The persistence of neurological symptoms after SARS-CoV-2 infection, as well as the presence of late axonal damage, is still unknown. We performed extensive systemic and neurological follow-up evaluations in 107 out of 193 consecutive patients admitted to the COVID-19 medical unit, University Hospital of Verona, Italy between March and June 2020. We analysed serum neurofilament light chain (NfL) levels in all cases including a subgroup (n = 29) of patients with available onset samples. Comparisons between clinical and biomarker data were then performed. Neurological symptoms were still present in a significant number (n = 49) of patients over the follow-up. The most common reported symptoms were hyposmia (n = 11), fatigue (n = 28), myalgia (n = 14), and impaired memory (n = 11) and were more common in cases with severe acute COVID-19. Follow-up serum NfL values (15.2 pg/mL, range 2.4–62.4) were within normal range in all except 5 patients and did not differentiate patients with vs without persistent neurological symptoms. In patients with available onset and follow-up samples, a significant (p < 0.001) decrease of NfL levels was observed and was more evident in patients with a severe acute disease. Despite the common persistence of neurological symptoms, COVID-19 survivors do not show active axonal damage, which seems a peculiar feature of acute SARS-CoV-2 infection.

SARS-CoV-2 感染后神经系统症状的持续存在，以及晚期轴突损伤的存在，仍然未知。我们对 2020 年 3 月至 2020 年 6 月意大利维罗纳大学医院 COVID-19 医疗单位连续收治的 193 名患者中的 107 名进行了广泛的全身和神经学随访评估。我们分析了所有患者的血清神经丝轻链 (NfL) 水平病例包括具有可用发病样本的患者亚组 ( n  = 29)。然后进行临床和生物标志物数据之间的比较。 在随访期间，仍有大量 ( n = 49) 患者出现神经系统症状。最常见的报告症状是嗅觉减退 ( n  = 11)、疲劳 ( n = 28)、肌痛 ( n  = 14) 和记忆力受损 ( n  = 11)，在严重急性 COVID-19 病例中更为常见。除 5 名患者外，所有随访血清 NfL 值（15.2 pg/mL，范围 2.4-62.4）均在正常范围内，并且未区分有与无持续性神经系统症状的患者。在有可用的发病和随访样本的患者中，观察到 NfL 水平显着 ( p  < 0.001) 下降，并且在患有严重急性疾病的患者中更为明显。尽管神经系统症状普遍持续存在，但 COVID-19 幸存者并没有表现出活跃的轴突损伤，这似乎是急性 SARS-CoV-2 感染的一个特殊特征。