Persistent Autonomic and Immunologic Abnormalities in Neurologic Post-Acute Sequelae of SARS-CoV2 Infection, 2024, Goldstein, Walitt, Nath+

Persistent Autonomic and Immunologic Abnormalities in Neurologic Post-Acute Sequelae of SARS-CoV2 Infection
David S. Goldstein, MD, PhD, Yair Mina, MD, Brian Walitt, MD, MPH, Patti Sullivan, CMT, Yoshimi Enose-Akahata, PhD, Steven Jacobson, PhD, My-Le Nguyen, MD, Stanislav Sidenko, BA, RCS, Amanda Wiebold, RN, Bryan Smith, MD, Janna Gelsomino, RN, Risa Isonaka, PhD, Sarah Moore, CRNP, and Avindra Nath, MD

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 “NeuroPASC”). 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, baroreflexcardiovagal 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.

Link | PDF (Neurology) [Open Access]

 

I approached this paper with trepidation, wondering what fresh hell Walitt was visiting upon us. Perhaps he didn't get the right to decide the wording this time. The study only had 7 participants, and so far it doesn't look as though they found one thing that might explain the long Covid pathology across all, or even just most of the participants. Still, they looked at a lot of things, and there are interesting things to note.

I do see some evidence of Walitt in the paper e.g.
In the discussion:

appears without qualification, but, only one of the 7 was found to have that, whatever it actually means

I don't know what the following really means

But with 5 out of the 7 participants having elevated copeptin levels, that looks like something worth exploring.


The final section 'Perspective' seems to suggest something about stress, but it's quite vague so I guess people can read into it whatever they want:

EAS=Extended autonomic system


So, based on a skim read, the paper doesn't seem to be traumatising and is worth looking at in detail, keeping in mind, this is just for 7 participants. Thank you to the participants for their effort.

 

Hutan beat me to it, but yes, no need for the big breath I and no doubt she took when opening! No evidence of low blood volume sounds useful info (small numbers).

 

Copeptin?
the following is mostly from Wikipedia

I've gone on about how I routinely get a high shock index and how, for me, a higher shock index correlates with symptom load. I don't know why it isn't measured and reported in ME/CFS and Long Covid.

 

From eAppendix 3:

This paper gives us detailed Tables 1 and 2 (telling us how many tests were the same or different at the first and the follow up visits. But, that's almost meaningless. What we really need is the actual data.

For instance I want to see the actual copeptin data. eAppendix 3 Figure 3 is a table with cells for each measure for each participant for each visit. They could have given us actual data there. But, instead they just coloured the cells to indicate high, low or normal values. I haven't found any figure that provides actual copeptin data.