2025 American Academy of Neurology Abstract Website

Objective:

This study aimed to assess the severity of cerebral arteriopathy in patients with persistent post-COVID headache and brain-fog and to explore its association with symptomatology and distribution.

Background:

Headache and brain-fog are common after COVID-19, with dysautonomia, thrombosis, and endothelial dysfunction were proposed as potential underlying mechanisms. This study aimed to delineate the extend and impact of cerebrovascular involvement in persistent long-COVID in an Asian cohort.

Design/Methods:

We prospectively collected data from patients with persistent (≥3 months) headache or brain fog following recovery from COVID-19. Patients who remained free of neurological symptoms within 3 months after COVID-19 resolution were recruited as controls. The anterior and posterior focal cerebral arteriopathy severity score (FCASS) was used to assess the severity of arteriopathy and was modified to account for bilateral involvement (total score: anterior: 0-40; posterior: 0-52). Headache and brain-fog were assessed using monthly headache days, MIDAS, and a self-reported brain fog severity scale (0-10).

Results:

A total of 108 patients (M: F= 28: 80) were divided into four groups based on symptoms categories (brain-fog or headache). The presence of more symptoms categories associated with higher anterior-FCASS (combined 6.6 [2.7] vs. headache 3.6 [1.6] vs. brain-fog 4.7 [1.7] vs. control 0.8 [0.6], p<0.001 by one-way ANOVA with Tukey's post hoc test), but not posterior-FCASS. Patients with pure brain-fog had a higher percentage of anterior circulation involvement compared to those with pure headache (80.8%, 48.0%, p=0.020), but the severity of brain-fog was correlated with the posterior-FCASS (Pearson’s r=0.371, p=0.005) rather than anterior-FCASS (Pearson’s r=0.164, p=0.222). However, there was no correlation between headache parameters (monthly headache days, MIDAS) and FCASS (anterior or posterior).

Conclusions:

Cerebral arteriopathy can be observed in patients with persistent post-COVID brain-fog or headache. Anterior circulation arteriopathy and hypoperfusion may underlie persistent post-COVID brain-fog. However, post-COVID headaches may not solely depend on changes in intracranial vessels.