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Brainstem neuropathology in two cases of COVID-19 (2021)


Senior Member
Brainstem neuropathology in two cases of COVID-19: SARS-CoV-2 trafficking between brain and lung | SpringerLink

Journal of Neurology volume 268, pages4486–4491 (2021)Cite this article


SARS-CoV-2 might spread through the nervous system, reaching respiratory centers in the brainstem.
Because we recently reported neurophysiological brainstem reflex abnormalities in COVID-19 patients, we here neuropathologically assessed structural brainstem damage in two COVID-19 patients.

Materials and methods

We assessed neuropathological features in two patients who died of COVID-19 and in two COVID-19 negative patients as controls. Neuronal damage and corpora amylacea (CA) numbers /mm2 were histopathologically assessed. Other features studied were the immunohistochemical expression of the SARS-CoV-2 nucleoprotein (NP) and the Iba-1 antigen for glial activation.


Autopsies showed normal gross brainstem anatomy. Histopathological examination demonstrated increased neuronal and CA damage in Covid-19 patients’ medulla oblongata.
Immunohistochemistry disclosed SARS-CoV-2 NP in brainstem neurons and glial cells, and in cranial nerves.
Glial elements also exhibited a widespread increase in Iba-1 expression. Sars-Co-V2 was immunohistochemically detected in the vagus nerve fibers.


Neuropathologic evidence showing SARS-CoV-2 in the brainstem and medullary damage in the area of respiratory centers strongly suggests that the pathophysiology of COVID-19-related respiratory failure includes a neurogenic component.

Sars-Co-V2 detection in the vagus nerve, argues for viral trafficking between brainstem and lung


Senior Member
U.S., Earth
Thanks for posting this great case report!

Brainstem neuropathology in two cases of COVID-19: SARS-CoV-2 trafficking between brain and lung (Bulfamonte et al., 2021)
Main points:
  • In two patients, damage was seen in the medulla oblongata part of the brainstem.
  • Coronavirus proteins were found in neurons in the brainstem and cranial nerves such as the vagus nerve.
  • The presence of the coronavirus in the vagus nerve and medulla oblongata suggests that the virus might travel inside the vagus nerve from the lung to the brainstem.
From: Neuroinflammation in Long Covid?