Persistent Autonomic and Immunologic Abnormalities in Neurologic Post-Acute Sequelae of SARS-CoV2 Infection

Area of Science:

• Neurology
• Immunology
• Cardiology

Background:

• Post-acute sequelae of SARS-CoV-2 infection, termed Neuro-PASC, commonly include neurological symptoms like fatigue and cognitive dysfunction.
• The persistence of these neuro-PASC abnormalities beyond one year requires further investigation.

Purpose of the Study:

• To evaluate the long-term persistence of neurological and physiological abnormalities in patients with Neuro-PASC.
• To assess whether initial findings in Neuro-PASC patients remain present after at least one year.

Main Methods:

• Observational study involving Neuro-PASC patients undergoing comprehensive inpatient testing.
• Follow-up assessments included symptom ratings, MRI, cerebrospinal fluid (CSF) analysis, physiological recordings (Valsalva, head-up tilt), blood volume measurement, skin biopsies, and blood sampling for neuroendocrine and immunologic markers.

Main Results:

• 71% of initially abnormal test results persisted at follow-up in 7 Neuro-PASC patients.
• Persistent abnormalities included CSF/serum oligoclonal bands, central catecholamine deficiency, baroreflex-cardiovagal dysfunction, tilt-evoked hypotension, and white matter hyperintensities on MRI.

Conclusions:

• Autonomic and immunologic abnormalities are frequently persistent in Neuro-PASC patients over one year post-infection.
• These findings highlight the chronic nature of some Neuro-PASC manifestations, particularly affecting autonomic function.