Major neurological syndromes with COVID-19: lessons to learn

Objective: Covid-19 is a highly infectious viral disease, and our understanding of the impact of this virus on the nervous system is limited. Therefore, we aimed to do a systematic analysis of the neurological manifestations. Methods: We retrospectively studied the clinical, laboratory, and radiological findings of patients with major neurological syndromes (MNS) in Covid-19 over 6 months. Results: We had 39 patients with major neurological syndromes (MNS). The most common MNS was cerebrovascular disease (CVD) (61.53%), in which ischemic stroke (83.33%), cortical sinus thrombosis (12.50%), and haemorrhagic stroke (4.16%) were seen. Among ischemic stroke patients, 50% had a large vessel occlusion, and 66.66% of patients with CVD had a significant residual disability. Cranial neuropathy (15.38%), GBS (10.26%), encephalitis (7.26%), and myelitis (5.12%) were the other MNS. Among the three encephalitis cases, two had CSF-Covid-19 PCR positivity and had severe manifestations and a poor outcome. Associated comorbidities included hypertension (30.76%), diabetes mellitus (12.82%), chronic kidney diseases (7.69%), and polycythaemia vera (2.56%). Lung involvement was seen in 64.1% of patients. Mortality was 17.94% in MNS with Covid-19. Conclusions: The most common major neurological syndrome associated with Covid-19 is CVD with increased frequency of large vessel occlusion causing significant morbidity and mortality. Simultaneous lung and other systemic involvement in MNS results in a deleterious outcome.

Trigeminal neuralgia of COVID-19: meta-analysis

Introduction: trigeminal nerve is fifth cranial nerve carrying face sensation and dividing into ophthalmic, maxillary and mandibular divisions. Trigeminal neuralgia is clinical condition can be presenting in Covid19 patients. The current study reviews the clinical cases of trigeminal neuralgia of covid19 and explains the anatomical mechanism of pain and its radiation as present with associated symptoms. On current studies reviews entire cases covid19 since 2019 up to 2022 presenting with Trigeminal pain. It found to be a very rare reason comparing to the previous reasons such as infection, tumor, thrombosis, vasculitis, autoimmune disease leading to direct or indirect effects on trigeminal nerve demyelination. Knowing the case presentation of covid19 patient presenting with trigeminal neuralgia may lead to prevent further complications and saving patients life. Learning new clinical issues based on understanding the basic medical sciences prepare good safe physicians to raise their level of education resulting in good medical services in future. Pediatricians, internist, radiologist, ophthalmologist, Otorhinolaryngologists and surgeons has to be aware of this clinical presentation to be able to take more precaution and avid outbreak of corvid 19 infection between medical staffs in different regions of hospital such as clinics, wards, emergency rooms and operations.

Assessment of risk factors for thrombosis in ICU patients with COVID-19

Introduction: According to scientific studies, a high incidence of thrombotic events is known in hospitalized patients with COVID-19. Less than 50% of pulmonary embolisms (PE) are associated with signs of deep vein thrombosis (DVT) of the lower extremities. Background: To identify significant risk factors for thrombosis thrombosis (DVT) in intensive care patients with COVID-19. Materials and methods: We conducted a prospective cross-sectional study that included 465 adult patients with laboratory-confirmed COVID-19 admitted to the intensive care unit. All patients underwent computer tomography of the chest organs, ultrasound angioscanning of lower extremities, body mass index was calculated, the presence of comorbotity diseases and indicators of volumetric blood saturation were considered. The level of D-dimer in blood plasma, coagulation parameters (fibrinogen, factor VIII) were taken from laboratory parameters in calculations. For subgroups with 5 or fewer people, the chi-square test and Fisher's exact test were used. For quantitative variables, analysis of variance (ANOVA) and the Pearson and Spearman correlation coefficient were used. For multiple variables, ordered logistic regression models were built, with likelihood ratio tests performed to compare the models. Results: A total of 465 patients were included in the study. Comorbidities were present in 435 of 465 patients (93.55%) had at least one comorbidity. The most common was arterial hypertension - 370 (79.57%), followed by chronic heart failure - 196 (42.15%), obesity - 161 (34.62%), diabetes mellitus - 144 (30.97%), chronic renal failure (CRF) -58 (12.47%) and oncological diseases -25 (5.38%). The average body mass index was 29.7 kg/m2. In patients with DVT and venostasis, the body mass index (BMI) was more than 30 kg/m2 than without DVT (32.57+or-10.92 kg/m2, and 30.24+or-6.85 kg/m2, versus 29.22+or-6.46 kg/m2, respectively). Ultrasound angioscanning (USAS) confirmed deep vein thrombosis in 60 patients (13.8%) and was associated with older age (71.12+or-13.98 versus 67.20+or-11.16, p < 0.006), venous stasis was detected in 56 patients (12%) no DVT was detected in the rest of the studied patients. In the majority of cases, DVT was detected in the tibial segment -26 (43.33%), in 18 (30%) patients it was diagnosed in the popliteal veins and in 14 (23.33%) cases in the femoral segment. Diabetes mellitus (p=0.041), obesity (p=0.01) and CRF (p=0.028) were also significant risk factors for DVT. Conclusions: Significant risk factors for deep vein thrombosis in intensive care patients with COVID-19 are high levels of D-dimer (>=2.33 g/ml) and comorbidities such as obesity, chronic kidney failure, and diabetes mellitus.

Does previous anti-thrombotic use affect the course of coronavirus disease-2019?

Introduction: Proinflammatory cytokines, produced as an immune response in severe acute respiratory syndrome-coronavirus 2 infection, activate the coagulation cascade as well. In this study, we investigated the difference in the clinical course of patients who had been already using anti-thrombotic therapy before coronavirus disease-2019 (COVID-19) for any reason compared to the group who had not. Methods: In this retrospective, multicenter study;patients who were hospitalized between March 11 and July 1, 2020 were divided into two main groups as who had been on anti-thrombotic therapy for any indication use previously at the time of admission or who had not been on anti-thrombotic therapy at the time of admission, and their selected clinical parameters were compared. Results: After analyzing the study population of 124 patients with a homogeneous distribution in terms of age and gender, the comparison of anti-thrombotic users and non-users showed no significant difference in hospitalization. There was a statistically significant decrease in mechanical ventilation apply rate, intensive care unit duration and mortality rate between the group using anti-thrombotic compared to the group not using it (p<0.05). Conclusion: It has already been shown that COVID-19 patients are more prone to thromboembolic events as it activates the coagulation cascade with the cytokine storm it creates and thus the mortality of COVID-19 infection increases significantly. Parallel to this fact the results of our study demonstrated that using anti-thrombotic therapy for any reason may affect the bad prognosis of the disease positively.

Elevated platelet large cell-ratio levels as a demonstrative biomarker associated with severe COVID-19

Objective: To represent the effects of the severity of COVID-19 infection on platelet large cell ratio (PLC-R). Materials and Methods: A hundred eleven patients diagnosed with COVID-19 were included in this study. Positive results for SARS-CoV-2 based on a typical RT-PCR test performed on nasopharyngeal swabs were included in the study Groups. Patients with COVID-19 were divided into three Groups according to their chest CT features. Group 1 (45 patients) was defined as mild, Group 2 (34 patients) as moderate and Group 3 (32 patients) as severe. Complete blood count parameters including platelet volume indices (PVI) values, CRP, D-dimer and lipid profiles were analyzed in all study participants. The correlation between COVID-19 patient Groups and PLC-R values were demonstrated using SPSS and ANFC methods. Results: The significant impact of our study is that PLC-R was significantly higher in the severe COVID-19 patients than the moderate and mild patients. Spearman's rho correlation analysis showed that PLC-R and WBC levels increased, and Htc and Hb levels decreased with the severity of the disease. ROC analysis showed that PLC-R > 38.3% had 59.4% sensitivity and 68.4% specificity in predicting severe COVID-19 disease (AUC 0.672, %95 CI 0.560, 0.784;p=0.005, cut off=38.3). CRP, ferritin and D-dimer values of the patients in Group 3 were significantly higher than the patients in Group 1, and the iron values of the patients in Group 3 were significantly lower than the patients in Group 1. Conclusion: PLC-R values are useful for anticipating acute thrombotic events. Based on the results of our study, PLC-R values can be used as appropriate biomarkers to describe the severity of COVID-19 infection.

Evaluation of stroke frequency in COVID-19 patients

Objective: Neurological symptoms occur due to central and peripheral nervous system involvement with different mechanisms in coronavirus disease 2019 (COVID-19). Microvascular thrombosis develops with prothrombotic activation along with the increase in cytokines in COVID-19 infection. We aimed to investigate the incidence of cerebrovascular disease and concomitant risk factors in COVID-19 positive patients. Materials and Methods: Acute and temporally related cerebrovascular diseases with a diagnosis of COVID-19 were evaluated. Cerebrovascular events were assessed in 4 groups as ischemic and hemorrhagic events, transient ischemic attacks, and cerebral venous thrombosis. Risk factors for cerebrovascular disease in these patients were also assessed, and which risk factors for cerebrovascular diseases in COVID-19 patients are high risk were examined. Results: Of the 1000 patients with COVID-19 disease were evaluated. Ischemic cerebrovascular disease and/or transient ischemic attack were found in 14 patients (1.4%). The most common symptoms related to COVID-19 were fever and respiratory distress in 14 patients with acute ischemic stroke diagnosed with COVID-19. Conclusion: COVID-19 increases the risk of stroke in patients with multiple risk factors. Close follow-up should be performed more carefully, especially in patients with pulmonary involvement and acute ischemic stroke, because mortality is likely to be higher.

I am what I am-Convergence Behaviors on Online Discussion about the Safety of COVID-19 Vaccines

Using data from an online discussion on the risk of getting blood clot from Johnson & Johnson vaccine moderated by the New York Times Facebook page, we investigated the presence of eleven convergence behaviors, and the interaction between them. While recent research focuses on misinformation or fake news as the object of analysis, we argue in this exploratory research that it is equally important to analyze who and, whenever possible, why people engage in information exchange given a particular crisis, hence their convergence behaviors. Mapping the types of postings to their authors would be an additional step to design, develop, implement, and possibly, regulate online discussions for a more effective and just civic engagement. As we witness a mass manipulation of public opinion, our findings suggest that the number of netizens that seek to correct misinformation is growing. If the society goal is to swiftly rebut as many conspiracy theories as possible, we advocate for a dual social media control strategy: restrain as much as possible the misinformation spreaders/manipulators and encourage correctors to help propagate countervailing facts. © 2022 IEEE Computer Society. All rights reserved.

Radiological findings of COVID-19-related thromboembolic complications

BackgroundThe ongoing global pandemic of coronavirus disease 2019 (COVID-19) may cause, in addition to lung disease, a wide spectrum of non-respiratory complications. Among these are thromboembolic complications. The theories that explain the mechanism of thromboembolic complications of COVID-19 are accumulating rapidly, and in addition to the role of imaging for assessment of COVID-19 pneumonia, CT may be useful for identification of these complications, such as pulmonary embolism, ischaemic stroke, mesenteric ischaemia, and acro-ischaemia.ResultsThromboembolic manifestations were diagnosed in 10% of our patients (124 patients out of the total 1245 COVID-19 patients);56 patients (45.2%) presented with pulmonary embolism, 32 patients (25.8%) presented with cerebrovascular manifestations, 17 patients (13.7%) presented with limb affection, and 19 patients (15.3%) presented with gastrointestinal thromboembolic complications.Most of our patients had significant comorbidities;diabetes was found in 72 patients (58%), dyslipidemia in 72 patients (58%), smoking in 71 patients (57.3%), hypertension in 63 patients (50.8%), and morbid obesity in 40 patients (32.2%).Thromboembolic events were diagnosed on admission in 41 patients (33.1%), during the first week in 61 patients (49.2%), and after the first week in 22 patients (17.7%).ConclusionsThe incidence of thromboembolic complications in COVID-19 patients is relatively high resulting in a multisystem thrombotic disease. In addition to the crucial role of imaging for assessment of COVID-19 pneumonia, CT is important for assessment of the thromboembolic complications, such as pulmonary embolism, ischaemic stroke, mesenteric ischaemia, and peripheral ischaemia, especially in patients with elevated d-dimer levels and those with sudden clinical deterioration.

Research progress of thrombosis in patients with COVID-19

The COVID-19 pandemic poses a huge challenge to the global economy and healthcare. Coagulation dysfunction and thrombosis are the main clinical features of severe COVID-19 patients, and closely related to the risk of death. Several mechanisms of thrombosis in COVID-19 have been proposed, such as immune inflammation, hypoxia, imbalance of angiotensin system, endothelial injury etc, and other high-risk factors such as combined with basic diseases, bed rest braking and intravenous catheterization.In this review, we summarize the mechanisms that may increase the risk of thrombosis in patients with severe COVID-19, in order to improve people's understanding of coagulation abnormalities and thrombosis complications in patients with severe COVID-19, and further explore effective methods to prevent and treat COVID-19 related thrombosis.

Science Digest

Using 30 breast cancer patients as a "model' the authors took blood samples at 4am and 10am, representing "resting" and "active" times. The original authors speculated that because the COVID-19 virus binds to the angiotensinogen converting enzyme-2 receptor (ACE-2), which is in many body cells including the heart it gives the virus access to the cells. In a report by Public Health England death rates for black, Asian and other minority groups has been shown to be higher than those in white British people. The authors concluded that understanding the differences between the groups may contribute to a better understanding relating to why ethnic groups are at greater risk of death with COVID-19 and should be considered when interpreting biochemical data.

Characteristics of Spontaneous Reports of Thrombosis with Thrombocytopenia Syndrome after COVID-19 Vaccines in the Netherlands: An International Journal of Medical Toxicology and Drug Experience

Introduction: In March 2021 first cases of thrombosis with thrombocytopenia syndrome (TTS), also called vaccine induced thrombosis with thrombocytopenia (VITT), were published and reported, raising a concern with the adenovector vaccine of AstraZeneca [1, 2]. One month later, TTS was also associated with the Janssen vaccine [3]. No conclusive evidence of VITT with mRNA vaccines is found [4]. In Europe, vaccination programmes were put on hold and the indications for use restricted. The role of pharmacovigilance was to monitor the events closely and estimate its frequency of occurrence. While mass vaccination campaigns were ongoing, information on case criteria and definitions was limited. In the Netherlands, internists wrote guidelines, organised centralised diagnostics for PF4 ELISA and HIPA tests and encouraged expert physicians to report suspected cases to The Netherlands Pharmacovigilance Centre Lareb [5]. Lareb managed to monitor TTS cases closely by a fast triage of relevant reports and strong collaboration with external specialists. Objective: Spontaneously reported cases of TTS in The Netherlands are described. Methods: We used CDC classification criteria combined with Dutch guidelines to determine confirmed and strongly suspected cases. CDC classification recognizes 'tier 1' with thrombosis at unusual sites not requiring tests and 'tier 2' with common types of thrombosis and requiring confirmatory tests [6]. Results: In total, 75 cases of thrombocytopenia with any kind of thrombosis were reported. Only 26 reports met criteria of TTS, concerning 19 AstraZeneca, 5 Janssen and 2 mRNA vaccines. The majority (23;89%) of the cases was reported following the first dose. Reporting rates for AstraZeneca and Janssen were 7.7 and 5.7 per million vaccinations in total, respectively, and 13.4 per million vaccinations of the first dose with AstraZeneca. Patient and report characteristics are described in table 1. 'Tier 1' criteria were met in 15 cases. 'Tier 2' criteria were met in 6 cases and in 5 cases TTS was strongly suspected based on the Dutch guidelines. A functional HIPA test was performed in 20 cases of which 17 were positive and 3 negative. Also, two reports were received with mRNA vaccines, one well documented with positive PF4-ELISA and HIPA-tests (Moderna, 3rd dose) and the other poorly documented but meeting 'tier 1' criteria (Pfizer, 1st dose). Conclusion: In The Netherlands, TTS was predominantly reported after the first dose of the AstraZeneca vaccine, similar to other countries [1]. Intensive collaboration between clinical practice and pharmacovigilance resulted in good monitoring of TTS cases with spontaneous reporting.

A European dashboard for monitoring vaccine conversations on the web and social networks

Introduction: The European Joint Action on Vaccination (EU-JAV) is a European project that aims at spurring long-lasting European cooperation against vaccine-preventable diseases. In the context of the EU-JAV's Work Package 8, the Italian National Institute of Health, in collaboration with the Bambino Gesu Children's Hospital (Rome, Italy), developed a web platform designed to monitor vaccination discourse on the web and on social media. Materials and methods: We collected data on vaccine-related content from Twitter, Reddit, Wikipedia and Google Trends, through validated keyword filters, in Italian, French and Spanish. The platform's analysis layer included two machine learning-based algorithms: the influencer analysis, aimed at identifying the most influential users involved in the vaccine discourse;and the early-signal detection, used to identify new hashtags emerging in the conversation.

Early discharge of patients with COVID-19

Introduction: Recently, this journal published a study on the experiences of 49 stable Covid-19 patients who were discharged early from hospital. These patients self-administered oxygen at home and were supervised remotely by a pulmonologist or lung nurse. In October 2020, a project started in Amsterdam in which Covid-19 patients were discharged early, received oxygen supplementation at home and were supervised by their own GP. We report the safety of this approach and describe the expectations beforehand and satisfaction afterwards of all involved. MethodAdult patients admitted to Amsterdam UMC, OLVG or BovenIJ hospital because of covid-19 were eligible for early discharge if they were clinically stable for at least 48 hours and had an oxygen saturation of 94% on oxygen therapy at 3 l/min (figure). Before discharge, patients were taught how to use a pulse oximeter (ihealth P03M, CE/FDA certified) and oxygen equipment. Treatment with dexamethasone and thrombosis prophylaxis were continued in accordance with current treatment guidelines as long as there was an indication. The participants were transferred verbally and in writing from the hospital to their own GP who then took over the supervision. In the period January 18-March 26, 2021, patients could be prospectively included in this evaluation. All patients discharged from October 23, 2020 to January 18, 2021 were retrospectively included. We collected clinical data from the patients and completed questionnaires among patients, general practitioners and caregivers, before hospital discharge and 14 days after.

Spontaneous atypical muscle bleeding of the anterior abdominal wall in patient with COVID-19 - case report

COVID-19 is an unpredictable disease that can lead to multiorgan dysfunctions. There is a high frequency of venous and arterial thrombosis, among other symptoms. Spontaneous bleeding in COVID-19 patients has also been described, but rarely, whether or not they are on anticoagulant therapy. We report a case of a 65-year-old female COVID-19 patient treated in our hospital. During the hospitalisation, she experienced sudden, severe pain in the lower part of the abdomen and had signs of hemorrhagic shock. CT of the abdomen and pelvis revealed a spontaneous giant haematoma of the anterior abdominal wall. A surgical procedure was done. We identified spontaneous bleeding in the muscles of the anterior abdominal wall. The patient recovered well. Rapid diagnosis and timely intervention are crucial to ensure a good patient outcome.

Incidence of pulmonary embolism in COVID-19 infection in the ED: ancestral, Delta, Omicron variants and vaccines.

PURPOSE: This retrospective review examines the incidence of pulmonary embolism (PE) during computed tomography pulmonary angiography (CTPA) exams performed in the emergency room setting of a tertiary care center over dominant periods of the ancestral, Delta, and Omicron variants of COVID-19. MATERIALS/METHODS: Demographic information, patient comorbidities and risk factors, vaccination status, and COVID-19 infection status were collected from patient's charts. Incidence of PE in COVID positive patients was compared between variant waves. Subgroup analysis of vaccination effect was performed. RESULTS: CTPA was ordered in 18.3% of COVID-19 positive patients during the ancestral variant period, 18.3% during the Delta period and 17.3% during the Omicron wave. PE was seen in 15.0% of the ancestral COVID-19 variant cohort, 10.6% in the Delta COVID cohort and 9.23% of the Omicron cohort, reflecting a 41% and 60% increased risk of PE with ancestral variants compared to Delta and Omicron periods respectively. The study however was underpowered and the difference in rate of PE did not reach statistically significance (p = 0.43 and p = 0.22). Unvaccinated patients had an 2.75-fold increased risk of COVID-associated PE during the Delta and Omicron periods (p = .02) compared to vaccinated or recovered patients. CONCLUSION: Vaccination reduces the risk of COVID-19 associated PE. Patients infected with the Delta and Omicron COVID-19 variants may have a lower incidence of pulmonary embolism, though a larger or multi-institution study is needed to prove definitively.

Immunopatogenetic basis of the severity of COVID-19. Literature review

Relevance. The outbreak of COVID-19 began in late 2019 in Hubei Province, China. Already in the first quarter of 2020, the disease spread around the world. On March 11, 2020, the WHO declared a COVID-19 pandemic. The first cases of the disease in Kazakhstan were registered in March 2020. The aim of the study: a systematic search for scientific information about the socially significant disease COVID-19 and its immunopathogenetic basis for the severity of the course. Search strategy: Research publications were searched in PubMed, ResearchGate, GoogleScholar databases. A total of 325 references were found, of which 89 were selected for analysis.

Acute mesenteric ischemia as a complication of COVID-19 infection: a case report and review of the literature

Background: Coronavirus disease 2019 (COVID-19) is a major health problem worldwide. Vascular thrombosis is increasingly observed in COVID-19 patients. This complication seems to be due to coagulopathy and endothelial damage. In this paper, we report a COVID-19 patient with superior mesenteric artery thrombosis and review of 27 COVID-19 cases with acute mesenteric ischemia (AMI). Case presentation: A 59-years old man with confirmed COVID-19 readmitted to the hospital due to abdominal pain and diarrhea two days after discharge from the emergency department. He was diagnosed with acute mesenteric ischemia by abdominal CT scan with contrast. The patient underwent emergency laparotomy and the ischemic gangrenous bowel was resected. Unfortunately, the patient succumbed one month after the operation.

Ischemic Stroke in a SARS-CoV-2-Positive Octagenarian Without Cardiovascular Risk Factors: A Case Report

Ischemic and hemorrhagic strokes are increasingly recognized as complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. The absence of cardiovascular risk factors in SARS-CoV-2-infected patients who suffer a stroke supports a causal relationship as shown in the following report. The patient is an 86-year-old female who developed a mild, brachio-facial, right-sided hemi-symptomatic during a mild infection with SARS-CoV-2. Cerebral magnetic resonance imaging (MRI) showed a corresponding, small, subacute, ischemic lesion in the left periventricular white matter and a microbleed in the left thalamus. Under dual platelet aggregation inhibitor therapy, the neurological deficits regressed almost completely within three weeks. If one considers that classic cardiovascular risk factors were missing, a causal link between the SARS-CoV-2 infection and the stroke becomes likely. Vasculopathy, coagulopathy, and cardiac disease caused by the virus or the immune response against it serve as pathophysiological explanations for the cerebral lesions. It is concluded that ischemic stroke can occur during infection with SARS-CoV-2. There are more arguments for than against a causal relationship between the viral infection and ischemic stroke.

Relationship between blood clots and COVID-19 vaccines: A literature review.

SARS-CoV-2 pandemic is one of the most critical pandemics during human civilization. Several therapeutic strategies for COVID-19 management have been offered; nonetheless, none of them seems to be sufficiently beneficial. In effect, vaccines have been proffered as a viable option. The critical issue now is to concentrate on protecting individuals against illness through immunization. One of the causes for concern among the researchers, physicians, and generally the whole community from the onset of vaccination has been the adverse effects (specifically blood clots) that may be observed after the injection of the COVID-19 vaccine. In some countries, such concerns have even resulted in the temporary or permanent discontinuation or abandonment of the application of some vaccines (especially AstraZeneca and Janssen). By evaluating rigorous studies published on this subject, the present article is aimed at identifying the association between blood clot incidence and COVID-19 vaccination. Various methods for producing the COVID-19 vaccines are analyzed, along with their possible pros and cons as well as common and rare side effects, especially VITT and blood clots. Finally, the differences of various vaccines on thrombotic events, WHO recommendations for VITT treatment, and blood clots statics are discussed.

Three cases of encephalopathy / disseminated encephalomyelitis in SARS-CoV-2 infection

As many other viral pandemics, the current SARS-CoV-2 is also characterized by nervous system involvement, mainly in elderly patients with comorbidities. Recent scientific reports indicate that involvement of the nervous system is manifested by a variety of clinical symptoms related to the severity and extent of brain damage. Encephalopathy, encephalitis and polyneuritis are among the complications reported in patients with SARSCoV- 2. These complications have been morphologically proven. As an immune-privileged structure, neural tissue is particularly vulnerable to autoimmune attacks. Therefore, various neurological diseases such as MS, Guillain-Barre syndrome, as well as autoimmune encephalitis and psychosis have also been reported in patients with SARS-CoV-2 infection. Herein, we present three cases of patients who died after infection with the SARS-CoV-2 virus. We emphasize on the pathomorphological changes found in a detailed study of the brain and cervical spine. The analysis of the inflammatory findings, mainly manifested by perivenous lymphocytic infiltrates, serodiapedesis and erythrocyte depots around the vessels, showed a presence of initial demyelination (in two of the cases). The blood supply of most venous vessels with different size and a pronounced "sludge" phenomenon were the most impressive findings, as in some sections these changes were demonstrated by a presence of thrombosis. Inflammatory manifestations were also observed in the brainstem near to the stem nuclei. The SARS-CoV-2 virus induces a variety of immune system responses. In some patients there is a negligible or no reaction, while in others there is a "cytokine storm" with a system damage of multiple organs - often including the brain.