No abstract

The role of the adaptive immune system in mediating COVID-19 is largely unknown. Therefore, it is difficult to predict the clinical course in patients with common variable immunodeficiency (CVID), a disease characterized by dysfunctional lymphocytes and impaired antibody production. We report a case of SARS-CoV-2 infection presenting as isolated neurological symptoms in a patient with CVID. The patient subsequently improved following steroids, intravenous immunoglobulin, and convalescent plasma (CP). The latter has been shown to be safe and efficacious in treating COVID-19 in patients with primary immunodeficiency. Recent data suggest that the mechanism of CNS injury in COVID-19 may be due to immunological dysregulation rather than direct viral-mediated injury. This case exemplifies the complex interaction between the brain, the immune system, and the SARS-CoV-2 virus.

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Neuromodulation is a treatment modality that can be used in the abortive and preventive treatment of migraine and other primary headache disorders. The basic concept of neurostimulation is to manipulate peripheral or central pain pathways with either magnetic or electrical impulses. Common neuromodulation techniques include occipital nerve stimulation, which is the oldest technique, and trigeminal nerve stimulation, combined occipital and trigeminal nerve stimulation, sphenopalatine ganglion stimulation, vagus nerve stimulation and transcranial magnetic stimulation, which were introduced soon after. The two newest modalities are remote electrical neuromodulation and caloric vestibular stimulation, the last of which is still in the experimental phases.