How Viruses Reshape the Brain: Imaging Neuroinflammation and Cancer Pathways with Claudia Kirsch

Dr. Claudia Kirsch joins Rethink Imaging to discuss how viruses like SARS-CoV-2 reshape the brain through inflammation, vascular injury, and immune pathways. From unexplained smell loss to the discovery of the nervus terminalis as a potential viral pathway, this episode highlights how advanced imaging is uncovering new insights into neuroinflammation and viral-driven disease including implications for cancer biology and long-term brain health.

When COVID-19 began flooding hospitals, neuroradiologists started seeing something alarming.

Dr. Claudia Kirsch recalls reading cases involving venous infarcts, massive inflammation, and devastating brain injury. Patients were experiencing hemorrhages and large infarctions linked to the virus. It was a wake-up cal, one that drove her to investigate how SARS-CoV-2 was affecting the brain at a structural and biological level.

One of the earliest mysteries? Smell loss.

Patients were losing their sense of smell without sinus inflammation. The virus requires ACE2 receptors to enter cells, yet those receptors are limited in the olfactory bulb. So how was it reaching the brain?

Emerging hypotheses point toward alternative pathways, including vascular spread and lesser-known neural structures such as the nervus terminalis, tiny unmyelinated fibers that connect the olfactory region to the hypothalamus and are associated with nitric oxide signaling, immune response, and blood supply regulation.

These discoveries extend beyond COVID.

The episode also explores how viruses influence inflammation more broadly including their role in cancer biology and immune modulation. Imaging is becoming central to identifying early inflammatory changes, mapping neural pathways, and understanding long-term consequences.

At its core, this conversation emphasizes a powerful truth: when clinicians understand what to look for, imaging becomes predictive not just diagnostic.

What You’ll Learn:

What neuroradiologists saw in early COVID brain scans
How COVID may trigger vascular injury and inflammation in the brain
Why smell loss remains biologically complex
The significance of the nervus terminalis in viral spread and immune response
How viral inflammation may intersect with cancer biology
Why advanced imaging is essential to precision medicine

Chapters:

[00:00] Introduction to Viral Neuroimaging
[04:47] The Wake-Up Call: Early COVID Brain Cases
[08:20] The Science Behind Smell Loss
[14:54] The Nervus Terminalis Discovery
[21:30] Neuroinflammation and Vascular Pathways
[29:45] Viral Mechanisms and Cancer Risk
[37:10] The Future of Imaging in Precision Medicine