ArticleNeuropathology and applied neurobiology2021
Intracerebral endotheliitis and microbleeds are neuropathological features of COVID-19.
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Who cites it
70 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Cerebral small vessel disease pathology in COVID-19 patients: A systematic review.Ageing research reviews · 2023Pooled it
- A case-based systematic review on the SARS-COVID-2-associated cerebrovascular diseases and the possible virus routes of entry.Journal of neurovirology · 2021Pooled it
- Autopsy Tool in Unknown Diseases: The Experience with Coronaviruses (SARS-CoV, MERS-CoV, SARS-CoV-2).Medicina (Kaunas, Lithuania) · 2021Pooled it
- Exploring cerebral small vessel disease signatures in familial Parkinson's disease.Scientific reports · 2026Article
- Structured assessment of brain MRI in Covid-19-related neurological disease: an international multicentre study.Neuroradiology · 2025Article
- Neuroimmune pathophysiology of long COVID.Psychiatry and clinical neurosciences · 2025Review
- Acute and long-term effects of COVID-19 on brain and mental health: A narrative review.Brain, behavior, and immunity · 2025Review
- Functional Connectivity Alterations Associated with COVID-19-Related Sleep Problems: A Longitudinal Resting-State fMRI Study.Nature and science of sleep · 2025Article
- Cerebrovascular Reactivity Assessed by Breath-Hold Functional MRI in Patients with Neurological Post-COVID-19 Syndrome-A Pilot Study.Neurology international · 2024Article
- Histochemical Evidence for Reduced Immune Response in Nasal Mucosa of Patients with COVID-19.International journal of molecular sciences · 2024Article
- High-dose glucocorticoids in COVID-19 patients with acute encephalopathy: clinical and imaging findings in a retrospective cohort study.Journal of neural transmission (Vienna, Austria : 1996) · 2024Article
- Acute neutrophilic vasculitis (leukocytoclasia) in 36 COVID-19 autopsy brains.Diagnostic pathology · 2024Article
- Multimodal neuroimaging in Long-COVID and its correlates with cognition 1.8 years after SARS-CoV-2 infection: a cross-sectional study of theFrontiers in neurology · 2024Article
- Cerebral microbleeds in patients with COVID-19: is there an inevitable connection?Brain communications · 2024Review
- COVID-19-associated cerebral microbleeds in the general population.Brain communications · 2024Article
- Postmortem neuropathology in COVID-19: An update.Brain pathology (Zurich, Switzerland) · 2023Article
- SARS-CoV-2 infects epithelial cells of the blood-cerebrospinal fluid barrier rather than endothelial cells or pericytes of the blood-brain barrier.Fluids and barriers of the CNS · 2023Article
- Complications of COVID-19 on the Central Nervous System: Mechanisms and Potential Treatment for Easing Long COVID.Aging and disease · 2023Review
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15 authors.
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Abstract
Coronavirus disease 19 (COVID-19) is a rapidly evolving pandemic caused by the coronavirus Sars-CoV-2. Clinically manifest central nervous system symptoms have been described in COVID-19 patients and could be the consequence of commonly associated vascular pathology, but the detailed neuropathological sequelae remain largely unknown. A total of six cases, all positive for Sars-CoV-2, showed evidence of cerebral petechial hemorrhages and microthrombi at autopsy. Two out of six patients showed an elevated risk for disseminated intravascular coagulopathy according to current criteria and were excluded from further analysis. In the remaining four patients, the hemorrhages were most prominent at the grey and white matter junction of the neocortex, but were also found in the brainstem, deep grey matter structures and cerebellum. Two patients showed vascular intramural inflammatory infiltrates, consistent with Sars-CoV-2-associated endotheliitis, which was associated by elevated levels of the Sars-CoV-2 receptor ACE2 in the brain vasculature. Distribution and morphology of patchy brain microbleeds was clearly distinct from hypertension-related hemorrhage, critical illness-associated microbleeds and cerebral amyloid angiopathy, which was ruled out by immunohistochemistry. Cerebral microhemorrhages in COVID-19 patients could be a consequence of Sars- CoV-2-induced endotheliitis and more general vasculopathic changes and may correlate with an increased risk of vascular encephalopathy.
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