Neuropathological findings of Covid-19: a systematic review

Abstract

Introduction. COVID-19, the coronavirus disease 2019, was first identified in China and showed a rapid worldwide expansion, being recognized as a pandemic in March 2020. Its etiological agent, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causes an airway infection. However, recent clinical findings and animal studies suggest that the virus also promotes notable neuronal pathways and circulatory system impairments, leading to injuries in the central nervous system. Objective. Collect and analyze data published between 2019 and 2020 regarding lesions found in the nervous system based on necropsy and image studies performed on humans. Method. A systematic search was performed in the PubMed and ScienceDirect databases using the descriptors “COVID-19” OR “SARS-CoV-2” OR “Coronavirus” AND “Central Nervous System” OR “Brain” AND “Autopsy” OR “RMI” . Original primary studies, published between 2019 and 2020, were included. Animal studies, unproven cases of COVID-19 contamination, and in vitro studies were excluded. Results. Although studies of pathological mechanisms and viral dissemination methods are still scarce, the main findings of this systematic review point to immunological, inflammatory, and infectious causes. Intracranial and intracerebral hemorrhage and ischemic stroke were the main reported events, with Covid-19  stroke tend to be severer than other causes. Conclusions. Even though the scientific data is still scarce to explain SARS-CoV-2 damage pathways in the central nervous system, the evidence available suggests a correlation between COVID-19 and neurological complications in some patients.