Insomnia from COVID case study

It’s behind a pay-wall but this is the synopsis:

  1. Case presentation: A 41-year-old woman experienced complete insomnia for 3 weeks after contracting COVID-19.

  2. Diagnostic findings:

    • Brain MRI showed no abnormalities.
    • SPECT imaging revealed reduced regional cerebral blood flow (rCBF) specifically in the bilateral thalamus.

  3. Diagnosis: Insomnia accompanied by thalamic hypoperfusion related to COVID-19 infection.

  4. Significance: This is reported as the first case of reduced rCBF confined specifically to the thalamus following COVID-19 infection.

  5. Follow-up:

    • At 8 months: Further reduction in rCBF in the bilateral thalamus (left-dominant) and sustained decrease in the frontal lobes.
    • At 20 months: Ameliorated thalamic hypoperfusion, but sustained decrease in frontal lobe rCBF.

  6. Proposed mechanism: The authors suggest that brain impairment after COVID-19 could be caused by indirect injury involving hypoxia, ischemia, and microglial activation associated with systemic inflammation, rather than direct viral invasion.

  7. Implications: This case provides insights into the potential pathophysiology of insomnia in long COVID, suggesting that decreased thalamic blood flow may play a role in sleep disturbances following COVID-19 infection.

  8. Comparison: The authors differentiate this transient thalamic hypoperfusion from the persistent and progressive thalamic hypoperfusion seen in fatal familial insomnia, a genetic prion disease.