tetano
Editor, Senior Moderator
Neurology
. 2024 Sep 24;103(6):e209742.
doi: 10.1212/WNL.0000000000209742. Epub 2024 Aug 22. Persistent Autonomic and Immunologic Abnormalities in Neurologic Post-Acute Sequelae of SARS-CoV2 Infection
David S Goldstein[SUP] 1 [/SUP], Yair Mina[SUP] 1 [/SUP], Brian Walitt[SUP] 1 [/SUP], Patti Sullivan[SUP] 1 [/SUP], Yoshimi Enose-Akahata[SUP] 1 [/SUP], Steven Jacobson[SUP] 1 [/SUP], My-Le Nguyen[SUP] 1 [/SUP], Stanislav Sidenko[SUP] 1 [/SUP], Amanda Wiebold[SUP] 1 [/SUP], Bryan Smith[SUP] 1 [/SUP], Janna Gelsomino[SUP] 1 [/SUP], Risa Isonaka[SUP] 1 [/SUP], Sarah Moore[SUP] 1 [/SUP], Avindra Nath[SUP] 1 [/SUP]
Affiliations
Objectives: 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 we evaluated whether abnormalities noted on initial evaluation persist after at least another year.
Methods: 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 including 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.
Results: 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.
Discussion: In Neuro-PASC most of the autonomic and immunologic abnormalities found initially are still present after more than a year.
. 2024 Sep 24;103(6):e209742.
doi: 10.1212/WNL.0000000000209742. Epub 2024 Aug 22. Persistent Autonomic and Immunologic Abnormalities in Neurologic Post-Acute Sequelae of SARS-CoV2 Infection
David S Goldstein[SUP] 1 [/SUP], Yair Mina[SUP] 1 [/SUP], Brian Walitt[SUP] 1 [/SUP], Patti Sullivan[SUP] 1 [/SUP], Yoshimi Enose-Akahata[SUP] 1 [/SUP], Steven Jacobson[SUP] 1 [/SUP], My-Le Nguyen[SUP] 1 [/SUP], Stanislav Sidenko[SUP] 1 [/SUP], Amanda Wiebold[SUP] 1 [/SUP], Bryan Smith[SUP] 1 [/SUP], Janna Gelsomino[SUP] 1 [/SUP], Risa Isonaka[SUP] 1 [/SUP], Sarah Moore[SUP] 1 [/SUP], Avindra Nath[SUP] 1 [/SUP]
Affiliations
- PMID: 39173103
- DOI: 10.1212/WNL.0000000000209742
Objectives: 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 we evaluated whether abnormalities noted on initial evaluation persist after at least another year.
Methods: 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 including 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.
Results: 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.
Discussion: In Neuro-PASC most of the autonomic and immunologic abnormalities found initially are still present after more than a year.