Blitshteyn Svetlana, Ruhoy Ilene S, Natbony Lauren R, Saperstein David S
Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo Jacobs, Buffalo, NY 14203, USA.
Dysautonomia Clinic, Williamsville, NY 14221, USA.
Neurol Int. 2024 Dec 25;17(1):2. doi: 10.3390/neurolint17010002.
Internal tremor (IT) is often reported by patients with post-acute sequelae of SARS-CoV-2, also known as Long COVID, as a distressing and disabling symptom. Similarly, physicians are typically perplexed by the nature and etiology of IT and find it extremely challenging to manage. We describe a patient with Long COVID who experienced IT as part of post-COVID postural orthostatic tachycardia syndrome (POTS) and small fiber neuropathy (SFN) and review the limited literature available on this topic. Our patient's IT improved significantly after intravenous saline infusions, but there was no effect on IT with oral hydration, increased oral sodium chloride intake, neuropathic pain medications, muscle relaxants, or medications used for the treatment of POTS. Based on this case, our clinical experience, and the limited literature available to date, we believe IT is a manifestation of POTS and SFN, which may be driven by hypovolemia, cerebral hypoperfusion, sympathetic overactivity, neuropathic pain, and mast cell hyperactivation. Subjective description, objective findings, and diagnostic and therapeutic considerations in patients with IT and Long COVID are discussed.
内部震颤（IT）常被感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）后急性后遗症（又称长期新冠）的患者报告为一种令人痛苦且致残的症状。同样，医生通常也对IT的性质和病因感到困惑，发现对其进行管理极具挑战性。我们描述了一名患有长期新冠的患者，其经历的IT是新冠后体位性直立性心动过速综合征（POTS）和小纤维神经病变（SFN）的一部分，并回顾了关于该主题的有限文献。我们的患者在静脉输注生理盐水后，IT有显著改善，但口服补液、增加口服氯化钠摄入量、使用神经性疼痛药物、肌肉松弛剂或用于治疗POTS的药物对IT均无效果。基于此病例、我们的临床经验以及迄今为止有限的文献，我们认为IT是POTS和SFN的一种表现形式，可能由血容量不足、脑灌注不足、交感神经过度活跃、神经性疼痛和肥大细胞过度活化所驱动。本文讨论了IT和长期新冠患者的主观描述、客观发现以及诊断和治疗考量。
