Indian Journal of Pathology and Microbiology
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Year : 2022  |  Volume : 65  |  Issue : 5  |  Page : 146-152

Neuropathology of COVID-19

1 Iowa Neuroscience Institute; Departments of Neuroscience and Pharmacology, Iowa City, IA, United States
2 Human Physiology, Iowa City, IA, United States
3 Iowa Neuroscience Institute; Pathology, Iowa City, IA, United States

Correspondence Address:
Marco M Hefti
25 S Grand Ave, MRC-108A, Iowa City, IA 52240
United States
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijpm.ijpm_1103_21

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The COVID-19 pandemic has placed global health care systems under unprecedented strain but has, at the same time, provided a unique opportunity for pathologists to turn autopsy findings into directly actionable insights into patient care. The current data on the neuropathology of COVID-19 remains preliminary and is limited by the lack of suitable controls, but certain tentative conclusions can be drawn. SARS-CoV-2 can infect multiple cell types in the central nervous system and does so in a subset of patients, although the clinical significance of direct infections remains in the central nervous system (CNS) and the peripheral nervous system (PNS) infections remains unclear. The best-described neuropathological manifestations of COVID-19 in the brain are variable patterns of neuroinflammation and vascular injury, although again, it remains unclear to what degree these findings are specifically due to COVID-19. There is also intriguing preliminary data to suggest a complex relationship between COVID-19 and neurodegeneration, with certain alleles that increase AD risk also increasing the risk of severe COVID-19, and conversely, the possibility that COVID-19 may increase the risk of neurodegenerative disease. The neuropathology of so-called “long-COVID” and the potential effects of COVID-19, or critical illness in general, on neurodegenerative disease remains unclear. There is thus an urgent need for long-term cohort studies of COVID-19 survivors, including brain donation, particularly in elderly patients, with careful recruitment of controls with similar non-COVID inflammatory illnesses.

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