A new study, published in medRxiv.org as a preprint, suggests that inflammation triggered by SARS-CoV-2 causes increased neurotoxic damage in some cortical areas. The levels of cerebrospinal fluid (CSF) inflammatory markers were noted to be tied to changes in gray matter volume and cortical thickness in the frontal, orbitofrontal, and temporal regions among hospitalized patients with severe COVID-19 with varying levels of neurologic involvement.

The prospective multicenter cross-sectional study included patients aged ≥18 years with COVID-19 infection and neurologic symptoms. The neurologic symptoms were categorized into mild, moderate, or severe. In a subgroup of patients, CSF studies were done. Age- and sex-matched healthy individuals constituted the control group. 

The study patients were found to have lower cortical gray matter volume in the right rostral anterior cingulate, left medial orbitofrontal, and left superior frontal regions, in comparison with controls. The differences in cortical thickness or surface area were not significant between the patients with COVID-19 and the control group. A positive correlation was seen between CSF/blood-albumin ratio and the left rostral anterior cingulate, left lateral orbitofrontal, left pars triangularis, left postcentral, and right paracentral regional cortical thickness. Additionally, there was a positive correlation between EN-RAGE and left pars triangularis. The researchers also noted a significant positive correlation for surface area between EN-RAGE and right posterior cingulate cortex. The orbitofrontal gray matter volume had a negative correlation with CSF/blood-albumin ratio, protein levels, and CSF EN-RAGE. CSF leukocytes were found to have a negative association with gray matter volume in the right lateral orbitofrontal and left inferior temporal regions. Furthermore, CSF lactate had a negative correlation with gray matter volume in the left inferior temporal, left rostral middle frontal, and right lateral orbitofrontal regions… (Medscape)