Sekrayray

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.

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.

Remember the Zune? Pretty sure they did the same thing then.

I’ve been saying for a few years now that the source of the next economic crash is going to be these services. We are essentially allowing the everyday consumer to create lines of credit on lines of credit. How many people are using these to extend their credit cards that are already deficient?

I think it definitely will. I’m at a large medical center and it’s always surprising what we’re able to do (that we consider to be basic) compared to rural places. Fingers crossed!

So sorry you’re going through all of this. As an ER provider I feel so terrible for the patients I see with chronic gastrointestinal issues. I always try to do some things to broaden the differential (I’ve had some pretty clutch diagnoses of chronic mesenteric ischemia in cases like yours by doing a CTA instead of just a CT—usually on patients who have had multiple CT’s), but there’s only so much you can do with the resources available to us in the ED. I always place a GI referral, but I feel like most GI’s actually ignore the chronic stuff if scopes are negative. It really sucks knowing a lot of possible answers but not being the person who can test for them.

Hopefully Mayo helps. Almost sounds like you have some sort of GI motility issue—I wonder if your trigemial neuralgia is actually a more nuanced symptom of an underlying CNS/PNS unifying diagnosis.

I feel personally attacked

EDIT: You gotta pump those email numbers up

Think of your sleep as reading a series of engaging books, where each book represents a sleep cycle, including chapters of both deep sleep (SWS) and dream sleep (REM). When you finish a book (sleep cycle), you reach a satisfying conclusion to that story arc—this is akin to waking up after a full sleep cycle. You feel refreshed because you’ve concluded the narrative neatly, without interrupting a tense plot twist or leaving a storyline unresolved.

However, just finishing one book doesn’t mean you’ve completed the whole series. If you stop after one book each night, you’re missing out on the depth and development that comes from reading more of the series (accumulating more sleep cycles). Initially, you might feel okay because you’ve concluded a story (cycle) properly, avoiding the grogginess of waking up mid-chapter (mid-cycle). Yet, this approach doesn’t give you the full, enriching experience (or rest) your body and brain need over time.

As days go on, if you continue this pattern, you accumulate a ‘reading debt’—akin to sleep debt. You’ve missed out on the broader, deeper insights and the full narrative arc that only comes from reading (sleeping) the whole series or book. This debt reflects not fully recharging your brain and body, leaving you progressively more tired. While you might feel a temporary refreshment from completing a cycle, without the full, restorative rest of multiple cycles, you’re not truly at 100%—you’re running on the satisfaction of a finished story, not the full restoration that comes from a complete series.

Yeah, it’s about getting enough REM and SWS cycles. The effect decays over time, though. If you time your wake up to a full sleep cycle (around 2.5-3 hours) one night, you may wake up feeling fine. If you do this multiple nights in a row, however, you will build up a REM/SWS debt. So on day one it feels fine, on day two it feels less fine, and on day three you’re dragging.

The frequency and death toll of those in other countries isn’t even comparable. The US had more mass shootings last year than any other leading nation did in the entire 21st century so far. Probably more than all of them combined. It’s honestly not even worth trying to compare.

Other countries aren’t perfect, but mass shootings are astoundingly more common/worse in America. To deny that is simply ignoring the facts.

If you put in the work upfront it will make the back half easier. If you slack on the front end you’ll need to sprint to the finish.

Mainly came to this conclusion in school with academics, but started applying it to everything. It’s not perfect—you can absolutely work hard and still not get the results because of forces of nature (or oppressive systems). But in general I’ve found it’s a good rule to live by.

This is a nostalgia bomb, I’ll probably actually give it a shot