Neurological sequelae in patients with covid-19: A histopathological perspective

Francesco Fisicaro, Mario Di Napoli, Aldo Liberto, Martina Fanella, Flavio Di Stasio, Manuela Pennisi, Rita Bella, Giuseppe Lanza, Gelsomina Mansueto

Research output: Contribution to journalReview articlepeer-review


Background: Neuroinvasive properties of SARS-CoV-2 have allowed the hypothesis of several pathogenic mechanisms related to acute and chronic neurological sequelae. However, neu-ropathological correlates have been poorly systematically investigated, being retrieved from reports of single case or limited case series still. Methods: A PubMed search was carried out to review all publications on autopsy in subjects with “COronaVIrus Disease-19” (COVID-19). Among them, we focused on histological findings of the brain, which were compared with those from the authors’ autoptic studies performed in some COVID-19 patients. Results: Only seven studies reported histological evidence of brain pathology in patients deceased for COVID-19, including three with reverse transcription–quantitative polymerase chain reaction evidence of viral infection. All these studies, in line with our experience, showed vascular-related and infection-related secondary inflammatory tissue damage due to an abnormal immune response. It is still unclear, however, whether these findings are the effect of a direct viral pathology or rather reflect a non-specific consequence of cardiovascular and pulmonary disease on the brain. Conclusions: Notwithstanding the limited evidence available and the heterogeneity of the studies, we provide a preliminary description of the relationship between SARS-CoV-2 and brain sequelae. Systematic autoptic investigations are needed for accurate detection and adequate management of these patients.

Original languageEnglish
Article number1415
Pages (from-to)1-16
Number of pages16
JournalInternational Journal of Environmental Research and Public Health
Issue number4
Publication statusPublished - Feb 2 2021


  • Autopsy
  • COVID-19
  • Histopathology
  • Long-term prognosis
  • Neuroinvasion
  • Neuropathology
  • Outcome
  • Pathogenesis
  • SARS-CoV-2

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Health, Toxicology and Mutagenesis


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