neurologic disorders
COVID Related Neuropsychiatric Manifestations
Symptoms and Signs of COVID Related Neuropsychiatric Manifestations
Neurologic manifestations have been reported in about 80% of hospitalized patients with COVID-19 ( Symptoms and signs references ). A large retrospective cohort study reported a substantial incidence of neurologic and psychiatric morbidity during the 6 months after hospitalization for COVID-19, especially in patients with severe disease ( Acute neurologic complications of COVID-19 can manifest as nonspecific neurologic symptoms such as headache, dizziness, myalgia, and fatigue. Symptoms more specific to COVID-19 include loss of smell ( Anosmia ) and taste (ageusia). In critically ill patients, Infrequent but more severe neurologic complications of COVID-19 may include acute ischemic stroke, intracranial hemorrhage, meningitis, encephalitis, and seizures. Neuromuscular disorders such as Guillain-Barré Syndrome (GBS) (GBS) have been reported, but the overall incidence of GBS during the COVID-19 pandemic appears to be no different from the baseline rate. However, the number of other infections that can trigger these disorders (eg, influenza) has decreased during the pandemic, so COVID-19 may be increasing risk more than other infections are. More severe complications of acute COVID-19, such as ischemic or hemorrhagic stroke, hypoxic-anoxic damage, posterior reversible encephalopathy syndrome (PRES), and acute disseminated myelitis, may lead to lingering or permanent neurologic deficits requiring extensive rehabilitation ( Symptoms and signs references ). (PRES is an acute or subacute clinical-radiologic syndrome characterized by varied neurologic symptoms, including headache, altered mental status, seizures, and visual disturbances and by a distinctive pattern of signal change in the parieto-occipital area that reflects vasogenic edema [shown on MRI].) Also, acute critical illness myopathy and peripheral neuropathies resulting from acute COVID-19 or from the use of neuromuscular blockers can cause residual symptoms that persist for weeks to months. During recovery and as part of post-COVID syndrome, many patients (eg, 80% in some series, even among patients not hospitalized) report more than one persistent neuropsychiatric symptom, including chronic malaise, diffuse myalgia, and nonrestorative sleep ( Symptoms and signs references ). Cognitive impairment occurs with or without fluctuations, including brain fog, which may manifest as problems with concentration, memory, receptive language, and/or executive function. These neurologic and cognitive symptoms are major features of long COVID and often significantly affect activities of daily living. Migraine-like headaches (often refractory to traditional analgesics) and numbness and tingling are also common. Loss of taste and smell may persist after other symptoms resolve. Symptoms of mood disorders, mainly anxiety and depression, are common and are more likely in patients recovering from COVID-19 than in those recovering from influenza or other serious respiratory tract infections ( Symptoms and signs references ). Patients are also at increased risk of Posttraumatic Stress Disorder (PTSD) , with recurrent, intrusive memories replaying the event and often nightmares; when present, PTSD complicates the diagnosis of any co-existing mood and anxiety disorders ( In a recent systematic review and meta-analysis, the pooled prevalence of persistent neuropsychiatric symptoms in patients with long COVID-19 was as follows ( Symptoms and signs references ): Sleep disturbances: 27.4% Fatigue: 24.4% Objective cognitive impairment: 20.2% Anxiety, 19.1% PTSD: 15.7% Subjective cognitive impairment:15.3% Depression: 12.9% Dysosmia: 11.4% Dysgeusia: 7.4% Headache: 6.6% Sensorimotor disturbances: 5.5% Dizziness: 2.9% ( Symptoms and signs references ) 1.Liotta EM, Batra A, Clark JR, et al; Frequent neurologic manifestations and encephalopathy-associated morbidity in Covid-19 patients.Ann Clin Transl Neurol7 (11):2221–2230, 2020. doi: 10.1002/acn3.51210 2.Taquet M, Geddes JR, Husain M, et al: 6-Month neurological and psychiatric outcomes in 236379 survivors of COVID-19: A retrospective cohort study using electronic health records.Lancet Psychiatry8:416–427, 2021. doi: 10.1016/S2215-0366(21)00084-5 3.Graham EL, Clark JR, Orban ZS, et al: Persistent neurologic symptoms and cognitive dysfunction in non-hospitalized Covid-19 “long haulers.”Ann Clin Transl Neurol8 (5): 1073–1085, 2021. doi: 10.1002/acn3.51350 4.Kubota T, Kuroda N, Sone D. Neuropsychiatric aspects of long COVID: A comprehensive review.Psychiatry Clin Neurosci77 (2):84–93, 2023. doi: 10.1111/pcn.13508 Epub 2022 Dec 12. 5.Badenoch JB, Rengasamy ER, Watson C et alPersistent neuropsychiatric symptoms after COVID-19: A systematic review and meta-analysis.Brain Commun4(1):fcab297, 2021. doi: 10.1093/braincomms/fcab297 