Neuroinflammation at the Dorsolateral Inferior Medulla: A Possible Central Nervous System Localization for POTS and LC, 2025, Svetlana Blitshteyn

Abstract
Both postural orthostatic tachycardia syndrome (POTS) and Long COVID are currently viewed as heterogeneous disorders with complex, multi-factorial and multi-systemic pathophysiology. POTS, one of the most common autonomic disorders, is a frequent sequela of SARS-CoV-2 infection. Both POTS and autonomic dysfunction, in general, are major pathophysiologic mechanisms of Long COVID. There is emerging evidence that neuroinflammation of the brainstem may be one of the mechanisms of POTS and Long COVID. This commentary argues that neuroinflammation at the dorsolateral inferior medulla is a possible central nervous system localization for POTS and Long COVID based on the limited scientific literature available to date and the neurologic manifestations of both disorders.

Further studies involving advanced neuroimaging techniques and animal models with immunohistochemical brainstem tissue assessments are needed to understand how and why possible neuroinflammation at the dorsolateral inferior medulla may occur in patients with Long COVID, POTS and other disorders involving autonomic dysfunction.
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From Svetlana Blitshteyn on X yesterday:

More evidence emerging from small studies that the brain undergoes significant changes in patients with LC and ME/CFS compared to healthy controls.

In the study from Australia, the authors found larger hippocampus in patients than healthy controls using 7T MRI. In a prior study using 7T MRI, another group found increased susceptibility in the medulla, which lead to my paper on neuroinflammation of the medulla as a possible CNS localization for POTS and LC.