In this paper, recently published in Lancet, the authors report the findings of autopsies of six patients (four men and two women, aged 58–82 years) who died from COVID-19 in April 2020 in Munich, Germany. The period from onset of symptoms to admission ranged from 2–10 days. Five patients were transferred to the ICU within the first 2 days of hospital admission. All patients eventually required ventilation or extracorporeal membrane oxygenation. The cause of death in the older patients (>65 years), all of whom were admitted with multiple comorbidities, was cardiorespiratory failure. By contrast, patients younger than 65 years died either of massive intracranial haemorrhage or pulmonary embolism, consistent with COVID-19-associated coagulopathy. These patients exhibited diffuse petechial haemorrhage throughout the entire brain. However, both groups showed lymphocytic pan-encephalitis and meningitis. The authors concluded that, in addition to viral pneumonia, pronounced CNS involvement with pan-encephalitis, meningitis, and brainstem neuronal cell damage were key events. Moreover, in patients younger than 65 years, CNS haemorrhage was a fatal complication of COVID-19.
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