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Santana MF, Frank CHM, Almeida TVR, Jeronimo CMP, de Araújo Pinto RA, Martins YF, de Farias MEL, Dutra BG, Brito-Sousa JD, Baía-da-Silva DC, Xavier MS, Lacerda MVG, Almeida Val FF, Monteiro GC, Sampaio VDS, Monteiro WM, Ferreira LCDL. Hemorrhagic and thrombotic manifestations in the central nervous system in COVID-19: A large observational study in the Brazilian Amazon with a complete autopsy series. PLoS One 2021; 16:e0255950. [PMID: 34506501 PMCID: PMC8432786 DOI: 10.1371/journal.pone.0255950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 07/27/2021] [Indexed: 12/25/2022] Open
Abstract
SARS-CoV-2 affects mainly the lungs, however, other manifestations, including neurological manifestations, have also been described during the disease. Some of the neurological findings have involved intracerebral or subarachnoid hemorrhage, strokes, and other thrombotic/hemorrhagic conditions. Nevertheless, the gross pathology of hemorrhagic lesions in the central nervous system has not been previously described in Brazilian autopsy cases. This study aimed to describe gross and microscopic central nervous system (CNS) pathology findings from the autopsies and correlate them with the clinical and laboratory characteristics of forty-five patients with COVID-19 from Manaus, Amazonas, Brazil. Forty-four patients were autopsied of which thirty-eight of these (86.36%) were positive by RT-PCR for COVID-19, and six (13.3%) were positive by the serological rapid test. Clinical and radiological findings were compatible with the infection. The patients were classified in two groups: presence (those who had hemorrhagic and/or thrombotic manifestations in the CNS) and absence (those who did not present hemorrhagic and/or thrombotic manifestations in the CNS). For risk assessment, relative risk and respective confidence intervals were estimated. Macroscopic or microscopic hemorrhages were found in twenty-three cases (52,27%). The postmortem gross examination of the brain revealed a broad spectrum of hemorrhages, from spots to large and confluent areas and, under microscopy, we observed mainly perivascular discharge. The association analyses showed that the use of corticosteroid, anticoagulant and antibiotic had no statistical significance with a risk of nervous system hemorrhagic manifestations. However, it is possible to infer a statistical tendency that indicates that individuals with diabetes had a higher risk for the same outcome (RR = 1.320, 95% CI = 0.7375 to 2.416, p = 0.3743), which was not observed in relation to other comorbidities. It is unknown whether the new variants of the virus can cause different clinical manifestations, such as those observed or indeed others. As a result, more studies are necessary to define clinical and radiologic monitoring protocols and strategic interventions for patients at risk of adverse and fatal events, such as the extensive hemorrhaging described here. It is imperative that clinicians must be aware of comorbidities and the drugs used to treat patients with COVID-19 to prevent CNS hemorrhagic and thrombotic events.
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Affiliation(s)
- Monique Freire Santana
- Departamento de Ensino e Pesquisa, Fundação Centro de Controle de Oncologia do Estado do Amazonas–FCECON, Manaus, AM, Brazil
- Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, AM, Brazil
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brazil
| | | | - Taynná Vernalha Rocha Almeida
- Programa de Pós-graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal do Amazonas, Manaus, AM, Brazil
| | | | - Rebecca Augusta de Araújo Pinto
- Departamento de Patologia e Medicina Legal, Hospital Universitário Getúlio Vargas, Universidade Federal do Amazonas, Manaus, AM, Brazil
| | - Yasmin Ferreira Martins
- Programa de Pós-graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal do Amazonas, Manaus, AM, Brazil
| | | | | | | | | | - Mariana Simão Xavier
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brazil
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Marcus Vinicius Guimarães Lacerda
- Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, AM, Brazil
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brazil
- Instituto de Pesquisas Leônidas & Maria Deane, Fundação Oswaldo Cruz, Manaus, AM, Brazil
| | - Fernando Fonseca Almeida Val
- Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, AM, Brazil
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brazil
- Programa de Pós-graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal do Amazonas, Manaus, AM, Brazil
| | - Gisely Cardoso Monteiro
- Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, AM, Brazil
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brazil
| | - Vanderson de Souza Sampaio
- Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, AM, Brazil
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brazil
- Fundação de Vigilância em Saúde do Amazonas, Manaus, AM, Brazil
| | - Wuelton Marcelo Monteiro
- Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, AM, Brazil
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brazil
| | - Luiz Carlos de Lima Ferreira
- Universidade do Estado do Amazonas, Programa de Pós-Graduação em Medicina Tropical, Manaus, AM, Brazil
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brazil
- Programa de Pós-graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal do Amazonas, Manaus, AM, Brazil
- Departamento de Patologia e Medicina Legal, Hospital Universitário Getúlio Vargas, Universidade Federal do Amazonas, Manaus, AM, Brazil
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