Thread by @RuhoyMD

Neurocovid tidbits from the annual neurology conference. Standing room only for this lecture.

Virus presumably enters brain via cribriform plate
But despite lots of viral particles in the nasal mucosa multiple brain biopsy studies show no viral particles in brain.

Congested blood vessels and microhemorrhages seen in brain

7T MRI studies shows thickened vessel walls, clots and microhemorrhages in sane vessel

11T MRI studies of pons found high levels of fibrinogen deposition and activated platelets, macrophages leading to neuronophagia

PECAM 1 staining shows activated endothelial cells (endothelial injury) but also deposition of IgG and IgM hence thought to be immune mediated.

Many have antiphospholipid antibodies.

Vestibular symptom immune mediated vasculitis.

T cell and cytokine mediated disease
Cranial nerve and spinal root involvement
Lots of macrophages in the vessels
Persistence of activated macrophages (due to fibrinogen)
Lymphocytes in perivascular regions
Dedifferentiated monocytes in CSF
Evidence of T cell exhaustion

#longcovid
F>M
Immune mediated
Usually mild sxs that initially improved but then recurred
Brain fog - mood, sleep, cognitive
Exercise intolerance
Looks like mecfs
Pots, SFN, dysautonomia

Symmetric decreased uptake of glucose on FDG-PET

Serial MRIs in UK study show total intracranial volume decrease and hippocampus gyrus volume decreased

Immune mediated attack of blood vessels
Activated macrophages chew up neurons

Lots of biomarker suggestions for neuronal and vascular injury.

And so much more…(gotta go to the next lecture)

Impressed by the number of studies, interest, and clinics opening.

#neurology