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The following is a summary of “Persistent Autonomic and Immunologic Abnormalities in Neurologic Post-Acute Sequelae of SARS-CoV2 Infection,” published in the August 2024 issue of Neurology by Goldstein et al. 

As the COVID-19 pandemic winds down, post-acute sequelae of SARS-CoV2 (PASC), especially cognitive issues like brain fog and fatigue, are becoming a significant public health concern. Known as Neuro-PASC, these symptoms often involve immune and autonomic system abnormalities. 

Researchers conducted a prospective study to evaluate if the immune and autonomic system issues identified in patients with Neuro-PASC persist after at least a year by repeating a range of tests to explore ongoing problems in the extended autonomic system.

They involved participants with Neuro-PASC research returned for follow-up at least a year after the initial inpatient testing at the NIH. Follow-up included symptom rating scales, MRI, lumbar puncture for CSF tests, physiological recordings during the valsalva maneuver and head-up tilting, blood volume measurements, skin biopsies to examine sympathetic innervation, and blood sampling for neuroendocrine and immunologic measures. 

The results showed that 7 patients with Neuro-PASC (6 women, aged 42-63) had follow-up testing. Almost 71% of the initial abnormalities persisted, including CSF and serum oligoclonal bands, central catecholamine deficiency, baroreflex-cardiovagal dysfunction, tilt-evoked hypotension, white matter hyperintensities, and CSF adaptive responses. 

Investigators concluded that most autonomic and immunologic issues observed in patients with Neuro-PASC initially persisted after over a year.

Source: neurology.org/doi/10.1212/WNL.0000000000209742