Neuropathology of Pediatric SARS-CoV-2 Infection in the Forensic Setting: Novel Application of Ex Vivo Imaging in Analysis of Brain Microvasculature

作者：Michelle Stram, Alan C. Seifert, Etty Cortés, Alara Akyatan, Emma Woodoff‐Leith, Valeriy Borukhov, Amber M. Tetlow, Dimath Alyemni, Michael D. Greenberg, Avneesh Gupta, Amanda Krausert, Lauren Mecca, Sophia Rodriguez, Jay Stahl‐Herz, Miguel A. Guzmán, Bradley N. Delman, John F. Crary, Kristen Dams-O’Connor, Rebecca D. Folkerth · 发表于：Frontiers in Neurology · 年份：2022 · DOI：10.3389/fneur.2022.894565 · 被引用次数：16 · 研究领域：Infectious Encephalopathies and Encephalitis、Long-Term Effects of COVID-19、Neonatal and fetal brain pathology

Two years into the COVID-19 pandemic, there are few published accounts of postmortem SARS-CoV-2 pathology in children. We report 8 such cases (4 infants aged 7–36 weeks, 4 children aged 5–15 years). Four underwent ex vivo magnetic resonance neuroimaging, to assist in identification of subtle lesions related to vascular compromise. All infants were found unresponsive (3 in unsafe sleeping conditions); all but 1 had recent rhinitis and/or influenza-like illness (ILI) in the family; 1 had history of sickle cell disease. Ex vivo neuroimaging in 1 case revealed white matter (WM) signal hyperintensity and diffuse exaggeration of perivascular spaces, corresponding microscopically to WM mineralization. Neurohistology in the remaining 3 infants variably encompassed WM gliosis and mineralization; brainstem gliosis; perivascular vacuolization; perivascular lymphocytes and brainstem microglia. One had ectopic hippocampal neurons (with pathogenic variant in DEPDC5 ). Among the children, 3 had underlying conditions (e.g., obesity, metabolic disease, autism) and all presented with ILI. Three had laboratory testing suggesting multisystem inflammatory syndrome (MIS-C). Two were hospitalized for critical care including mechanical ventilation and extracorporeal membrane oxygenation (ECMO); one (co-infected with adenovirus) developed right carotid stroke ipsilateral to the ECMO cannula and the other required surgery for an ingested foreign body. Autopsy findings included: acute lung injury in 3 ...