Abstract Details

Title Neuroimage and Autonomic Abnormalities in patients with CoVID-19 Happy Hypoxemia

Topic Infectious Disease

Presentation(s) Infectious Disease Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 073

Objective

To describe the autonomic and SNC manifestations of patients with coronavirus disease 2019 (COVID-19) and happy hypoxemia.

Background

Happy hypoxemia is the absence of dyspnea despite low oxygen saturation. Several hypotheses for its occurrence include potential viral neuroinvasion, autonomic dysfunction, and cortical ischemic damage.

Design/Methods

We studied prospectively nine patients with COVID-19 who arrived at the ER with very low oxygen saturation (50-79%) and no dyspnea complaints. Patients were invited to participate and underwent a full clinical history, brain MRI with gadolinium, and 24H-Holter with spectroscopy while hospitalized and bed-ridden. We used Pearson's coefficient correlation for the correlation analysis.

Results Two patients were excluded from the study because they no longer wished to participate and one because he had FA. we analyzed six patients (66% women) with a mean age of 59 years old (47-83). Two patients had high blood pressure, one patient had a history of tuberculosis, and one had Down Syndrome. Upon arrival at the ER, the mean oxygen saturation was 67% and PaO2 59.3 (47-83). One patient (14%) complain of headache and none of anosmia or ageusia. Four patients underwent a brain MRI that showed gadolinium enhancement of the olfactory bulbs and white matter lesions. One patient also had a left insular lesion. Three patients had abnormal SDNN<100 (83ms, 30-146), and one had RMSSD <15. Vagally mediated changes reflected in HRv were significantly lower in patients with lower blood O2 saturation (SDDN p=0.002, r=.95, HF p=0.009, r=.92, LF/HF ns, -0.42).

Conclusions

Patients with happy hypoxemia had decreased heart rate variability that correlated with the degree of hypoxemia, suggesting altered modulation of vagal tone and autonomic dysregulation. All the patients had olfactory bulb enhancement. In our patients, hyposmia /anosmia did not correlate with olfactory bulb hyperintensities or happy hypoxemia.

Authors/Disclosures
Maria Alejandra Gonzalez Duarte, MD, F�鶹��ýӳ�� (NYU Dysautonomia Center) PRESENTER	Dr. Gonzalez Duarte has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Alnylam. Dr. Gonzalez Duarte has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Astra Zeneca. Dr. Gonzalez Duarte has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Alnylam . The institution of Dr. Gonzalez Duarte has received research support from Pfizer.
Miguel García-Grimshaw, MD	Dr. García-Grimshaw has nothing to disclose.
	No disclosure on file
	No disclosure on file
Daniel Rebolledo, Jr., MD (Instituto Nacional de Ciencias Médicas Y Nutrición Salvador Zubirán)	Dr. Rebolledo has nothing to disclose.
	No disclosure on file
Alma P. Vigueras Hernández	Alma Poema has nothing to disclose.
	No disclosure on file
	No disclosure on file

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