Preprint Perivascular spaces in neuropsychiatric post-COVID syndrome, 2026, Bernal et al.

[Chandelier]

Perivascular spaces in neuropsychiatric post-COVID syndrome

Spoiler: Authors

Bernal, Jose; Ilik, Selin Yavuz; Mai, Huy; Mattern, Hendrik; Coello, Roberto Duarte; Valdés-Hernández, Maria d.C.; Rocktäschel, Tonia; Reuken, Philipp A.; Stallmach, Andreas; Wardlaw, Joanna; Opel, Nils; Gaser, Christian; Walter, Martin; Ziegler, Gabriel; Düzel, Emrah; Schreiber, Stefanie; Besteher, Bianca

Abstract
Persistent neuropsychiatric symptoms after COVID-19 have been found associated with neurovascular dysfunction, but their relationship with the brain’s perivascular spaces (PVS) remains unclear.
We examined whether MRI-visible PVS burden differed by neuropsychiatric post-COVID syndrome status and age and was related to syndrome duration, depressive symptoms, and health-related quality of life.

In this exploratory cross-sectional study, we segmented PVS on high-resolution T1-weighted MRI from 116 participants (59 with neuropsychiatric post-COVID syndrome and 57 without it).
Regional PVS burden was quantified as fractional volume and count within the centrum semiovale (CSO ROI) and basal ganglia (BG ROI).
Adjusted multivariable regional models examined age-by-status interactions, associations with syndrome duration among affected participants (n = 50), and status-dependent relationships with depressive symptoms and SF-36 domains.
Complementary voxel-wise analyses of the spatially normalised PVS segmentation maps assessed the localisation of these effects.

At younger ages, participants with and without neuropsychiatric post-COVID syndrome had similar CSO PVS burden.
With increasing age, however, those with the syndrome had higher CSO PVS volume and count. Voxel-wise analysis localised these differences predominantly to juxtacortical white matter, especially that beneath the primary motor, premotor, and supplementary motor cortices.
Within the syndrome group, longer syndrome duration was associated with higher CSO PVS volume.
Higher PVS burden was also more strongly associated with poorer SF-36 Physical Functioning, Social Functioning, and Role Limitations due to Physical Health among individuals with the syndrome than among those without it.
However, higher PVS burden was not associated with greater depressive symptom severity within the syndrome group.

These findings suggest an age- and duration-related CSO PVS pattern in neuropsychiatric post-COVID syndrome, alongside possible functional correlates.
Longitudinal imaging is needed to distinguish pre-existing susceptibility from changes developing during the syndrome.


Web | DOI | Research Square | Open Access

 

[rvallee]

"Neuropsychiatric" meaning

the study included patients who reported fatigue, depressed mood, or memory and concentration impairments during their post-COVID outpatient clinic visit, focusing on neuropsychiatric impairment.

basically fatigue and brain fog, so pretty much ME/CFS, which is not a psychiatric disorder, but also some of the most common and disabling symptoms of flu-like illness. There is a huge mess of classification in a discipline that carries more baggage than a major airport. Without a clear capacity to differentiate from context (it's perfectly normal and expected to feel miserable when ill, even more so for a long time), it's all just a mess.

There is a definition of psychiatric that means "the brain", the physical organ that does a crap ton of things, which is fine, but obviously our dualist opponents would find that "biomedically reductive", and another that involves changes in behavior despite normal circumstances. Except the circumstances are abnormal, and in fact explain pretty much everything, is very much expected. If instead of comparing us to healthy people, they compared us with responses from people sick with a flu-like illness, things would be more consistent. No one is happy and able to function and laugh with joy with a splitting headache.

There seems to be significant differences:



And notable that it correlates with illness time, as is clearly visible above with the slopes:

Within the syndrome group, longer syndrome duration was associated with higher fractional CSO PVS volume.

One thing that's become apparent with ME/CFS is that odds of recovery are better with lower age, could be significant:

Rather than showing a uniform case-control difference, our main finding indicates that the association between neuropsychiatric post-COVID syndrome and PVS burden varies with age. Within the CSO ROI, between-group differences in fractional PVS volume and count increased with age, with a higher burden among older participants with the syndrome.