Review Pathophysiology, diagnosis, and management of neuroinflammation in covid-19, 2023, Brown et al.

[SNT Gatchaman]

Pathophysiology, diagnosis, and management of neuroinflammation in covid-19
Rachel L Brown; Laura Benjamin; Michael P Lunn; Tehmina Bharucha; Michael S Zandi; Chandrashekar Hoskote; Patricia McNamara; Hadi Manji

Although neurological complications of SARS-CoV-2 infection are relatively rare, their potential long term morbidity and mortality have a significant impact, given the large numbers of infected patients. Covid-19 is now in the differential diagnosis of a number of common neurological syndromes including encephalopathy, encephalitis, acute demyelinating encephalomyelitis, stroke, and Guillain-Barré syndrome.

Physicians should be aware of the pathophysiology underlying these presentations to diagnose and treat patients rapidly and appropriately. Although good evidence has been found for neurovirulence, the neuroinvasive and neurotropic potential of SARS-CoV-2 is limited. The pathophysiology of most complications is immune mediated and vascular, or both. A significant proportion of patients have developed long covid, which can include neuropsychiatric presentations. The mechanisms of long covid remain unclear. The longer term consequences of infection with covid-19 on the brain, particularly in terms of neurodegeneration, will only become apparent with time and long term follow-up.

Link | PDF (BMJ)

 

[SNT Gatchaman]

Long covid for me was characterized by severe daily headache, dizziness, nausea, fatigue, and difficulty concentrating. At one stage I experienced word finding difficulties during conversation. I needed six months off work. Two years later, I am progressively much improved. I am still unable to work as hard as I used to due to ongoing problems with mental endurance and frequent headaches following periods of focus. With careful activity pacing, I am on the whole able to function normally at work, and also, socially.

The fatigue associated with long covid for me has been a very different experience from normal tiredness. The physical fatigue is a whole body experience that is like a brick wall exhaustion. That has now settled. The mental fatigue is characterized by an inability to focus, think through complex problems and, sometimes, even have a conversation. It is triggered by long sustained periods of mental activity. I still experience this in a much milder way two years later, but have learnt that I can avoid it with pacing and by taking proper rest breaks at work.

As a doctor myself, I am all too aware of poorly understood clinical presentations. I now carefully frame how I tell a patient that their test results are normal. Instead I tell them that the results don’t explain their symptoms. This avoids a misunderstanding that I might think their symptoms are imagined or due to anxiety.

A pandemic with large numbers of patients with the same condition provides a perfect pool for research. I hope this will help patients with myalgic encephalomyelitis/chronic fatigue syndrome too. It is noteworthy that many of these patients report an infective trigger prior to symptom onset.

 

[Hutan]

As a doctor myself, I am all too aware of poorly understood clinical presentations. I now carefully frame how I tell a patient that their test results are normal. Instead I tell them that the results don’t explain their symptoms. This avoids a misunderstanding that I might think their symptoms are imagined or due to anxiety.

Thanks for highlighting that bit SNT. I think that's useful wording to suggest in the 'Language' section of the UK Consultation on the ME/CFS Delivery Plan.

Link here:
5. UK: 2023 Interim Delivery Plan on ME/CFS consultation: Language use