Emerging potential mechanisms and predispositions to the neurological manifestations of COVID-19, 2021, Jesuthasan et al

Abstract

A spectrum of neurological disease associated with COVID-19 is becoming increasingly apparent. However, the mechanisms behind these manifestations remain poorly understood, significantly hindering their management. The present review subsequently attempts to address the evolving molecular, cellular and systemic mechanisms of NeuroCOVID, which we have classified as the acute and long-term neurological effects of COVID-19. We place particular emphasis on cerebrovascular, demyelinating and encephalitic presentations, which have been reported. Several mechanisms are presented, especially the involvement of a “cytokine storm”. We explore the genetic and demographic factors that may predispose individuals to NeuroCOVID. The increasingly evident long-term neurological effects are also presented, including the impact of the virus on cognition, autonomic function and mental wellbeing, which represent an impending burden on already stretched healthcare services. We subsequently reinforce the need for cautious surveillance, especially for those with predisposing factors, with effective clinical phenotyping, appropriate investigation and, if possible, prompt treatment. This will be imperative to prevent downstream neurological sequelae, including those related to the long COVID phenotypes that are being increasingly recognised.

Open access, https://www.jns-journal.com/article/S0022-510X(21)00302-6/fulltext

 

This doesn’t seem to have prevented decades of mistreatment of other conditions, including ME.

 

With the mention of "cytokine storm" in the abstract (which we know isn't associated with COVID), I am not expecting this one to be terribly enlightening.

 

I keep seeing cytokine storm associated with covid written in articles & people commenting on it to me etc. I know it's inaccurate because i have seen you & JE discussing it. But i wish i could refute it myself. How do we know that the initial reports/idea of a storm were inaccurate.

I'd love to be able to say ''actually cytokine storm is not associated with covid as was 1st suspected... see here <insert citation>"

Are you able to please help me out with a reference (or equivalent) @Snow Leopard ? I dont think 'because Snow Leopard says so', will quite cut it with the people i am talking to - despite it being entirely convincing to me!

 

We knew in mid 2020 that it was BS. The problem is mildly increased cytokine levels is somehow being equated to a "storm", when this is nonsense when compared to the true cytokine release syndrome where levels are extremely high.

Study of critically ill patients finds no cases:
https://jamanetwork.com/journals/jama/article-abstract/2770484

Is a “Cytokine Storm” Relevant to COVID-19?
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2767939

Given that there have been millions of infections, there are likely to be some rare cases, but these are not typical.

Notably anti-cytokine therapies (such as tocilizumab) have not found to be effective for acute severe COVID cases (the exception is when paired with dexamethasone, but the effect may be biased due to the desamethasone).
https://www.covid19treatmentguidelines.nih.gov/tables/table-4d/

 

Fantastic @Snow Leopard thank you.

I feel so privileged to have found S4 & get to learn from & pick the brains of scientists, doctors, mathematicians & psychologists, super-smart & enlightened lay folk too. What a total boon