this post was submitted on 27 Feb 2024
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This study shows links between Long COVID’s neurological effects, including brain fog and cognitive decline, and brain blood vessel integrity, offering hope for new treatments and diagnostic methods.

https://www.nature.com/articles/s41593-024-01576-9 (open access)

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[–] [email protected] 103 points 8 months ago (6 children)

Bringing in a medical perspective since there is a lot of subtle misunderstanding in the comments section:

The source study is not referring to “brain bleeding” or “mini strokes” as a cause of long COVID—the results point more towards a breakdown of the integrity of the blood brain barrier and maybe micro vascular ischemia.

You can essentially think of your central nervous system (brain and spinal cord) as being surrounded by a very selective security system called the Blood Brain Barrier (BBB). The BBB exists to prevent certain chemicals and cell signaling molecules from entering the central nervous system and messing things up. Neurons and many of the cells that support neurons do not regenerate and tolerate stress as well as other parts of the body, which is why the BBB is so important. Through the various assays the primary authors used it seems like in the setting of long COVID there is a breakdown of the BBB—it starts letting things in and out that it shouldn’t be. This leads to inflammation and damage in the brain which likely results in immediate decreased processing ability and also long-term damage (which further leads to decreased processing ability). One of the components which “leaks” in this setting of BBB breakdown are components of the coagulation cascade (the things that make blood clot) which may potentiate small areas of clotting and decreased blood flow (a thing we called micro vascular ischemia—like an ischemic stroke but in very small capillaries). This entire mechanism is similar to (but very different in nuance) “leaky gut syndrome,” where the gut endothelium starts to break down and cause inflammation. I put that out there since leaky gut is gaining more popular understanding these days and may be more familiar for some folks.

As of now there is no available treatment that restores the endothelial integrity of the BBB. Off of the top of my head this study may suggest that more treatments to modulate the inflammsome (roughly—the amount of inflammation in your body) could be beneficial—which sort of tracks since there is some scattered evidence that high dose Omega-3’s help long COVID.

[–] [email protected] 15 points 8 months ago

This is an excellent explanation. Thank you for taking the time to write it.

[–] [email protected] 5 points 8 months ago (1 children)

Is there a way to check if one has this condition?

[–] [email protected] 15 points 8 months ago

Not exactly—although an MRI w/wout contrast may show some microvascular ischemia or cortical volume loss. Based on the study there may be some clues from secondary inflammatory markers, but those aren’t specific (other things can elevate them beyond long COVID).

I think this will likely remain a clinical diagnosis for several years until we understand more.

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[–] [email protected] 94 points 8 months ago (2 children)

I’ve been waiting since 2021 for my sense of smell and taste to come back :(

[–] [email protected] 48 points 8 months ago (2 children)

Anecdotal but several of my friends claimed that psilocybin therapy restored their sense of smell.

[–] [email protected] 42 points 8 months ago (2 children)

That is interesting. Psilocybin has been shown to grow new brain neural pathways. It does seems plausible.

https://www.cell.com/neuron/fulltext/S0896-6273(21)00423-2

[–] [email protected] 6 points 8 months ago

Another option is Ketamine, wich also promotes BDNF. Some countries make use of it as a treatment for depression

[–] [email protected] 5 points 8 months ago (1 children)

Someone tell me when this becomes prescribable

[–] [email protected] 4 points 8 months ago (2 children)

You can just pick em yourself in the autumn

[–] [email protected] 7 points 8 months ago (7 children)

Or ask Uncle Ben for help, takes almost zero effort and you reap heaps.

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[–] [email protected] 3 points 8 months ago

I'm not good with mushrooms... I'm not a mycologist...

[–] [email protected] 14 points 8 months ago

Holy crap, now that you mention it, im pretty sure I've felt something similar from shrooms

[–] [email protected] 24 points 8 months ago* (last edited 8 months ago) (10 children)

Apologies if you've already tried this or something similar, it doesn't work for everyone, but I got mine back by using essential oils to retrain [edited as my phone autocorrected to 'restrain'] my olfactory system. After over a year of my food tasting like trash, or like it was off, and a dangerous incident (with a trip to A&E) where my brain fog meant I left an unlit gas oven on all night and couldn't smell it until I'd already got carbon monoxide poisoning (thankfully mild and temporary), I regained my smell and taste in about a week. Here's an article about it, it links to a charity that works in the field of loss of smell : https://www.saga.co.uk/magazine/health-wellbeing/treatments/smell-training-for-anosmia

Edit: if the down votes are because people think this is alternative medicine or woo, it isn't, it's a technique used in conventional medicine clinics. Try reading before you down vote.

[–] [email protected] 34 points 8 months ago* (last edited 8 months ago) (2 children)

To educate downvoters: Yes, “essential oil” health advice is a common bullshit indicator! But! They’re the standard pharmaceutical for this task, found in kits like this one used to train food and beverage scientists. Any diverse set of strong familiar smells can work.

I worked in a related field and got my ass kicked by long COVID shortly after the start of the pandemic. This is a good starter on the biology involved, a journal article from Nature, unpaywalled: https://web.archive.org/web/20220623072436/https://www.nature.com/articles/d41586-022-01628-9

Treating anosmia from brain damage is the same for post-COVID as for a car accident or getting gassed in WWI: you diligently breathe in the olfactory training kit and try to vividly remember those smells.

Pull quote: “Sometimes, the sense of smell recovers spontaneously after injury. The olfactory nerve is the only cranial nerve that can repair itself when damaged, and olfactory sensory neurons — cells in the upper part of the nose that recognize different odorant molecules — renew themselves periodically throughout life.“

edit to add, extreme sympathies to anyone who has found themselves experiencing this!

e2: corrected link

[–] [email protected] 9 points 8 months ago

Thank you. I should have realised that it needed more of an explanation. Shame that people don't engage their brains before a trigger finger downvote in a science thread though.

[–] [email protected] 8 points 8 months ago (1 children)

I got COVID twice, and both times I lost my sense of smell. The first time it lasted 3 days, and the second time, the total loss was only for half a day. Both times, one of the first smells I was able to detect was the vinegar in salt&vinegar chips. It's a strong smell that seemed to "pierce through" the block.

[–] [email protected] 5 points 8 months ago

So I didn’t completely lose my taste, but vinegar somehow ended up tasting like bleach to me for a few weeks. Strange how it affects everyone differently.

[–] [email protected] 18 points 8 months ago (1 children)

regarding your edit there, I guess most people stopped reading at 'essential oils' without knowing where this was going.

this is one (the only?) actual medical use for these things - their main thing is that they smell in a certain way that is consistent, so you use them to retrain your sense of smell. that's it. no taking internally or applying to skin or whatever. just take the stopper off the wee bottle, sniff and repeat for as many bottles as you can be arsed.

when I had covid-19, I didn't have so well defined scents on hand, but I did have several colognes I could sniff, and I knew fairly well how they were supposed to smell and could use those to gauge my senses. fun times, they were...

[–] [email protected] 5 points 8 months ago

I only realised I'd lost my smell completely when I smelled some perfume and thought it must be off, because it smelled of nothing. Then I realised that my other perfumes were 'off', and then went around my home smelling random things and finally realised it was me. I think it was the effect on my taste that was the hardest thing though. Onions and garlic especially made everything taste horrible.

[–] [email protected] 13 points 8 months ago

Clever! An actual legit medical use for essential oils!

[–] [email protected] 9 points 8 months ago (3 children)

Try reading before you down vote.

Speaking only for myself, what really threw me off was the following:

Apologies if you’ve already tried this or something similar, it doesn’t work for everyone, but I got mine back by using essential oils to restrain [emphasis mine] my olfactory system.

I think that if I'd realized that you meant to say "retrain" here instead of "restrain", I would not have been so quick to initially dismiss it as obviously nonsense.

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[–] [email protected] 54 points 8 months ago (2 children)

Holy shit I had a mild case of COVID with headaches as my only symptom. I then had long COVID and couldn't think straight, forgot words all the time, had trouble finishing sentences. It's terrifying to think this is why that was happening but it tracks because every time my feet got cold during that same time period one of my toes swelled up. Probably the same thing happening in my foot and my brain.

[–] [email protected] 14 points 8 months ago (2 children)

Oh wow I've been blaming alcohol abuse on brain fog. I quit drinking last year but still can't remember words all the time, same with finishing sentences. Struggling with being articulate all the time. And this all started during covid.

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[–] [email protected] 11 points 8 months ago* (last edited 8 months ago)

This is terrifying. I am 8 weeks in after testing positive. A blood exam reveal no more viral or bacterial infection but I still experience some anxiety and brain fog, today was one of those days (yesterday was an awesome day on the other hand).

I get cold hands all the time when I am starting to feel unwell.

[–] [email protected] 49 points 8 months ago

So this is actually pretty close to what a lot of people thought was going on: mini strokes.

[–] [email protected] 45 points 8 months ago (2 children)

Can it be treated? Does it heal?

[–] [email protected] 43 points 8 months ago

understanding the underlying cause of these conditions will allow us to develop targeted therapies for patients in the future,” said Prof. Matthew Campbell

Lets hope so. I imagine they might try medicines to reduce the bleeding and improve healing.

[–] [email protected] 30 points 8 months ago (1 children)

Anecdotally speaking I had covid a few months before vaccination became available (yay) and had horrible brain fog. I forgot a lot of words and really struggled with finishing sentences, things like that. It did improve but it took about a year. At the same time one of my toes kept swelling up every time my feet got cold and that stopped around the same time my ability to think improved.

[–] [email protected] 9 points 8 months ago (1 children)

Thanks for sharing a hopeful anecdote about long COVID, they’re few and far between. I’m glad you got better.

[–] [email protected] 8 points 8 months ago (1 children)

Thank you so much. It was a scary time because I felt like my brain was never going to work again.

[–] [email protected] 8 points 8 months ago (1 children)

I really empathize from nearly 5 years of gut dysfunction and related autoimmune issues. Healing felt like a miracle.

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[–] [email protected] 43 points 8 months ago (1 children)

Good god. I had covid twice, once before the vaccines and once after being vaxxed. I had a month of bad brain fog after each. It's terrifying to think I was going to work and driving while my brain was leaking.

[–] [email protected] 20 points 8 months ago (1 children)

Capitalism's gotta make sure you earn those profits for shareholders. Strokes be damned.

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[–] [email protected] 37 points 8 months ago (1 children)

After covid I had some regular and unusually strong headaches for a while. Maybe my brain was bleeding?

[–] [email protected] 34 points 8 months ago (1 children)

Unlikely. The most likely answer is that your sinuses never drained and you had a secondary infection.

But it's possible that leaky blood vessels had some effect. Note that leaky vessels are very different from an actual bleed.

[–] [email protected] 13 points 8 months ago (1 children)

A sinus headache is distinguishable from a regular headache, so I wouldn't discount the leaky blood vessels possibility.

Good point pointing out the difference between a "leak" and a "bleed," though: if your brain is bleeding, that's a full-blown emergency.

[–] [email protected] 4 points 8 months ago

Just a tiny little bleed 🥺

[–] [email protected] 19 points 8 months ago (5 children)

I'm so grateful that I didn't manage to catch COVID

[–] [email protected] 29 points 8 months ago (1 children)

Yet...

The virus is far from extinction and isn't going anywhere in our lifetimes.
Expecting to never catch Covid over the next few decades is like expecting to never catch the common cold.

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[–] [email protected] 25 points 8 months ago (2 children)

How do you know you didn't catch it? One of the problems, especially early on, was that some infections were asymptomatic.

[–] [email protected] 9 points 8 months ago

Indeed, I'm not sure even testing is sufficient. My family recently got it (my wife and I visiting my parents), but thought nothing of it for a week. My father had a sore throat, my mother had watery eyes and some nasal congestion. My father masked indoors (because I don't want a regular cold either) and chalked my mother's symptoms to seasonal allergies (the cars were covered with Pine pollen all week). Then, on the drive home, my wife felt off. 10 hours in the car together. She slept in the guest room that night and, just for grins, tested for Covid the next morning. She was positive. We called and had my parent's test - both positive. I tested negative so I packed my things and rented a hotel room for the week and worked there alone. I tested every other day and was never positive, but I cancelled all my client meetings.

I still never "got it" but...is it really feasible I didn't have some low level? This is my second trip in a car for multiple hours with someone who tested positive the next day. Granted, I'm about 4 vaccines in (2xOG, 1 updated, 1 XBB variant), but so is my wife. I have to think that I had some sub-clinical level of viral load, or at least below the antigen test threshold, but I'm thankful I escaped symptoms.

[–] [email protected] 6 points 8 months ago

And sometimes mild enough to be mistaken for allergies

[–] [email protected] 5 points 8 months ago (3 children)

Haha it took me 3 (almost 4) years to finally catch it :(

[–] [email protected] 7 points 8 months ago (1 children)

Same. I was so (oddly) proud of my streak. Then my spouse brought it home from a meeting with friends : P

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[–] [email protected] 6 points 8 months ago (1 children)

Finally got it for the first time last week, tested positive on my wedding day 😭

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[–] [email protected] 4 points 8 months ago

You've indeed been lucky.

[–] [email protected] 4 points 8 months ago (2 children)

Have you had any flu like symptoms since 2020?

Were you vaccinated and boostered?

Lots of people like to pretend they didn't get it while not actually knowing.

[–] [email protected] 7 points 8 months ago

Yeah, this is my 65-year-old aunt. Never got covid she says - and yet she's been sick more than once since 2019. She just never tests - so she never gets covid! Easy!

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