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Frequent neurological symptoms of COVID long-haul carriers

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Editor’s Note: Find the latest COVID-19 news and guidance from Medscape Coronavirus Resource Center.

Cognitive dysfunction was at the top of the list of neurological complaints in long-distance COVID-19 patients, and the disease was not severe enough to be hospitalized, but new studies show that it is not the only problem. I will.

Researchers who followed 100 COVID-19 long-distance non-hospitalized patients from May to November found that 85% reported four or more neurological symptoms.

“This is the first study of this type of neurological condition in unhospitalized patients,” said Igor Coralnick, MD, a senior author and professor of neurology at the Northwestern University of Chicago, Illinois. Medscape Medical News..

“Most of what we know today [about long-haulers] It’s happening to critically ill patients in hospitals, “added Koralnik, who is also responsible for neuroinfection and global neurology.

The study was published online today Annual report on clinical and translational neurology.

Persistent and debilitating symptoms

Patients followed showed clinical symptoms consistent with COVID-19, Koralnik said, but only mild and fleeting respiratory symptoms. No one developed pneumonia or hypoxic levels that required hospitalization.

Long COVID-19 was defined as having symptoms lasting more than 6 weeks, and there was consensus that most patients would fully recover from COVID-19 in 4-6 weeks.

Surprisingly, according to Coralnick, patients showed persistent and debilitating symptoms for several months after they appeared, even though they did not require hospitalization.

Researchers also found it difficult to predict whether a particular symptom might resolve within a particular time frame, as recovery from symptoms appears to vary widely from patient to patient.

To track patient progress, researchers used quality of life in the Patient Reporting Outcome Measurement Information System (PROMIS) and cognitive assessments in the National Institutes of Health (NIH) Toolbox, among other means. did.

The 10 most common complaints among study participants (70% female, average age 43 years) were:

  • Cognitive dysfunction reported by 81%

  • headache, 68%

  • Numbness and tingling, 60%

  • Dysgeusia, 59%

  • Smell disorders, 55%

  • Muscle pain, 55%

  • Vertigo, 47%

  • Pain, 43%

  • Blurred vision, 30%

  • Tinnitus (Tinnitus), 29%

In addition, many reported non-neurological symptoms include:

  • Fatigue, 85%

  • depression. Or anxiety, 47%

  • Shortness of breath, 46%

  • Chest pain, 37%

  • insomnia, 33%

  • Heart rate and blood pressure fluctuations, 30%

  • Gastrointestinal dissatisfaction, 29%

According to Coralnick, researchers tracked 50 long-haul carriers who tested positive in the laboratory and 50 who tested negative in the laboratory, all set by the Infectious Diseases Society of America. It met the definition of COVID-19 according to the criteria.

He added that this reflects the limits of early testing. In the early stages of a pandemic, people are often not tested, are not tested in a time frame to accurately detect an infection, or are tested insensitive enough to accurately detect an infection. He said he did.

The patient lived in 21 states. At the Neuro COVID-19 Clinic, 52 people were seen directly and 48 were seen by telemedicine.They were limited or inclusive Cognitive testMemory and attention deficit problems were common.

Many patients (42%) reported depression or anxiety prior to COVID diagnosis, Coralnick said, suggesting a “neuropsychiatric vulnerability” to the development of long-distance COVID-19.

About 70% of long-distance patients were women and 16% had pre-existing autoimmune diseases. According to Coralnick, this profile resembles the ratio of women to men with autoimmune diseases, including: Multiple sclerosis Or Rheumatoid arthritis..

This study was not intended to explain why some patients develop long-distance COVID-19, but suggests that post-infection autoimmune mechanisms may be at work. I will.

According to Coralnick, the range of symptoms was very different, with some patients experiencing cognitive impairment and dizziness, no olfactory or taste problems, and vice versa.

He said it is still impossible to predict recovery from a particular symptom. “People tend to improve over time, but they do it at their own pace.”

“We wanted the farther away from the onset of the disease, the more patients could feel recovered. In fact, it wasn’t,” said Coralnick.

Some reported that 95% recovered after 2 months, but 10% took 9 months. That is, he said, it is impossible to tell patients with certain symptoms to expect recovery after a certain period of time.

Accurate reflection of clinical practice

Comments on the survey results Medscape Medical NewsAllison Nevis, MD, an assistant professor of neuroinfectious diseases at Mount Sinai School of Medicine in New York City and a chief clinical neurologist at the Post COVID Center at Mount Sinai School of Medicine, said she reflected clinical practice. Was seen in at least 200 long-distance patients.

She welcomed studies focused on neurological symptoms and said she “does not fully understand what is happening” in long-distance patients.

“Many people see improvement, but it takes time. For some of the more debilitating symptoms, there are effective treatments such as headache medications.”

One of the promising clues from this study, according to Nevis, who was not involved in the study, is that long-distance symptoms may be an autoimmune response similar to other post-infection syndromes.

This study shows that it is important not to deny the patient’s persistent symptoms. “‘Just get over it’ is not the right approach,” she said.

The source of funding is not listed. The author of the study does not disclose the relevant financial relationship.

Ann Clin Transl Neurol. Published online on March 23, 2021.

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