Neuronophagia and microglial nodules in a SARS-CoV-2 patient with cerebellar hemorrhage

Osama Al-Dalahmah, Kiran T. Thakur, Anna S. Nordvig, Morgan L. Prust, William Roth, Angela Lignelli, Anne Catrin Uhlemann, Emily Happy Miller, Shajo Kunnath-Velayudhan, Armando Del Portillo, Yang Liu, Gunnar Hargus, Andrew F. Teich, Richard A. Hickman, Kurenai Tanji, James E. Goldman, Phyllis L. Faust, Peter Canoll

Research output: Contribution to journalArticlepeer-review

80 Scopus citations


We document the neuropathologic findings of a 73-year old man who died from acute cerebellar hemorrhage in the context of relatively mild SARS-CoV2 infection. The patient developed sudden onset of headache, nausea, and vomiting, immediately followed by loss of consciousness on the day of admission. Emergency medical services found him severely hypoxemic at home, and the patient suffered a cardiac arrest during transport to the emergency department. The emergency team achieved return of spontaneous circulation after over 17 min of resuscitation. A chest radiograph revealed hazy bilateral opacities; and real-time-PCR for SARS-CoV-2 on the nasopharyngeal swab was positive. Computed tomography of the head showed a large right cerebellar hemorrhage, with tonsillar herniation and intraventricular hemorrhage. One day after presentation, he was transitioned to comfort care and died shortly after palliative extubation. Autopsy performed 3 h after death showed cerebellar hemorrhage and acute infarcts in the dorsal pons and medulla. Remarkably, there were microglial nodules and neuronophagia bilaterally in the inferior olives and multifocally in the cerebellar dentate nuclei. This constellation of findings has not been reported thus far in the context of SARS-CoV-2 infection.

Original languageEnglish (US)
Article number147
JournalActa neuropathologica communications
Issue number1
StatePublished - Aug 26 2020
Externally publishedYes


  • COVID-19
  • Microglial nodules
  • Neuronophagia
  • Neuropathology
  • SARS-CoV-2

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Clinical Neurology
  • Cellular and Molecular Neuroscience


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