuronal and CA damage in Covid-19 patients’ medulla oblongata. Immunohistochemistry disclosed SARS-CoV-2 NP in brainstem neurons and glial cells, and in cranial nerves. Glial elements also exhibited a widespread increase in Iba-1 expression. Sars-Co-V2 was immunohistochemically detected in the vagus nerve fibers. Discussion: Neuropathologic evidence showing SARS-CoV-2 in the brainstem and medullary damage in the area of respiratory centers strongly suggests that the pathophysiology of COVID-19-related respiratory failure includes a neurogenic component. Sars-Co-V2 detection in the vagus nerve, argues for viral trafficking between brainstem and lung.

Brainstem neuropathology in two cases of COVID-19: SARS-CoV-2 trafficking between brain and lung / G. Bulfamante, T. Bocci, M. Falleni, L. Campiglio, S. Coppola, D. Tosi, D. Chiumello, A. Priori. - In: JOURNAL OF NEUROLOGY. - ISSN 0340-5354. - (2021), pp. 1-6. [Epub ahead of print] [10.1007/s00415-021-10604-8]

Brainstem neuropathology in two cases of COVID-19: SARS-CoV-2 trafficking between brain and lung

G. Bulfamante
Co-primo
;
T. Bocci
Co-primo
;
M. Falleni
Secondo
;
L. Campiglio;S. Coppola;D. Tosi;D. Chiumello
Penultimo
;
A. Priori
Ultimo
2021

Abstract

Introduction: SARS-CoV-2 might spread through the nervous system, reaching respiratory centers in the brainstem. Because we recently reported neurophysiological brainstem reflex abnormalities in COVID-19 patients, we here neuropathologically assessed structural brainstem damage in two COVID-19 patients. Materials and methods: We assessed neuropathological features in two patients who died of COVID-19 and in two COVID-19 negative patients as controls. Neuronal damage and corpora amylacea (CA) numbers /mm2 were histopathologically assessed. Other features studied were the immunohistochemical expression of the SARS-CoV-2 nucleoprotein (NP) and the Iba-1 antigen for glial activation. Results: Autopsies showed normal gross brainstem anatomy. Histopathological examination demonstrated increased neuronal and CA damage in Covid-19 patients’ medulla oblongata. Immunohistochemistry disclosed SARS-CoV-2 NP in brainstem neurons and glial cells, and in cranial nerves. Glial elements also exhibited a widespread increase in Iba-1 expression. Sars-Co-V2 was immunohistochemically detected in the vagus nerve fibers. Discussion: Neuropathologic evidence showing SARS-CoV-2 in the brainstem and medullary damage in the area of respiratory centers strongly suggests that the pathophysiology of COVID-19-related respiratory failure includes a neurogenic component. Sars-Co-V2 detection in the vagus nerve, argues for viral trafficking between brainstem and lung.
Brainstem; COVID-19; Medulla oblongata; Neurological COVID-19; Neuropathology; SARS-CoV-2
Settore MED/08 - Anatomia Patologica
Settore MED/26 - Neurologia
Settore MED/41 - Anestesiologia
18-mag-2021
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2434/866868
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