Evolution of neurologic symptoms in non‐hospitalized COVID‐19 “long haulers”

Abstract

Objective We characterized the evolution of neurologic symptoms and self‐perceived recovery of non‐hospitalized COVID‐19 “long haulers” 6–9 months after their initial Neuro‐COVID‐19 clinic evaluation. Methods In this follow‐up study on the first 100 patients, 50 SARS‐CoV‐2 laboratory‐positive (SARS‐CoV‐2 + ), and 50 laboratory‐negative (SARS‐CoV‐2 − ), evaluated at our Neuro‐COVID‐19 clinic between May and November 2020, patients completed phone questionnaires on their neurologic symptoms, subjective impression of recovery and quality of life. Results Of 52 patients who completed the study (27 SARS‐CoV‐2 + , 25 SARS‐CoV‐2 − ) a median 14.8 (range 11–18) months after symptom onset, mean age was 42.8 years, 73% were female, and 77% were vaccinated for SARS‐CoV‐2. Overall, there was no significant change in the frequency of most neurologic symptoms between first and follow‐up evaluations, including “brain fog” (81 vs. 71%), numbness/tingling (69 vs. 65%), headache (67 vs. 54%), dizziness (50 vs. 54%), blurred vision (34 vs. 44%), tinnitus (33 vs. 42%), and fatigue (87 vs. 81%). However, dysgeusia and anosmia decreased overall (63 vs. 27%, 58 vs. 21%, both p < 0.001). Conversely, heart rate and blood pressure variation (35 vs. 56%, p = 0.01) and gastrointestinal symptoms (27 vs. 48%, p = 0.04) increased at follow‐up. Patients reported improvements in their recovery, cognitive function, and fatigue, but quality of life measures remained lower than the US normative population ( p < 0.001). SARS‐CoV‐2 vaccination did not have a positive or detrimental impact on cognitive function or fatigue. Interpretation Non‐hospitalized COVID‐19 “long haulers” continue to experience neurologic symptoms, fatigue, and compromised quality of life 14.8 months after initial infection.

Therapeutic Approaches to the Neurologic Manifestations of COVID-19

“…Around 13% of all COVID-19 survivors have persistent fatigue at 6 months [143]. In our Neuro-COVID-19 clinic, 85% of non-hospitalized Neuro-PASC patients complained of fatigue [61], which persisted an average of 14.8 months after COVID-19 symptoms onset in a follow-up study [151].…”

“…The main neurologic manifestations were "brain fog" (81%), headache (68%), numbness/tingling (60%), dysgeusia (59%), and anosmia (55%). In a follow-up study, there was no significant change in the frequency of most neurologic symptoms at a median of 14.8 months from disease onset [151].…”

Otovestibular Symptoms of COVID-19 and Its Vaccines/Treatments

“…The mechanism through which auditory and vestibular symptoms could be provoked by COVID-19 remains unclear; proposed mechanisms include vestibular (or vestibulocochlear) neuritis; direct infection of cochlear and/or vestibular hair cells; labyrinthine ischemia; intralabyrinthine hemorrhage; and autonomic dysfunction. The pandemic has lasted long enough for investigators to begin to recognize "long-haul" COVID-19 symptoms, often defined as symptoms persisting >6 months beyond initial infection; a recent study of such patients reported that symptoms such as dizziness and tinnitus, if present at the initial evaluation, were either still present or had actually increased by the time of the followup evaluation at 6-9 months [49].…”

“…A smaller but growing literature is also beginning to document an association between COVID-19 and tinnitus [36,37,39,44,45,[48][49][50][51][52][53]. In many cases, the tinnitus accompanies hearing loss [36,37,39].…”

Special Issue “COVID-19: Diagnostic Imaging and Beyond—Part II”

“…Gastrointestinal symptoms with, for instance, signs of colitis at computed tomography (e.g., bowel wall thickening) [9,12], anosmia expressed as olfactory bulb anomalies at MR [10,13] or myocarditis-like features (e.g., myocardial edema and/or late gadolinium enhancement) at cardiac MR in children with multisystem inflammatory syndrome (MIS-C) due to COVID-19 [11,14] are just some examples of disease manifestation which can be radiologically identified. Such a wide spectrum of symptoms may occur and also persist in the so called Post-COVID syndrome or Long-COVID that, as recently demonstrated, may last over a year [15]. In fact, patients may experience enduring pulmonary, cardiovascular, endocrine, hematologic, gastrointestinal, neurological, and/or psychiatric signs [16].…”