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Brain autopsies in fatal COVID-19 and postulated pathophysiology: more puzzling than a Rubik’s cube
  1. Sudhir Mehta1,
  2. Sudhir Bhandari1,
  3. Shaurya Mehta2
  1. 1 Department of Medicine, SMS Medical College (University Medical School), Jaipur, Rajasthan, India
  2. 2 Department of Nephrology, Jaslok Hospital & Research Centre, Mumbai, Maharashtra, India
  1. Correspondence to Professor Sudhir Mehta, Department of Medicine, SMS Medical College (University Medical School), Jaipur, Rajasthan 302004, India; s.smehta{at}

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The Editor

A little over century after the 1918 influenza pandemic, the world is witnessing another pandemic of similar magnitude, caused by SARS-CoV-2 and affecting nearly 215 countries. Although SARS-CoV-2 primarily affects the lungs, neurological presentations are being recognised with increasing frequency. Recently, Ellul and colleagues1 have elaborated a spectrum of neurological diseases in 901 patients of COVID-19. Here, we describe three case series of brain autopsies2–4 that have revealed distinctly different pathologies, failing to explain the common pathobiological mechanism of central nervous system (CNS) involvement in severe COVID-19.

Solomon et al 2 reported histopathological changes in autopsies of 18 patients with COVID-19 from a teaching hospital. Gross inspection showed no changes suggestive of acute stroke, herniation or olfactory bulb damage. Microscopic examination revealed changes of acute hypoxia in the cerebrum and cerebellum in 100% of patients with COVID-19, with neuronal loss in various structures like cerebral cortex, hippocampus and cerebellar Purkinje cell layer. There were no findings of thrombosis or vasculitis. Focal …

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  • Handling editor Runjan Chetty.

  • Contributors All authors contributed equally to the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.