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Research

1 in 100 COVID patients develop brain conditions

A new study reveals the risk of stroke, haemorrhage or encephalitis as a result of the virus

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Around one in 100 patients hospitalised with COVID-19 will develop brain conditions including stroke and haemorrhage as a result of the virus, the largest multi-site study to date has found. 

The multi-institutional research investigated brain complications of COVID and found that complications of the central nervous system can occur in one in 100 people. 

“Much has been written about the overall pulmonary problems related to COVID-19, but we do not often talk about the other organs that can be affected,” said study lead author Dr Scott H. Faro, professor of radiology and neurology and director of the division of neuroradiology/head and neck imaging at Thomas Jefferson University in Philadelphia. 

“Our study shows that central nervous system complications represent a significant cause of morbidity and mortality in this devastating pandemic.”

The most common complication was ischemic stroke, with an incidence of 6.2 per cent, followed by intracranial haemorrhage (3.72 per cent) and encephalitis (0.47 per cent), an inflammation of the brain.

Dr Faro initiated the study after discovering that existing literature on central nervous system complications in hospitalised COVID-19 infected patients was based on a relatively small number of cases.

To derive a more complete picture, he and his colleagues analysed nearly 40,000 cases of hospitalised COVID-19 positive patients from seven US and four western European university hospitals. 

The patients had been admitted between September 2019 and June 2020. Their average age was 66 years old, and there were twice as many men as women.

The most common cause of admission was confusion and altered mental status, followed by fever. Many of the patients had co-morbidities like hypertension, cardiac disease and diabetes.

There were 442 acute neuroimaging findings that were most likely associated with the viral infection. The overall incidence of central nervous system complications in this large patient group was 1.2 per cent.

“Of all the inpatients who had imaging such as MRI or a CT scan of brain, the exam was positive approximately ten per cent of the time,” Dr Faro said. 

“The incidence of 1.2 per cent means that a little more than one in 100 patients admitted to the hospital with COVID-19 are going to have a brain problem of some sort.”

The researchers also discovered a small percentage of unusual findings, such as acute disseminating encephalomyelitis, an inflammation of the brain and spinal cord, and posterior reversible encephalopathy syndrome, a syndrome that mimics many of the symptoms of a stroke.

“It is important to know an accurate incidence of all the major central nervous system complications,” Dr Faro said. 

“There should probably be a low threshold to order brain imaging for patients with COVID-19.”

The study is being presented at the annual meeting of the Radiological Society of North America (RSNA).

Research

Blood test for Glioblastoma moves closer

University of Sussex breakthrough hailed as ‘major step forward’ in the development of an accurate, non-invasive and time-saving diagnosis method

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The quest to develop a blood test capable of diagnosing the most aggressive form of brain tumour – Glioblastoma – has moved one step closer. 

Researchers at the University of Sussex have identified distinctive biomarkers within patient blood samples, which could signal the presence of Glioblastoma. 

The biomarkers were identified within extracellular vesicles – small particles which all cells secrete which carry different information, such as DNA or proteins. 

The ability to identify these biomarkers within the extracellular vesicles suggests that a liquid biopsy approach could be a viable option for glioblastoma diagnosis, providing both a quicker and less invasive alternative to current diagnostic methods.

More than 11,000 people are diagnosed with a primary brain tumour in the UK each year, with efforts ongoing to find effective treatments. 

Glioblastoma is the most common high grade primary brain tumour in adults, which means it can grow and spread exceptionally quickly. As a result, it is important for diagnosis to be quick, so patients can access treatment as soon as possible.

Professor Georgios Giamas and his team are leading the research in collaboration with Mr Giles Critchley, consultant neurosurgeon and spinal surgeon at University Hospitals Sussex.

“Currently, Glioblastoma detection relies on the display of symptoms, magnetic resonance imaging and invasive tissue biopsies – all of which can delay the identification of the rapidly growing malignant mass,” said Prof Giamas. 

“A growing body of research is looking into the possibility of developing liquid biopsies which would afford timely and non-invasive assessment of the disease in patients, starting from just a small sample of blood.

“Our study, which effectively does this in a small patient group, is a major step forward in the development of an accurate, non-invasive and time-saving diagnosis method.”

In November 2019, Prof Giamas’s lab at Sussex identified specific biomarkers that Glioblastoma cell lines are able to ‘package’ within extracellular vesicles allowing for better classification between those cell lines (e.g. less vs more aggressive). 

Biomarkers can be considered as biological signatures for a disease, and can therefore indicate the presence of cancer in the body. 

This new stage of research now proves that a liquid biopsy approach can successfully determine the presence of such biomarkers in a Glioblastoma patient and therefore improve the disease diagnosis and ultimately the patients’ prognosis and quality of life.

Funded by Action Against Cancer, Prof Giamas now hopes to conduct further research into the clinical value of their findings, by analysing blood samples of a larger cohort of Glioblastoma patients obtained from Genomics England.

The team also aims to investigate the presence and levels of such biomarkers in response to specific cancer treatments in an attempt to monitor the progression of the disease and evaluate the importance and role of these biomarkers.

He added: “If we can show that the biomarker signatures of extracellular vesicles obtained from blood samples change/disappear then this could be a huge breakthrough for monitoring the success of treatments too.”

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Neuropsychology

COVID cognitive symptoms linked to cerebrospinal fluid

The study could help increase understanding of ‘brain fog’ among people recovering from COVID and those with Long COVID

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Cognitive symptoms experienced by people recovering from COVID-19 may be linked to abnormalities found in cerebrospinal fluid, new research has revealed. 

The new findings around the role of cerebrospinal fluid, which saw similar changes in those recovering from a mild bout of COVID as people with other infectious diseases, may provide new insight into how the SARS-CoV-2 virus impacts the brain.

‘Brain fog’ has become recognised as a common after effect of COVID and symptom of Long COVID, which can cause varying degrees of cognitive issues.

In a small study with 32 adults, comprising 22 with cognitive symptoms and ten control participants without, researchers from UC San Francisco and Weill Cornell Medicine, New York, analysed the cerebrospinal fluid of 17 of the participants who consented to lumbar puncture. 

All participants had had COVID but had not required hospitalisation.

They found that ten of 13 participants with cognitive symptoms had anomalies in their cerebrospinal fluid – but all four of the cerebrospinal samples from participants with no post-COVID cognitive symptoms were normal. 

Participants with these symptoms presented with executive functioning issues, said senior author Dr Joanna Hellmuth, of the UCSF Memory and Aging Center. 

“They manifest as problems remembering recent events, coming up with names or words, staying focused, and issues with holding onto and manipulating information, as well as slowed processing speed,” she said.

Examinations of the cerebrospinal fluid revealed elevated levels of protein, suggesting inflammation, and the presence of unexpected antibodies found in an activated immune system. 

Some were found in the blood and cerebrospinal fluid, implying a systemic inflammatory response, or were unique to the cerebrospinal fluid, suggesting brain inflammation. 

While the targets of these antibodies are unknown, it is possible that these could be “turncoat” antibodies that attack the body itself.

“It’s possible that the immune system, stimulated by the virus, may be functioning in an unintended pathological way,” said Dr Hellmuth, who is principal investigator of the UCSF Coronavirus Neurocognitive Study and is also affiliated with the UCSF Weill Institute for Neurosciences. 

“This would be the case even though the individuals did not have the virus in their bodies,” she said, noting that the lumbar punctures took place on average ten months after the participants’ first COVID symptom.

The researchers also found that the participants with cognitive symptoms had an average of 2.5 cognitive risk-factors, compared with an average of less than one risk factor for participants without the symptoms. 

These risk-factors included diabetes and hypertension, which can increase the risk of stroke, mild cognitive impairment and vascular dementia; and a history of ADHD, which may make the brain more vulnerable to executive functioning issues. Other risk factors included anxiety, depression, a history of  heavy alcohol or repeated stimulant use, and learning disabilities.

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Brain injury

New light shed on Brazilian Jiu-Jitsu and brain injury

Athletes may be at less risk of causing long-lasting injury than has previously been feared, new research has revealed

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Brazilian Jiu-Jitsu (BJJ) athletes may be at less risk of causing long-lasting injury to the brain than has previously been feared, new research has revealed. 

BJJ is a popular martial art that exposes participants to recurrent intermittent asphyxiation due to controlled application of neck chokes. 

Unlike several combat sports, BJJ categorically prohibits strikes to the body, especially the head, favouring limb manipulation and neck chokes to coerce an opponent into submission.

However, concerns have been raised regarding the potential link between repetitive neck chokes, structural brain damage and implications for cognitive function.

But now, in the first study of its kind, researchers at the University of South Wales (USW) – who have previously led pioneering research to show the extent of rugby players’ cognitive decline in just one season – have shed new light on BJJ. 

The team from the Neurovascular Research Laboratory at USW examined blood flow to the brain using Duplex ultrasonography and cognitive function via neuropsychological tests in elite BJJ athletes. 

They found preliminary evidence that the BJJ athletes had a higher resting blood flow to the brain, alongside intact cognitive function, when compared to a control group of athletes matched by age, gender, and cardiorespiratory fitness.

Benjamin Stacey, lecturer in clinical science, said: “The popularity of BJJ is growing exponentially and is likely attributable to many people witnessing its effectiveness in Mixed Martial Arts (MMA) on promotions such as the Ultimate Fighting Championship (UFC) and Bellator. 

“The inclusivity of BJJ allows for all individuals to train together, regardless of age, sex or physical ability and when compared to other combat sports, BJJ carries a lesser risk to injury.

“Our unique findings argue against the notion that BJJ predisposes an individual to greater risk of long-lasting brain damage and conversely, provides evidence for enhanced protection for the brain. 

“These observations may be attributed to choke-induced pre-conditioning and/or exposure to BJJ-specific high-intensity interval training, which we know can confer protective benefits for the brain.

“These findings can help to inform much-needed follow-up research to extensively examine both the short and long-term implications of participation in the sport.”

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