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Long Covid symptoms linked to brainstem damage, University of Cambridge research suggests




Damage to the brainstem could be responsible for symptoms of long Covid, such as breathlessness and fatigue, University of Cambridge research suggests.

Powerful MRI scanners were used to examine patients who had been admitted to hospital with Covid-19, and revealed “long-lasting brain changes”.

Brainstem clusters. Image: University of Cambridge
Brainstem clusters. Image: University of Cambridge

This was “likely caused by an immune response to the virus”, researchers said.

People with Covid-19 usually feel better within a few days or weeks, although for some people symptoms can last longer.

The condition, also known as long Covid, can cause extreme tiredness, shortness of breath, brain fog, dizziness, heart palpitations and muscle aches.

Cambridge scientists used ultra high-resolution 7-Tesla (7T) scanners that show the living brain in fine detail.

3D projections of QSM maps on the rendered brainstem. Image: University of Cambridge
3D projections of QSM maps on the rendered brainstem. Image: University of Cambridge

Dr Catarina Rua, of the Department of Clinical Neurosciences, said: “Things happening in and around the brainstem are vital for quality of life, but it had been impossible to scan inflammation of brainstem nuclei in living people, because of their tiny size and difficult position.

“Usually, scientists only get a good look at the brainstem during post-mortem examinations.”

The team scanned the brains of 30 patients with Covid-19 who had been admitted to hospital during the pandemic and compared their results to scans of 51 people with no history of infection.

The results showed multiple regions of the brainstem, which connects the brain and spinal cord and regulates many bodily functions, had abnormalities associated with a neuroinflammatory response.

The abnormalities appeared weeks after patients were admitted to hospital with Covid-19, and in parts of the brain responsible for breathing control.

Researchers suggested “lasting symptoms might be an indirect effect of brainstem inflammatory injury following Covid-19”.

Brainstem clusters. Image: University of Cambridge
Brainstem clusters. Image: University of Cambridge

Changes were also “more evident in patients with longer hospital stays, higher Covid severity, more prominent inflammatory responses and worse functional outcomes”, they added.

Dr Rua said: “The fact that we see abnormalities in the parts of the brain associated with breathing strongly suggests that long-lasting symptoms are an effect of inflammation in the brainstem following Covid-19 infection. These effects are over and above the effects of age and gender, and are more pronounced in those who had had severe Covid-19.”

Prof James Rowe, who co-led the study, added: “Mental health is intimately connected to brain health, and patients with the most marked immune response also showed higher levels of depression and anxiety.

“Changes in the brainstem caused by Covid-19 infection could also lead to poor mental health outcomes, because of the tight connection between physical and mental health.”



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