Neuronophagia and microglial nodules in a SARS-CoV-2 patient with cerebellar hemorrhage
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CASE REPORT
Neuronophagia and microglial nodules in a SARS‑CoV‑2 patient with cerebellar hemorrhage Osama Al‑Dalahmah1* , Kiran T. Thakur2, Anna S. Nordvig2, Morgan L. Prust2, William Roth2, Angela Lignelli3, Anne‑Catrin Uhlemann4, Emily Happy Miller4, Shajo Kunnath‑Velayudhan1, Armando Del Portillo1, Yang Liu1, Gunnar Hargus1, Andrew F. Teich1,2, Richard A. Hickman1, Kurenai Tanji1,2, James E. Goldman1, Phyllis L. Faust1 and Peter Canoll1
Abstract We document the neuropathologic findings of a 73-year old man who died from acute cerebellar hemorrhage in the context of relatively mild SARS-CoV2 infection. The patient developed sudden onset of headache, nausea, and vomiting, immediately followed by loss of consciousness on the day of admission. Emergency medical services found him severely hypoxemic at home, and the patient suffered a cardiac arrest during transport to the emergency depart‑ ment. The emergency team achieved return of spontaneous circulation after over 17 min of resuscitation. A chest radiograph revealed hazy bilateral opacities; and real-time-PCR for SARS-CoV-2 on the nasopharyngeal swab was positive. Computed tomography of the head showed a large right cerebellar hemorrhage, with tonsillar herniation and intraventricular hemorrhage. One day after presentation, he was transitioned to comfort care and died shortly after palliative extubation. Autopsy performed 3 h after death showed cerebellar hemorrhage and acute infarcts in the dorsal pons and medulla. Remarkably, there were microglial nodules and neuronophagia bilaterally in the inferior olives and multifocally in the cerebellar dentate nuclei. This constellation of findings has not been reported thus far in the context of SARS-CoV-2 infection. Keywords: Microglial nodules, Neuronophagia, SARS-CoV-2, COVID-19, Neuropathology Introduction Symptomatic SARS-CoV-2 infection presents as a respiratory syndrome with upper and lower respiratory systems manifestations, characterized by cough, dyspnea, fever, chills, hyposmia, and ageusia [5, 20]. Male patients [9] as well as patients with comorbidities such as diabetes, obesity, hypertension, cardiac disease, pulmonary disease, and other chronic diseases [32], are prone to more severe manifestations. While the majority of *Correspondence: [email protected] 1 Department of Pathology and Cell Biology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center and the New York Presbyterian Hospital, New York, NY, USA Full list of author information is available at the end of the article
infections are mild, severe infections can lead to serious end-organ damage due to respiratory failure, acute kidney injury, disseminated intravascular coagulation-like systemic coagulopathy [12], and thrombosis [16]. Neurologic sequelae have been reported in a number of SARSCoV-2 patients including ischemic stroke, seizures, Guillain–Barre Syndrome, and acute necrotizing hemorrhagic leukoencephalopathy [3, 8, 14, 15, 19, 25, 35]. It is yet to be determined whether
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