Despite symptoms, NIH research finds no evidence of ‘Havana

syndrome’ in brain scans

By Katie Bo Lillis and Jen Christensen, CNN / Published 10:00 AM EDT, Mon March 18, 2024

Researchers with the National Institutes of Health published a pair of

studies on Monday that found few clinical differences between patients
with a mysterious ailment known as “Havana syndrome” and healthy
comparison groups.
In one study , NIH researchers took a closer look at the brains of people
who were believed to have Havana syndrome and found no consistent
evidence of brain injury and no significant differences between that
group and a healthy comparison group.
In the second study , scientists ran a battery of tests on 86 US
government staff and family members who reported Havana syndrome,
comparing them with 30 people who had similar jobs but had no such
symptoms, and found that by most clinical and biomarker measures, the
two groups were the same.
The mysterious illness first emerged in late 2016, when a cluster of
diplomats stationed in the Cuban capital of Havana began reporting
symptoms consistent with head trauma, including dizziness and extreme
headaches. In subsequent years, there have been cases reported around
the world, including clusters of at least 60 incidents in Bogota,
Colombia, and Vienna, Austria. There have been about 1,500 reported
cases across the US government in 96 different counties, officials said
last year, but the number of reported incidents has dropped significantly
in recent years.
Despite longstanding speculation that the illness could have been the
result of a targeted campaign by an enemy of the US, the US intelligence
community said last year that it cannot link any cases to a foreign
adversary, ruling it unlikely that the unexplained illness was the result of
a targeted campaign by an enemy of the US.
But the illness — and its cause — have remained frustratingly opaque to
both the intelligence community and the medical community.
Dr. David Relman, a professor of microbiology and immunology at
Stanford who worked on earlier investigations of people with Havana
syndrome, argued in an editorial published alongside the research
Monday that while the study involving brain scans may appear to show
that “nothing, or nothing serious” happened with these cases, coming to
this conclusion “would be ill-advised.”
Earlier work found evidence of abnormalities, he said, and the same is
true for the study that did a wider variety of tests. Because the
condition can look different in each person, he said, doctors don’t have
specific tests that can fully determine what is wrong with them.
“Clearly, new, sensitive, standardized, non-invasive tests of nervous
system function, especially involving the vestibular system, are needed,
such as more specific blood markers of different forms of cellular injury,”
Relman wrote.

‘Institutional failures’ contributed to outcomes, expert says

One problem facing the medical community is that there is still not a
clear definition of Havana syndrome — or what the government terms
“anomalous health incidents” or AHIs. These tests were done, in some
cases, long after symptoms began, making it harder to understand what
physically happened.
In 2022, an intelligence panel investigating the cause of AHIs said
that some of the episodes could “plausibly” have been caused by
“pulsed electromagnetic energy” emitted by an external source.
But Relman noted that there is a relative lack of information about the
biological effects of electromagnetic and acoustic energy on the brain,
even if this is what actually triggered the problems in people with
Havana syndrome.
Some current and former CIA officers have raised concerns that a CIA
task force in charge of investigating Havana syndrome soft-pedaled its
investigation, CNN has previously reported .
And some patients and former officials have said they were treated with
skepticism and in some cases outright dismissal by the Trump
administration in the months and years following the appearance of the
first cases.
Despite the uncertainty surrounding the condition, Congress in 2021
passed legislation mandating compensation for CIA and government
victims, which the agency began disbursing in 2022.
Relman noted that as with any kind of highly publicized clinical
syndromes, such as Gulf War syndrome and now Havana syndrome, it is
difficult for scientists to deal with “uncertainty, complexity, the need for
transdisciplinary approaches, insufficient information or misinformation,
and a topic that is politically charged and divisive.”
“Going forward, we must address the underlying institutional failures and
vulnerabilities that contributed to these outcomes,” Relman writes. He
argued for surveillance systems designed to detect early cases across
government agencies and objective independent panels to review
emerging data.
“Prejudice and poorly supported assumptions must be set aside,” he
wrote.

What the new studies found

The neuroimaging study compared the brains of 81 people thought to
have Havana syndrome and those of 48 people who had no such health
complaints. Twenty-nine members of the comparison group had similar
employment as the 81 in the patient group.
To look for differences in the participants’ brains, the scientists used
imaging known as high-quality diffusion MRI, which doctors typically use
to check for conditions such as a stroke, a brain tumor, multiple
sclerosis and epilepsy. This kind of MRI can visualize white matter fibers
in the brain and determine whether the brain matter is normal or if there
are problems.

When the researchers compared the two groups, they found no

significant differences in the structures and measurements of the brains.
“These findings suggest that the origin of the symptoms of participants
with AHIs may not be linked to an MRI-identifiable injury to the brain,”
the study concluded.
There are limitations to this research, however. The control group was
small and not perfectly matched to those with Havana syndrome. The
earliest scans were also conducted within 14 days after the person said
they experienced the event that triggered their symptoms, and the
results may have been different if done at a different time.
The study results differ from previous imaging studies that found
evidence of some brain abnormalities, but past studies were done on
smaller number of participants.
In the second study, researchers tested hearing, balance, eyesight and
neuropsychological state, and they looked at blood biomarkers, in the
two groups.
There were no significant clinical differences between the two groups
when it came to their hearing or vision, nor were there differences when
the researchers tested the inner ear or checked the blood for certain
biomarkers. Cognitive tests were also similar.
There were some differences in self-reported symptoms, however,
including fatigue, depression, post-traumatic stress, imbalance and some
neurobehavioral issues.
Headache was a common concern among the participants with Havana
syndrome. Most developed daily persistent headaches, the study said,
but only eight were diagnosed with new-onset migraines.
“While we did not identify significant differences in participants with
AHIs, it’s important to acknowledge that these symptoms are very real,
cause significant disruption in the lives of those affected and can be
quite prolonged, disabling and difficult to treat,” Dr. Leighton Chan, lead
author on one of the papers and acting chief scientific officer of the NIH
Clinical Center, said in a news release.
The authors of the study noted several limitations to their research,
including the fact that some of the assessments, though sensitive, are
not specific, and some are not used clinically, so it is unclear exactly
how impactful they are.
There were also no psychiatric evaluations performed. Anxiety,
depression pain and fatigue can affect balance, hearing and cognitive
testing, so abnormalities can be difficult to interpret.
The study concluded that whatever caused Havana syndrome seems to
create symptoms “without persistent or detectable physiologic changes.
A lack of evidence for a brain injury does not necessarily mean that no
injury is present or that it did not occur at the time of the AHI.”
“Alternatively, the ‘attack’s’ physiological effects might be so varied and
idiosyncratic that they cannot be identified with the current
methodologies and sample size,” the study said.

CIA doctor hit by Havana syndrome says he was in ‘disbelief’ as

he suffered what he was investigating
By Katie Bo Lillis, Updated 10:08 AM EDT, Sun September 25, 2022
01:15
03:11
CIA physician Dr. Paul Andrews was one of the first people sent to
Havana, Cuba, to investigate a spate of mysterious health incidents that
were impacting embassy and agency personnel in 2017 when he was
struck by the same set of debilitating symptoms, he told CNN Chief
Medical Correspondent Dr. Sanjay Gupta in his first public interview for a
CNN Special Report: “Immaculate Concussion: The Truth About Havana
Syndrome.”
Andrews, who is using a pseudonym in order to speak publicly, had
already been studying the first victims of what has come to be known
colloquially as “Havana syndrome,” or officially as “anomalous health
incidents.” Physicians in Florida had recorded a series of symptoms that
hinted that victims were suffering from a brain injury that was impacting
their balance, among other things. Andrews traveled to Cuba to
investigate about two months after he became aware of the first cases.
He wasn’t too worried for his own safety, at first. On his first night, he
went to sleep around 11:30 p.m. in his hotel room. But shortly before 5
a.m., he was awakened by severe pain in his right ear, nausea and a
terrible headache. Then he began to hear a clicking noise that past
victims had reported hearing at the onset of their symptoms — a sound
that Andrews had previously only heard on audio clips.
His first thought was that he was dreaming.
“This can’t be happening. And I sat on the edge of the bed for a minute,
and things were getting worse and worse and worse,” he recalled. “I’m
really in disbelief. And I start to think, is this a dream? I had no idea.”
Because officials at the time suspected some kind of sonic attack,
Andrews went into the bathroom and sat with headphones on for 45
minutes. The symptoms didn’t abate, and by 6 a.m., he had decided to
pack up and leave the room.
But he found that he could hardly pack. He checked the bathroom “at
least four or five times” to make sure he had his toothbrush, then did the
same getting his coat out of the closet. On his way to meet colleagues at
the hotel cafeteria, he couldn’t figure out if he was supposed to push or
pull doors. And he realized his balance was “way off.”
Certain that he and his colleagues were being surveilled, he tried to tell
his colleagues quietly that he thought he may have been injured — but he
wasn’t sure they understood. For the rest of the day, Andrews said he
was in a fog: nauseated, disoriented, and struggling with basic tasks like
counting money and displaying his ID card to security staff.
When he returned to the United States, he called the same doctor in
Florida that he had been working with to investigate the original victims,
and told him he needed help.

A mystery illness
Anomalous health incidents — AHIs for short — are still a source of
mystery and debate within the intelligence community. One panel
investigating the incidents, which have now impacted dozens of US
officials across the globe, has said that some of the episodes could
“plausibly” have been caused by “pulsed electromagnetic energy”
emitted by an external source. But the panel stopped short of making a
definitive determination.
An interim report issued early this year by a separate CIA task force
examining who might be behind the episodes found that it was unlikely
Russia or any other foreign adversary is conducting a widespread global
campaign designed to harm US officials. But the agency also did not rule
out that a nation state – including Russia – might be responsible for
roughly two dozen cases that investigators have been unable to explain
by any other known cause.
In short, sources say, after years of investigation, the intelligence
community is no closer to determining who or what is causing these
injuries — or even if all of the roughly two dozen unsolved cases are all
caused by the same actor or mechanism.
Some victims — now including Andrews — have raised concerns about
how the agency handled the initial tranche of cases. Former CIA officials
have alleged that their injuries were not taken seriously at first by CIA
leadership, in part because many of the symptoms were subtle and could
be associated with any number of known health conditions.
“The narrative just was going the wrong way. And no matter what I did or
said to people, that just continued,” Andrews said. “In fact, to this day, a
lot of things that were done seemed not appropriate to my standards.”
Some officers who were impacted didn’t want to report for fear of
damaging their careers, Andrews said.
“Another person at one point told me as an aside that he or she thought
that they may have been hit and that they’re hearing and or pain in their
ear was present,” he said. “And I said, are you gonna report this? And
they said, absolutely not.”
Victims have broadly praised CIA Director Bill Burns’ handling of the
issue, and the Biden administration has been careful to avoid any hint
that it is not taking victims seriously.
“I think we’ve made significant progress in ensuring people get the care
that they need and deserve,” Burns said in public remarks at the Aspen
Security Forum in July. “We tripled the number of full time personnel in
our medical office that deals with this issue. We worked out very
important relationships, not just with Walter Reed, but, you know, private
medical systems to make sure people got the care.”
Congress in 2021 passed legislation mandating compensation for
victims, and some of those payments have been disbursed, according to
a source familiar with the matter.
The CIA declined to comment for this story.

Five years later

More than five years later, Andrews still suffers debilitating symptoms.
He still has balance and vision problems that have made it almost
impossible for him to function normally. He has trouble reading, going
hiking or jogging as it makes him nauseated, and forget being in a crowd
at a museum: turning his head left and right to look at the art and avoid
bumping into other patrons makes him dizzy and sick.
“It gets to the point where you just don’t want to go out of the house
because you say what’s the point? I want to go do this, but I know it’s
going to make me sick,” he said. “I don’t want to be nauseated. I don’t
want to be tripping and falling.
“It’s very frustrating that all those things you want to do, you can’t,” he
said.
Andrews has been examined by a battery of physicians, who have found
damage to his vestibular structures — the parts of the body that govern
balance and orientation. But like many AHI victims, Andrews lacks one
single, clear diagnosis. Some victims have been diagnosed with
traumatic brain injuries, which he questions because even though he
says AHIs are clearly brain injuries, they appear to him to be a different
kind of brain injury than doctors have seen before.
For Andrews, like the intelligence community, there is little more
certainty about who or what is behind this strange phenomenon than
when he traveled to Cuba in spring of 2017.
“I certainly learned about the condition more than I wanted to learn,” he
told Gupta.