Table 1 Clinical, radiological and pathological central nervous system features in seven fatal COVID-19 cases

Patient 1

M, 45y

Heart failure, anasarca, dyspnea, ARDS, ARF

12

5

Bilateral old infarcts (right frontal and left parietal)

Bilateral cortical infarcts (right frontal and left parietal) with cortical necrosis and petechial hemorrhage (probably chronic) and old left cerebellar infarct (Fig. 2)

Reactive microglia, "red neurons," edema, congestion, fibrin thrombi, perivascular hemorrhages and hemosiderin deposits, small vessel disease

RT-PCR + IH + 

Patient 2

F, 39y

Anasarca, abdominal pain, nausea, dyspnea, ARF, seizures. Cardiorespiratory arrest, shock, thrombolytic therapy in the day of death due to suspected pulmonary embolism. Previous depression

31

2

Subarachnoid hemorrhage, bilateral basal ganglia and parietal hypoattenuation

Subarachnoid hemorrhage, corticospinal tract, basal ganglia and cortical subcortical biparietal and right frontal signal abnormalities (Fig. 3)

Reactive microglia, "red neurons," Alzheimer type II glia, edema, congestion, perivascular hemorrhages and hemosiderin deposits

RT-PCR + IH + 

Patient 3

M, 74y

SAH, DM, ischemic cardiopathy, Flu-like symptoms (myalgia, cough, adynamia, poor appetite), ARDS, stupor, A-V block, cardiorespiratory arrest, refractory shock

17

10

Diffuse cerebral edema

Diffuse cerebral edema and patchy white matter focal abnormalities (Fig. 4a, b)

Not evaluated *

Patient 4

F, 11y

Flu-like symptoms, odynophagia, fever, chest pain, headache, diarrhea, ARDS, AKI, refractory shock

8

1

Normal

Focal signal abnormality in the splenium of corpus callosum with microbleeds and subtle sulcal effacement (Fig. 4c, d)

Reactive microglia, "red neurons," edema, congestion, discrete perivascular hemorrhages

IH + (RT-PCR not performed)**

Patient 5

F, 74y

Breast cancer (2019 treatment), neutropenia, SAH, hypothyroidism, cough, fever, ARDS, ARF, pneumothorax (drained) and refractory shock

23

3

Atheromatosis, globus pallidus calcification, focal areas of white matter hypoattenuation

Focal white matter signal abnormalities and focal frontal white matter hemorrhagic foci (Fig 5a, b)

Reactive microglia, "red neurons," edema, congestion, perivascular hemorrhages, small vessel disease and focal ischemia

RT-PCR + IH + 

Patient 6

F, 35y

Pregnancy (third trimester), asthma, DM, obesity, myalgia, chills, headache, fever, anosmia and ageusia, dyspnea, ARDS, severe bronchospasm, emergency cesarean section, tachyarrhythmias, CPR > 1 h

16

7

Normal

Normal

Reactive microglia, "red neurons," congestion, periventricular vascular ectasia, small vessel disease, Alzheimer type II glia

RT-PCR + IH + 

Patient 7

M, 32y

Flu-like symptoms, fever, headache, diarrhea, myalgia, decreased appetite and cough. ARDS, pneumonia, ECMO, refractory shock

32

7

Normal

Few punctate hemorrhagic periventricular foci (Fig 5c, d)

Reactive microglia, "red neurons," edema, congestion, perivascular hemorrhages, Alzheimer type II glia, peri-ependymal focal hemorrhagic encephalitis with mixed inflammatory reaction

RT-PCR + IH +