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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

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. Neve...

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Autores principales: Santana, Monique Freire, Frank, Carlos Henrique Michiles, Almeida, Taynná Vernalha Rocha, Jeronimo, Christiane Maria Prado, de Araújo Pinto, Rebecca Augusta, Martins, Yasmin Ferreira, de Farias, Maria Eduarda Leão, Dutra, Bruna Guimarães, Brito-Sousa, José Diego, Baía-da-Silva, Djane Clarys, Xavier, Mariana Simão, Lacerda, Marcus Vinicius Guimarães, Almeida Val, Fernando Fonseca, Monteiro, Gisely Cardoso, Sampaio, Vanderson de Souza, Monteiro, Wuelton Marcelo, Ferreira, Luiz Carlos de Lima
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8432786/
https://www.ncbi.nlm.nih.gov/pubmed/34506501
http://dx.doi.org/10.1371/journal.pone.0255950
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author Santana, Monique Freire
Frank, Carlos Henrique Michiles
Almeida, Taynná Vernalha Rocha
Jeronimo, Christiane Maria Prado
de Araújo Pinto, Rebecca Augusta
Martins, Yasmin Ferreira
de Farias, Maria Eduarda Leão
Dutra, Bruna Guimarães
Brito-Sousa, José Diego
Baía-da-Silva, Djane Clarys
Xavier, Mariana Simão
Lacerda, Marcus Vinicius Guimarães
Almeida Val, Fernando Fonseca
Monteiro, Gisely Cardoso
Sampaio, Vanderson de Souza
Monteiro, Wuelton Marcelo
Ferreira, Luiz Carlos de Lima
author_facet Santana, Monique Freire
Frank, Carlos Henrique Michiles
Almeida, Taynná Vernalha Rocha
Jeronimo, Christiane Maria Prado
de Araújo Pinto, Rebecca Augusta
Martins, Yasmin Ferreira
de Farias, Maria Eduarda Leão
Dutra, Bruna Guimarães
Brito-Sousa, José Diego
Baía-da-Silva, Djane Clarys
Xavier, Mariana Simão
Lacerda, Marcus Vinicius Guimarães
Almeida Val, Fernando Fonseca
Monteiro, Gisely Cardoso
Sampaio, Vanderson de Souza
Monteiro, Wuelton Marcelo
Ferreira, Luiz Carlos de Lima
author_sort Santana, Monique Freire
collection PubMed
description 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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spelling pubmed-84327862021-09-11 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 Santana, Monique Freire Frank, Carlos Henrique Michiles Almeida, Taynná Vernalha Rocha Jeronimo, Christiane Maria Prado de Araújo Pinto, Rebecca Augusta Martins, Yasmin Ferreira de Farias, Maria Eduarda Leão Dutra, Bruna Guimarães Brito-Sousa, José Diego Baía-da-Silva, Djane Clarys Xavier, Mariana Simão Lacerda, Marcus Vinicius Guimarães Almeida Val, Fernando Fonseca Monteiro, Gisely Cardoso Sampaio, Vanderson de Souza Monteiro, Wuelton Marcelo Ferreira, Luiz Carlos de Lima PLoS One Research Article 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. Public Library of Science 2021-09-10 /pmc/articles/PMC8432786/ /pubmed/34506501 http://dx.doi.org/10.1371/journal.pone.0255950 Text en © 2021 Santana et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Santana, Monique Freire
Frank, Carlos Henrique Michiles
Almeida, Taynná Vernalha Rocha
Jeronimo, Christiane Maria Prado
de Araújo Pinto, Rebecca Augusta
Martins, Yasmin Ferreira
de Farias, Maria Eduarda Leão
Dutra, Bruna Guimarães
Brito-Sousa, José Diego
Baía-da-Silva, Djane Clarys
Xavier, Mariana Simão
Lacerda, Marcus Vinicius Guimarães
Almeida Val, Fernando Fonseca
Monteiro, Gisely Cardoso
Sampaio, Vanderson de Souza
Monteiro, Wuelton Marcelo
Ferreira, Luiz Carlos de Lima
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
title 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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_short 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
title_sort 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
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8432786/
https://www.ncbi.nlm.nih.gov/pubmed/34506501
http://dx.doi.org/10.1371/journal.pone.0255950
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