After acute coronavirus disease-2019 (COVID-19), people often experience fatigue, "brain fog," or other central neurologic symptoms (neuro-post-acute SARS-CoV2, or "Neuro-PASC"). In this observational study the authors evaluated whether abnormalities noted on initial evaluation persist after at least another year. Neuro-PASC research participants who had undergone comprehensive inpatient testing at the NIH Clinical Center returned after at least 1 year for follow-up assessments were included. Symptoms rating scales, MRI, lumbar puncture for tests of the CSF, physiologic recordings during the Valsalva maneuver and head-up tilting (with serial plasma catechols and cardiac Doppler ultrasound during the tilting), blood volume measurement, skin biopsies to examine sympathetic innervation, and blood sampling for neuroendocrine and immunologic measures were collected.
7 patients with Neuro-PASC (6 women, age range 42-63 years) underwent follow-up testing. 71% of initially abnormal test results remained abnormal at follow-up, including the pattern of CSF and serum oligoclonal bands, CSF indices of central catecholamine deficiency, baroreflex-cardiovagal dysfunction, the occurrence of tilt-evoked sudden hypotension, white matter hyperintensities on MRI, and adaptive responses in CSF. The authors concluded underlying that in Neuro-PASC most of the autonomic and immunologic abnormalities found initially are still present after more than a year.
Goldstein DS, Mina Y, Walitt B, Sullivan P, Enose-Akahata Y, Jacobson S, Nguyen ML, Sidenko S, Wiebold A, Smith B, Gelsomino J, Isonaka R, Moore S, Nath A. Persistent Autonomic and Immunologic Abnormalities in Neurologic Post-Acute Sequelae of SARS-CoV2 Infection. Neurology. 2024 Sep 24;103(6):e209742. doi: 10.1212/WNL.0000000000209742. Epub 2024 Aug 22. PMID: 39173103; PMCID: PMC11343584.