Small fiber neuropathy underlying dysautonomia in COVID‐19 and in post‐SARS‐CoV‐2 vaccination and long‐COVID syndromes

Letter to the Editor: SARS-CoV-2-Related Polyradiculitis Requires Exclusion of Alternative Causes and Long-Term Follow-up

“…Unfortunately, autonomic function tests were not performed in our cases, which prevented us from detecting any underlying autonomic nervous system dysfunction. However, given the increasing reports of COVID-19 associated with autonomic neuropathy and long COVID-19 syndrome, 7 8 9 10 further research into the potential involvement of the autonomic nervous system in COVID-19-related GBS is warranted.…”

Neurological post‐acute sequelae of SARS‐CoV‐2 infection

“…diabetes), medications (e.g. anticancer drugs, antibiotics, and antiarrhythmic drugs), or incomplete recovery from autonomic involvement in Guillain–Barre syndrome 117 …”

“…anticancer drugs, antibiotics, and antiarrhythmic drugs), or incomplete recovery from autonomic involvement in Guillain-Barre syndrome. 117 Postural orthostatic tachycardia syndrome Postural orthostatic tachycardia syndrome (POTS) is clinically characterized by lightheadedness, palpitation ('heart racing'), tremulousness, and atypical chest discomfort. Additionally, sleep disturbance, headache, chronic fatigue, exercise intolerance and deconditioning, perceived cognitive impairment, peripheral acrocyanosis ('POTS feet'), frequent nausea, mild diarrhea, constipation, and bloating, or nonspecific abdominal pain ('irritable bowel syndrome') may be present.…”

Cardiovascular and autonomic dysfunction in long-COVID syndrome and the potential role of non-invasive therapeutic strategies on cardiovascular outcomes

“…A recent study of 5 million patients revealed that COVID-19 survivors experienced a significant increase (up to 2,000%) in the risk of suffering from cardiovascular (infarction, arrhythmias), pulmonary (hypoxemia, dyspnea), metabolic (diabetes, dyslipidemia) and neurological (cognitive impairment, sleep disorders, cerebral infarction) conditions from 1 to 6 months post-infection ( 1 ), with the highest risk observed in patients who were critical, followed by hospitalized and asymptomatic patients ( 3 ). Subsequent studies have shown a relationship between cardiovascular sequelae of COVID-19 and development of dysautonomia ( 6 ), often a product of chronic systemic inflammation that increases sympathetic nerve activity ( 6 – 8 ). This dysautonomia is a component of “post-COVID Guillan-Barré syndrome” (PCGBS) which is the most recurrent type of neurological post-COVID disorder (observed in 15% of patients) ( 8 – 11 ) and has been linked to the neuro-psychological sequelae of long COVID, such as anxiety, depression, and cognitive impairment ( 9 , 10 ).…”

“…Subsequent studies have shown a relationship between cardiovascular sequelae of COVID-19 and development of dysautonomia ( 6 ), often a product of chronic systemic inflammation that increases sympathetic nerve activity ( 6 – 8 ). This dysautonomia is a component of “post-COVID Guillan-Barré syndrome” (PCGBS) which is the most recurrent type of neurological post-COVID disorder (observed in 15% of patients) ( 8 – 11 ) and has been linked to the neuro-psychological sequelae of long COVID, such as anxiety, depression, and cognitive impairment ( 9 , 10 ). Despite the fact that long COVID has not yet been fully characterized, dysautonomia is thought to play an important role in the pathophysiology of the syndrome ( 11 , 12 ), especially with respect to the cardiovascular and neurological aspects.…”