BLOG: Some patients with COVID-19 experience neurological symptoms
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Although COVID-19 primarily attacks the lungs and respiratory system, it is now clear that the virus can affect many parts of the body, including the heart, brain and nervous system, according to Messinger.
Reports suggest that one in three patients with COVID-19 will experience neurological and psychological effects (Cooney). The neurological effects may include strokes, nerve damage, cranial nerve palsy, altered cognition or “brain fog” and balance problems.
One early study from China, for example, suggested that 17% of confirmed COVID-19 cases reported dizziness (Mao et al). Those who spend extensive time in an intensive care unit may also experience post intensive care syndrome, which can further affect balance and muscle tone.
Psychological effects such as depression and anxiety may occur indirectly, as a result of virus-related stresses, or as a direct result of the virus’s impact on the brain or vision-vestibular system. Unresolved vision-vestibular issues are known to cause anxiety because they affect the same areas of the brain.
Neurological and psychological symptoms may be more likely in patients with severe disease who have spent time in the ICU, but we should also be aware that they can occur in “long haulers” (those with persistent symptoms, whether hospitalized or not), as well as initially asymptomatic or never-diagnosed patients.
I recently saw a 17-year-old girl who was experiencing headaches, trouble focusing, anxiety and difficulty sleeping. As an athlete, she was familiar with our optometric neuro-rehabilitation care for concussion, but she denied any recent head injury. Upon examination, she had a receded near point of convergence as well as mild optic nerve head swelling. Although she didn’t fit the classic profile for pseudotumor, I referred her to her primary care physician and neurologist for further testing. Her MRI was normal, and a spinal tap was negative for viral meningitis. Within 3 weeks, her eye movements improved, the headaches were gone, and her affect had dramatically improved.
Although this patient was never diagnosed with COVID-19 and never had a fever or cough, she did have neurological symptoms consistent with a viral cause. We discussed lifestyle, sleep, hydration and nutritional supplements to support her immune system, and we are going to do a few sessions of vision-vestibular proprioception techniques to ensure that her brain reserves are back to or above baseline in the hopes of avoiding worse consequences if she has a concussion or viral illness in the future.
I suspect we will see more of these patients without a formal diagnosis of COVID-19 but presenting with odd symptoms. Any patient with diagnosed or suspected COVID-19 should undergo a good neurological exam, including evaluation for cranial nerve palsy, visual fields and eye movements. Early intervention with vision rehabilitation can be tremendously helpful for those with vision-vestibular problems, even as the viral effects on the lungs, heart and other systems are addressed by other health care providers.
References:
- Cooney E. Long after the fire of a Covid-19 infection, mental and neurological effects can still smolder. Stat News. Aug 12, 2020. https://www.statnews.com/2020/08/12/after-covid19-mental-neurological-effects-smolder.
- Mao L, et al. JAMA Neurol. 2020;doi:10.1001/jamaneurol.2020.1127.
- Messinger H. Uncovering the neurological connections to COVID-19. Penn Medicine News. Aug. 4, 2020. https://www.pennmedicine.org/news/news-blog/2020/august/uncovering-the-neurological-connections-to-covid-19.
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DeAnn M. Fitzgerald, OD, has been providing eye care to eastern Iowa since graduating from Pacific University School of Optometry in 1984. She runs a busy primary care clinic where she diagnoses and treats ocular disease and evaluates patients with brain injury. In 2007, she opened a multidisciplinary clinic, Cedar Rapids Vision in Motion, which provides low vision services and vision skills rehabilitation, with an emphasis on vestibular and visual skills. She recently launched her sports vision and concussion clinic, Active Evolution Studio. She is president of the Neuro-Optometric Rehabilitation Association (NORA).
Disclaimer: The views and opinions expressed in this blog are those of the authors and do not necessarily reflect the official policy or position of the Neuro-Optometric Rehabilitation Association unless otherwise noted. This blog is for informational purposes only and is not a substitute for the professional medical advice of a physician. NORA does not recommend or endorse any specific tests, physicians, products or procedures. For more on our website and online content, .
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