• SONY MORENO

    Madrid

Updated Friday, 21 January 2022-14:26

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Since the SARS-CoV-2 coronavirus burst into our lives, it was clearly seen that this respiratory virus was behind a

wide variety of neurological symptoms

. For many,

anosmia

was the first warning sign of infection, although with the

omicron

variant it seems that it is no longer one of the common initial manifestations. Among the

neurological complications described

in the acute phase of covid are

confusion

(what has been called "mental fog"),

strokes

and

neuromuscular disorders

; but also

sequels

such as concentration problems, headaches, sensory disturbances, depression and even psychosis can persist for months after infection, sometimes as part of a persistent covid picture.

This is how a review in

Science

that is published on the impact of the coronavirus on the central nervous system

presents it

.

In this scientific article,

Serena Spudich

, a neurologist and specialist in Infectious Diseases at Yale University, and

Avindra Nath

, a neurologist at the US National Institute of Neurological Diseases and Stroke, break down what is known about the

pathophysiological mechanisms

that cause these complications and what Possible

consequences

arrive

after the initial infection

, aspects that still pose gaps and on which doctors and scientists remain vigilant.

This is how the virus damages the brain

Despite initial speculation that SARS-CoV-2 could enter the central nervous system through the nasal cavity and the olfactory pathway, even circulating across the blood-brain barrier,

analysis of cerebrospinal fluid

from patients with clinical manifestations Neuropsychiatric studies have not detected viral RNA, nor have many cells infected by the virus been seen in the

brain tissue of autopsies

of deaths from covid-19. In contrast,

infiltration

of macrophages, CD8+ T lymphocytes in perivascular regions, and generalized microglial activation in the brain

have been observed in these studies .

Therefore, the authors infer that "the

main drivers

of

neurological disease

in acute covid they are

immune activation

and

inflammation

in the central nervous system."

The central nervous system is not 'your playground'

When (albeit few) infected cells are detected in the brain, studies indicate that they "lack surrounding clusters of inflammatory cells, suggesting that the

presence

of

SARS-CoV-2

in the central nervous system (CNS) does not cause

encephalitis.

" classic virus.

The president of the Spanish Society of Neurology, José Miguel Láinez, abounds in this, stating that "

it is not a neurotropic virus

, there is little direct involvement of the brain. In the acute phase, brain disorders are a secondary consequence of

hypoxia

,

toxicity

,

neuroinflammation

and

vascular alteration

, but not by direct invasion of the virus.

Is there a 'covid stroke'?

"Acute COVID-19 is associated with an

increased

risk of stroke

compared

with

influenza -like illness of

similar

severity

, even after correcting for stroke risk factors. Overt cerebrovascular events during the acute phase of COVID-19 19 often occur in people with

vulnerability

to vascular disease (such as older age and heart disease)," the authors write in

Science

.

"Increases in blood markers of vascular inflammation, as well as thrombosis and infarction in other tissues can also be found in patients with covid-19 and stroke, suggesting that the

endothelial inflammation

and

coagulopathy

contribute to these events". Professor Láinez also comments that "directly there is no stroke caused by covid, but

indirectly

covid can act on the

endothelium

in the vessel walls and generate a prothrombotic state, factors that may

contribute to precipitating

stroke. Stroke has been seen in a young person in which the trigger factor was probably covid."

Spudich and Nath go a step further and state that "it is plausible that

subtle forms of generalized vascular dysfunction

, including thrombotic microangiopathy (microscopic blood clots) in the brain, may cause neurological symptoms even in the absence of clinically apparent stroke."

Persistent Covid, also in young people and after mild infection

"Among the neurological and psychiatric disorders that persist in some patients after acute covid infection, alterations in memory, concentration and the ability to perform daily tasks, frequent headaches, alterations in skin sensitivity, autonomic dysfunction, intractable fatigue, and, in severe cases, delusions and paranoia Many people who experience neurological symptoms that persist after acute covid-19 are

under 50 years of age and

were healthy and active before infection

In particular, most she was never hospitalized during her acute phase of covid-19, reflecting mild initial illness," the American neurologists note in this review.

At the last congress of the SEN, the series on persistent covid presented draw a promising perspective, adds Láinez.

"On the one hand,

no structural lesions are seen

in the imaging tests, which in principle is usually a symptom of a good prognosis. In addition, in most patients, the

evolution

is towards

improvement

. There are even cases in which that improvement occurs after vaccination, which is a very positive fact. In principle, it seems that most of these cases are not going to present major problems. However, we remain

vigilant

and attentive to the fact that in certain patients with some

special genetic

susceptibility

this improvement does not occur, but they would be exceptional cases".

The 'dejà vu' of chronic fatigue

Many of the symptoms experienced by people with persistent covid or

long covid

"are similar to those of

myalgic encephalomyelitis

/

chronic fatigue syndrome

(MME/CFS)", another syndrome that has been linked to various infectious agents, they expose in this review .

Since this condition is also little known and without curative treatment, the authors trust that the study of persistent covid will also benefit these patients.

However, they have an arduous task ahead of them because, as they also recognize "the

heterogeneity

of the

symptoms

that affect people with

long covid

and the

difficulties

in

determining

which symptoms may be a

consequence of SARS-CoV-2 infection

versus

aggravation of pre-existing

or coincident conditions pose enormous challenges for mechanistic understanding and treatment approaches."

Watch out for Alzheimer's and Parkinson's disease

As is obvious in a disease that emerged two years ago, the

full extent

of its

long-term

complications is not known.

Without leaving the field of neurological disease, the authors of the review speculate on the possibility that neuroinflammation and neuronal injury in acute cases of covid trigger or accelerate

neurodegenerative diseases such

as Alzheimer's or Parkinson's.

A hypothesis against which the president of the SEN is cautious, because "there is no data to

speculate

in that negative sense; in my opinion, it is a somewhat alarmist vision."

Sick, not disease

As always in medicine, we must take into account factors contributed by each patient.

These researchers remind us that the

characteristics that explain the wide variability

in clinical

manifestations

, due to which some patients develop persistent post-infectious complications, have yet to be identified.

And of special importance, these neurologists also point out, is the need for "

intervention trials

based on these discoveries to determine approaches to reduce or reverse the effects of covid-19 on the nervous system."

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