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. 2021 Feb 4;384(5):481-483.
doi: 10.1056/NEJMc2033369. Epub 2020 Dec 30.

Microvascular Injury in the Brains of Patients with Covid-19

Myoung-Hwa Lee  1 , Daniel P Perl  2 , Govind Nair  1 , Wenxue Li  1 , Dragan Maric  1 , Helen Murray  1 , Stephen J Dodd  1 , Alan P Koretsky  1 , Jason A Watts  3 , Vivian Cheung  3 , Eliezer Masliah  4 , Iren Horkayne-Szakaly  5 , Robert Jones  5 , Michelle N Stram  6 , Joel Moncur  5 , Marco Hefti  7 , Rebecca D Folkerth  6 , Avindra Nath  8
Affiliations

Microvascular Injury in the Brains of Patients with Covid-19

Myoung-Hwa Lee et al. N Engl J Med. .
No abstract available

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Figures

Figure 1
Figure 1. Pathological Studies of Microvascular Injury in the Brains of Patients Who Died from Covid-19.
Panel A (magnetic resonance microscopy of the olfactory bulb) shows an area of hyperintense signal (arrow). Panel B shows the corresponding area on multiplex immunofluorescence imaging, which revealed a focal area of fibrinogen leakage (in the box, fibrinogen is shown in green, collagen IV is shown in yellow, and nuclei are shown in blue). Panel B1 shows diffuse leakage of fibrinogen in the parenchyma (an enlarged view showing marked blood vessel staining for collagen IV is shown in Panel B2). Panel B2 (collagen IV immunostaining) shows intact (arrowhead) and thinned (arrow) basal lamina with fibrinogen leakage into the parenchyma. Panel C shows magnetic resonance microscopy of the pons, and Panel D (fibrinogen staining) shows areas of increased signal intensity corresponding to the vascular leakage visible on magnetic resonance microscopy. The arrows and the area within the dashed lines in Panels C and D indicate the vascular leakage. Panels A through E represent imaging performed in Patient IA1. Panel E (collagen IV immunostaining) shows areas of fibrinogen leakage in blood vessels in Patient IA1. Panel F shows magnetic resonance microscopy of the medulla in Patient IA3. The yellow arrows indicate linear hypointense signals, and the red arrows indicate linear hyperintense signals. Panel G shows CD68+ perivascular macrophages in the pons in Patient NY6. Panel H shows perivascular astrocytosis in the basal ganglia in Patient NY5. Panel I shows perivascular CD3+ cells in the cerebellum in Patient IA1. Panel J shows intraluminal and perivascular CD8+ cells in the pons in Patient NY6. Panel K shows perineuronal IBA1 cells in the pons in Patient NY6. Panel L shows CD68+ cells in the dorsal motor nucleus of the vagus nerve in Patient IA1. Panel M shows a solitary nucleus in the medulla and Panel N shows a pre-Bötzinger complex in Patient IA1. (Diaminobenzidine staining was used in Panels G through N.)
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References

    1. Solomon IH, Normandin E, Bhattacharyya S, et al. Neuropathological features of Covid-19. N Engl J Med 2020;383:989-992. - PMC - PubMed
    1. Matschke J, Lütgehetmann M, Hagel C, et al. Neuropathology of patients with COVID-19 in Germany: a post-mortem case series. Lancet Neurol 2020;19:919-929. - PMC - PubMed
    1. Varga Z, Flammer AJ, Steiger P, et al. Endothelial cell infection and endotheliitis in COVID-19. Lancet 2020;395:1417-1418. - PMC - PubMed

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