Findings offer insight into biological mechanisms, pointing to possible treatments.

Background and Objectives SARS-CoV-2 infection has been associated with a syndrome of long-term neurologic sequelae that is poorly characterized. We aimed to describe and characterize in-depth features of neurologic postacute sequelae of SARS-CoV-2 infection (neuro-PASC).

Methods Between October 2020 and April 2021, 12 participants were seen at the NIH Clinical Center under an observational study to characterize ongoing neurologic abnormalities after SARS-CoV-2 infection. Autonomic function and CSF immunophenotypic analysis were compared with healthy volunteers (HVs) without prior SARS-CoV-2 infection tested using the same methodology.

Results Participants were mostly female (83%), with a mean age of 45 ± 11 years. The median time of evaluation was 9 months after COVID-19 (range 3–12 months), and most (11/12, 92%) had a history of only a mild infection. The most common neuro-PASC symptoms were cognitive difficulties and fatigue, and there was evidence for mild cognitive impairment in half of the patients (MoCA score
Discussion CSF immune dysregulation and neurocirculatory abnormalities after SARS-CoV-2 infection in the setting of disabling neuro-PASC call for further evaluation to confirm these changes and explore immunomodulatory treatments in the context of clinical trials.

3D-FLAIR=
: 3D fluid-attenuated inversion recovery;
BP=
: blood pressure;
COVID-19=
: coronavirus disease 2019;
CVNN=
: coefficient of variation of interbeat intervals for normal beats;
DHPG=
: 3,4-dihydroxyphenylglycol;
DOPAC=
: 3,4-dihydroxyphenylacetic acid;
ESR=
: erythrocyte sedimentation rate;
FBF=
: forearm blood flow;
HF=
: high frequency;
HR=
: heart rate;
HRV=
: heart rate variability;
HV=
: healthy volunteer;
KPS=
: Karnofsky Performance Status;
MAP=
: mean arterial pressure;
MoCA=
: Montreal Cognitive Assessment;
OCBs=
: oligoclonal bands;
PASC=
: postacute sequelae of SARS-CoV-2 infection;
PROMIS=
: Patient-Reported Outcome Measurement Information System;
PRT=
: pressure recovery time;
RBD=
: receptor-binding domain;
SDNN=
: standard deviation of interbeat intervals for normal beats;
SARS-CoV-2=
: severe acute respiratory distress syndrome coronavirus 2;
SV=
: stroke volume;
TE=
: effective echo time;
TI=
: inversion time;
TR=
: repetition time;
TPR=
: total peripheral resistance;
UPSIT=
: University of Pennsylvania Smell Identification Test