Detailed neuropathologic report of COVID-19 complicated by large intracerebral hemorrhage and periventricular lesions with macrophagic infiltrates

  • Adrian Levine Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
  • Carol Lee Division of Forensic Pathology, Royal Columbian Hospital, Vancouver, BC, Canada
  • Craig Fava Division of Critical Care, Royal Columbian Hospital, BC, Canada
  • Frankie Tsang British Columbia Center for Disease Control, Vancouver, BC, Canada
  • Kelly McNeil Cancer Genetics & Genomics Laboratory, BC Cancer, Vancouver, BC, Canada
  • Stephen T. Yip Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada; Cancer Genetics & Genomics Laboratory, BC Cancer, Vancouver, BC, Canada
  • Veronica Hirsch-Reinshagen Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
Keywords: COVID-19, Cerebral hemorrhage, Brain, Postmortem, Histology, Neuropathology

Abstract

Infection with the SARS-CoV-2 virus affects a wide range of systems. Significant involvement of the central nervous system has been described, including ischemic and hemorrhagic strokes. Thus far, neuropathologic reports of patients who passed away from COVID-19 have generally described non-specific findings, such as variable reactive gliosis and meningeal chronic inflammatory infiltrates, as well as the consequences of the infection’s systemic complications on the brain, including ischemic infarcts and hypoxic/ischemic encephalopathy. The neuropathological changes in patients with COVID-19 and large hemorrhagic strokes have not been described in detail. We report the case of an elderly male who had a long course of COVID-19 and ultimately passed away from a large intracerebral hemorrhage. In addition to acute hemorrhage, neuropathologic examination demonstrated non-specific reactive changes and chronic periventricular lesions with macrophagic and perivascular lymphocytic infiltrates without evidence of demyelination or presence of SARS-CoV-2 by PCR test. This manuscript expands the spectrum of reported neuropathological changes in patients with COVID-19.

Published
2021-03-25
How to Cite
Levine, A., Lee, C., Fava, C., Tsang, F., McNeil, K., Yip, S. T., & Hirsch-Reinshagen, V. (2021). Detailed neuropathologic report of COVID-19 complicated by large intracerebral hemorrhage and periventricular lesions with macrophagic infiltrates. Free Neuropathology, 2, 7. https://doi.org/10.17879/freeneuropathology-2021-3266
Section
Case Report