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 /mm 2 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. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-021-10604-8.
【저자키워드】 COVID-19, SARS-CoV-2, Neuropathology, Brainstem, Medulla oblongata, Neurological COVID-19, 【초록키워드】 immunohistochemistry, Respiratory failure, lung, Antigen, Spread, Viral, pathophysiology, cells, Patient, nervous system, respiratory centers, Brainstem, Medulla oblongata, Other, expression, COVID-19 patients, Evidence, cranial nerves, Neuron, Autopsies, glial cells, negative patients, vagus nerve, brainstem reflex, Activation, supplementary material, two patients, material, histopathological examination, SARS-CoV-2 nucleoprotein, abnormality, two COVID-19 patients, element, SARS-Co, Anatomy, widespread, controls, feature, Result, died, include, reported, exhibited, demonstrated, increase in, COVID-19 negative, cranial, neuronal, oblongata, the SARS-CoV-2, 【제목키워드】 Brain,