Neuropathological findings in COVID-19: an autopsy cohort

Kathryn L. Eschbacher, Rachel A. Larsen, Ann M. Moyer, Ramanath Majumdar, Robert Ross Reichard

Research output: Contribution to journalArticlepeer-review


The literature regarding the neuropathological findings in cases of SARS-CoV-2 infection, which causes coronavirus disease 2019 (COVID-19), is expanding. We identified 72 patients who died of COVID-19 (n = 48) or had recovered shortly before death (n = 24) and had autopsies performed at our institution (49 males, 23 females; median age at death 76.4 years, range: 0.0-95.0 years). Droplet digital polymerase chain reaction (ddPCR) for the detection of SARS-CoV-2 was performed (n = 58) in multiple brain regions. In cases the assay was successfully completed (n = 50), 98.0% were negative (n = 49) and 2% were indeterminate (n = 1). Most histologic findings were typical of the patient age demographic, such as neurodegenerative disease and arteriolosclerosis. A subset of cases demonstrated findings which may be associated with sequelae of critical illness. We identified 3 cases with destructive perivascular lesions with axonal injury, one of which also harbored perivascular demyelinating lesions. These rare cases may represent a parainfectious process versus sequelae of vascular injury. The lack of detectable SARS-CoV-2 by ddPCR or significant histologic evidence of direct infection suggests that active encephalitis is not a feature of COVID-19.

Original languageEnglish (US)
Pages (from-to)21-28
Number of pages8
JournalJournal of Neuropathology and Experimental Neurology
Issue number1
StatePublished - Dec 19 2022


  • Autopsy
  • COVID-19
  • Neuropathological findings
  • SARS-CoV-2

ASJC Scopus subject areas

  • General Medicine


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