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Central Nervous System Involvement by Severe Acute Respiratory Syndrome Coronavirus -2 (SARS-CoV-2)

Fig. a. Brain capillary endothelial cells showing virus particles within cytoplasmic vacuoles (← arrow) b. Blebbing of viral particles coming in/out of the endothelial cell wall (circles) The relationship of virus particles (arrows ←) to the endothelial cells

(virus ingress/egress) is depicted. Note the dense inner core and densely stained periphery of viral particles. c. Endothelial neural cell interface showing a cytoplasmic vacuole filled with viral particles in various stages of bud formation (arrow ←) adjacent to the basement membrane within the neural cell (frontal lobe). d. Neural intracytoplasmic vesicle showing viral-like particles. Insert: Detail on viral particle exhibiting electron dense centers with distinct stalk-like peplomeric projections.

Neurologic sequelae can be devastating complications of respiratory viral infections. We report the presence of virus in neural and capillary endothelial cells in frontal lobe tissue obtained at postmortem examination from a patient infected with Severe Acute Respiratory Syndrome Coronavirus‐2. Our observations of virus in neural tissue, in conjunction with clinical correlates of worsening neurologic symptoms, pave the way to a closer understanding of the pathogenic mechanisms underlying CNS involvement.

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