COVID-19 Neuropathology at Columbia University Irving Medical Center/New York Presbyterian Hospital

Kiran T. Thakur; Emily Happy Miller; Michael D. Glendinning; Osama Al-Dalahmah; Matei A. Banu; Amelia K. Boehme; Alexandra L. Boubour; Samuel S. Bruce; Alexander M. Chong; Jan Claassen; Phyllis L. Faust; Gunnar Hargus; Richard A. Hickman; Sachin Jambawalikar; Alexander G. Khandji; Carla Y. Kim; Robyn S. Klein; Angela Lignelli-Dipple; Chun-Chieh Lin; Yang Liu; Michael L. Miller; Gul Moonis; Anna S. Nordvig; Jonathan B. Overdevest; Morgan L. Prust; Serge Przedborski; William H. Roth; Allison Soung; Kurenai Tanji; Andrew F. Teich; Dritan Agalliu; Anne-Catrin Uhlemann; James E. Goldman; Peter Canoll


Brain. 2021;144(9):2696-2708. 

In This Article


In our single centre study of 41 consecutive autopsies of COVID-19 patients we found significant neuropathology in all brains, most commonly diffuse hypoxic/ischaemic damage, acute and subacute infarcts, both large and small, the latter often with a haemorrhagic component, and diffuse and focal microglial activation, including neuronophagia, predominantly localized to the brainstem. There was sparse T cell infiltration and no evidence for acute vascular wall damage. Quantitative RT-PCR on multiple frozen brain tissues of many brains showed low or absent levels of viral RNA. RNAscope® and immunohistochemistry for S and N proteins were negative. Although we cannot conclusively rule out the presence of viral RNA and protein in these brains, we conclude that it is unlikely that viral infection of brain tissue directly accounts for the pathological changes.

Second, our predominantly older, Hispanic population had multiple comorbidities, including those only identified in the post-mortem period. Patients died in a range of time periods, with prolonged hospital courses associated with a significant number of hospital related complications. Notably, neuropathological findings did not appear to correlate with time of hospitalization, further suggesting that pathology was not closely correlated with hospital interventions like medications or mechanical ventilation.