Cerebrospinal fluid of patients experiencing significant COVID-19 neurological symptoms contains high levels of inflammatory cytokines, often for weeks afterward.
Little evidence for any viral material in CNS tissue based on CSF samples at least.
Occasional vascular damage.
Overall, consistent with the view that post-acute COVID-19 neurological symptoms are likely mediated in large part by persistent inflammatory processes.
Evidence for both neutralizing and autoimmune origins:
medrxiv.org/content/10.110…
High frequency of cerebrospinal fluid autoantibodies in COVID-19 patients with neurological symptoms
biorxiv.org/content/10.110…
Immunologically distinct responses occur in the CNS of COVID-19 patients
Meta-analysis likewise implicates both neutralizing and autoimmune inflammatory responses in the neurological manifestations of COVID-19.
ncbi.nlm.nih.gov/pmc/articles/P…
Viral neuroinvasion is known to be possible, but does not appear necessary in the pathogenesis of these symptoms.
Overall, further evidence favoring anti-inflammatory and immunomodulatory drugs in the treatment of post-acute COVID-19 neurological symptoms.
If there are no trials, then we must resort to mechanisms. We will never have RCTs on every possible subject.
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