Recent research suggests a potential link between Long-COVID and the brainstem (Yong 2021). In this educational blog, we will delve into this connection and its implications. Long-COVID is an unofficial term used to describe post-viral symptoms that persist after a COVID-19 infection, affecting individuals of any age (Greenhalgh et al. 2020). While the condition lacks official criteria, common symptoms include fatigue, brain fog, dyspnoea, headache, cognitive impairments, cough, joint and chest pains, smell and taste dysfunctions, and myalgia. These symptoms can persist for weeks or even years (Greenhalgh et al. 2020).
The Brainstem and Long-COVID
Neuroscientists conducted a study involving brain dissections of individuals who suffered from COVID-19 (Matschke et al. 2020). The study proposed a hypothesis that viral infiltration of the brainstem by the Neurotropic virus COVID-19 may be responsible for the persistent neurological symptoms observed in Long-COVID patients. The autopsy studies revealed viral invasion and subsequent neurodegeneration in multiple areas of the brainstem. The brainstem contains a high density of ACE2 receptors, which the virus utilizes to infect cells. This phenomenon, known as COVID-19 tropism, leads to the virus gathering and infecting specific areas (Yong 2021). The researchers theorized that the infection triggers an inflammatory response, resulting in the production of inflammatory mediators that damage the brainstem and vascular structures. The resulting micro thrombosis from vascular injury may further exacerbate neuroinflammation and brainstem dysfunction (Yong 2021).
Significance of Brainstem Involvement
Many Long-COVID symptoms suggest a potential involvement of the brainstem. The brainstem houses nuclei responsible for cranial nerves, which control smell and taste. Additionally, autonomic functions like sleep, breathing, and heart function are unconsciously regulated by the brainstem (Basinger & Hogg. 2022).
Connection Between the Brainstem and Upper Cervical Spine
The brainstem is a vital component of the central nervous system, responsible for regulating important bodily functions beyond conscious control. It is located adjacent to the cerebellum, just below the cerebral hemispheres, and extends down through the base of the skull into the posterior aspect of the foramen magnum. The brainstem blends with the spinal cord, which is secured by the upper cervical spine (C1 and C2). The dentate ligaments attach the brainstem and spinal cord to the inside of these vertebrae, tethering the spinal cord within the neural canal and allowing movement with the vertebrae. Misalignment of these vertebrae can impact brainstem and spinal cord function through various mechanisms:
Mechanical Stress: The dentate ligament attachments can cause torsion to the brainstem's dura, negatively affecting its function.
Vascular Stress: Disrupted blood supply to the central nervous system (CNS) can also impair brainstem function, either through the small blood vessels supplying the cord or the vertebral arteries that pass through the narrow passages in the vertebral bodies.
(Upper Cervical Studies 2013)
The COVID-19 tropism observed in the brainstem was most prominent in the pons and medulla, which are closest to the upper cervical spine and susceptible to impairment from dentate ligament stress. These structures regulate processes such as smell and taste (pons) and breathing and heart function (medulla). Consequently, stress on the brainstem from the upper cervical spine could potentially contribute to or exacerbate the symptoms experienced in Long-COVID (Yong 2021).
Brainstem Dysfunction in Other Chronic Disorders
Brainstem dysfunction is also implicated in other chronic disorders, including migraines and chronic fatigue syndrome. Dysfunctional brainstem and nervous system play significant roles in these debilitating conditions (Yong 2021). A recent study also found that similar changes to brainstem volume in that were observed in chronic fatigue and myalgic encephalomyelitispatients were also found in those with long covid (Thapaliya et al. 2023).
How Chiropractic Care Can Help
Recent case studies exploring the role of chiropractic care in Long-COVID have found notable improvements in long-term sufferers receiving cervical spine corrections (McIvor 2022). As Upper Cervical Chiropractors, we specialize in analysing the neck and correcting any issues we find, particularly misalignments of the spinal joints.
At Top Chiropractic, we utilize state-of-the-art 3D imaging to assess the spine and its relation to the brainstem. This advanced technology allows us to make precise corrections to ensure the proper functioning of the cervical spine without negatively impacting the brainstem's function.
Chiropractic care can help address misalignments in the upper cervical spine that may be contributing to brainstem dysfunction. By realigning the vertebrae and relieving stress on thejoints and surrounding structures, we aim to restore proper nerve function and optimize the body's overall well-being.
1. Yong, S.J. (2021). Persistent Brainstem Dysfunction in Long-COVID: A Hypothesis. ACS Chem. Neurosci. 2021, 12, 573-580.
2. Greenhalgh, T., Knight, M., A'Court, C., Buxton, M., & Husain, L. (2020). Management of post-acute covid-19 in primary care. BMJ (Clinical research ed.), 370, m3026. https://doi.org/10.1136/bmj.m3026
3. Matschke, J., Lütgehetmann, M., Hagel, C., Sperhake, J. P., Schröder, A. S., Edler, C., Mushumba, H., Fitzek, A., Allweiss, L., Dandri, M., et al. (2020) Neuropathology of Patients with COVID-19 in Germany: A Post-Mortem Case Series. Lancet Neurol. 19 (11), 919− 929.
4. Basinger, H., Hogg, JP. (2022). Neuroanatomy, Brainstem. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK544297/
5. Adler, J. (2013). The Holy Grail. Upper cervical studies; WordPress. Available from: https://ucstudies.wordpress.com/tag/dentate-ligament/#:~:text=Dr.,and%20deform%20the%20spinal%20cord. [Accessed 26/06/2023]
6. Thapaliya, K., Marshall-Gradisnik, S., Barth, M., Eaton-Fitch, N., Barnden, L. (2023). Brainstem volume changes in myalgic encephalomyelitis/chronic fatigue syndrome and long COVID patients. Front. Neurosci., 17(1). https://doi.org/10.3389/fnins.2023.1125208
7. McIvor, C. (2022) Case reports examine long covid sufferers under chiropractic care.Australian Spinal Research Foundation. Available at: https://spinalresearch.com.au/case-reports-examine-long-covid-sufferers-under-chiropractic-care/ (Accessed: 26 June 2023).