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Multifocal Microvascular Injury ID'd in Brain in COVID-19

THURSDAY, Jan. 14, 2021 -- Multifocal microvascular injury has been observed in the brain and olfactory bulbs in postmortem observation of patients who died from COVID-19, according to a research letter published online Dec. 30 in the New England Journal of Medicine.

Myoung-Hwa Lee, Ph.D., from the U.S. National Institute of Neurological Disorders and Stroke in Bethesda, Maryland, and colleagues collected brain tissue from 19 autopsy cases. Postmortem images were obtained from the brains of 13 patients with COVID-19, and conventional histopathological examination was performed on the brains of 18 patients.

The researchers observed abnormalities on magnetic resonance imaging of brains from 10 patients. Punctate hyperintensities were seen in nine patients on magnetic resonance microscopy, representing areas of microvascular injury and fibrinogen leakage. In five patients, these areas showed thinning of the basal lamina of the endothelial cells. In 10 patients, punctate hypointensities on imaging corresponded with congested blood vessels, with surrounding areas of fibrinogen leakage. Minimal perivascular inflammation was seen, and there was no vascular occlusion. In 13 patients, there were perivascular-activated microglia, macrophage infiltrates, and hypertrophic astrocytes; in eight patients, there were CD3+ and CD8+ T cells in the perivascular spaces and in lumens adjacent to endothelial cells. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was not detected by polymerase chain reaction, RNA sequencing, or RNA in situ hybridization and immunostaining.

"The brains of patients who contract infection from SARS-CoV-2 may be susceptible to microvascular blood vessel damage," a coauthor said in a statement. "Our results suggest that this may be caused by the body's inflammatory response to the virus."

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Posted: January 2021

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