Two Cases of Encephalitis with Brainstem Involvement and Microglial Activation in SARS-CoV-2 Infection

Abstract

Corona Virus Disease 2019 (COVID-19) primary involves the respiratory system. However, as many other viral pandemics, the current severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is also characterized by nervous system involvement, mainly in elderly patients with comorbidity. The involvement of the nervous system is manifested by a variety of clinical symptoms, and results in morphology: encephalopathy, polyneuritis, brainstem encephalitis, etc. We present two PCR proven cases of patients who died after infection with the SARS-CoV-2 virus. The analysis of the inflammatory findings mainly manifested by perivenous lymphocytic infiltrates, also showed increase number of activated microglial cells. The blood supply of most venous vessels with different size and a pronounced “sludge” phenomenon made us a special impression, as in some sections these changes were demonstrated by a presence of thrombosis. Inflammatory manifestations were also observed in the brainstem near to the stem nuclei. We emphasize on the pathomorphological changes found in the brainstem, where inflammatory manifestations were also observed near to the stem nuclei.