Covid Brain Damage: Coronavirus (COVID-19)
Specialized scanning allows a better understanding of the virus’s possible effects on the brain.
While it is mainly a respiratory disease or illness, COVID-19 infection affects other organs, including the brain.
One of the initial spectroscopic imaging-based studies of neurological injury in COVID-19 patients has been reported by researchers at Harvard-affiliated Massachusetts General Hospital (MGH) in the American Journal of Neuroradiology. Looking at 6 patients using a specialized magnetic resonance (MR) technique, they discovered that COVID-19 patients with neurological symptoms display some of the same metabolic disturbances in the brain as patients who have suffered oxygen deprivation (hypoxia) from other causes, but there are also significant differences.
It is thought that the disease or illness’s main effect on the brain is through hypoxia, but few studies have documented the certain types of damage that distinguish COVID-19 associated brain injury or brain damage. Several thousand patients with COVID-19 have been seen at the Massachusetts General Hospital (MGH) since the outbreak started early this year, and this study included findings from 3 of those patients.
The seriousness of neurological symptoms changes, ranging from one of the most well-known a momentary loss of smell to more severe symptoms for example dizziness, confusion, seizures, and stroke.
We were interested in characterizing the biological explanations of some of these symptoms, says Eva-Maria Ratai, a researcher in the Department of Radiology and senior author of the study. Moving forward, we are also interested in understanding the prolonged lingering effects of COVID-19, including headaches, fatigue, and cognitive impairment. So-called ‘brain fog’ and other impairments that have been discovered to continue long after the acute phase, adds Ratai, also an associate professor of radiology at Harvard Medical School.
The researchers used three Tesla Magnetic Resonance Spectroscopy (MRS), a specialized type of scanning that is sometimes known as a virtual biopsy. Magnetic Resonance Spectroscopy (MRS) could identify neurochemical abnormalities even when structural imaging findings are normal. COVID-19 patients’ brains showed N-acetyl-aspartate (NAA) reduction, choline elevation, and Myo-inositol elevation, identical to what is seen with these metabolites in other patients with white matter abnormalities (leukoencephalopathy) after hypoxia without COVID.
One of the patients with COVID-19 who showed the most serious white matter damage (necrosis and cavitation) had particularly pronounced lactate elevation on Magnetic Resonance Spectroscopy (MRS), which is another sign of brain damage caused by oxygen deprivation.2 of the 3 COVID-19 patients were intubated in the intensive care unit (ICU) at the time of imaging, which was conducted as part of their care. One had COVID-19 related necrotizing leukoencephalopathy.
Another recently suffered heart failure and showed subtle white matter changes in structural MR. The third had no clear encephalopathy or recent heart attack. The non-COVID control cases included one patient with white matter damage because of hypoxia from other causes (post-hypoxic leukoencephalopathy), one with sepsis-associated white matter damage, and a normal, age-matched, healthy volunteer.
A key question is whether it is just the decline in oxygen to the brain that is causing these white matter changes or whether the virus is itself attacking the white matter, says Massachusetts General Hospital (MGH) neuroradiologist Otto Rapalino, who shares the first authorship with Harvard Massachusetts General Hospital (MGH) post-doctoral research fellow Akila Weerasekera.
Compared to conventional structural MR imaging, Magnetic Resonance Spectroscopy (MRS) could better characterize pathological processes, for example, neuronal injury, inflammation, demyelination, and hypoxia, adds Weerasekera. Based on these findings, we believe it can be used as a disease or illness and therapy monitoring tool.
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