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By Dr . Kirtida Acharya
Neurological Manifestations of Covid 19
A slap in the face !
As the Covid-19 pandemic sweeps across the globe in its ever-changing now 3rd wave , we are learning that we have to be ready for a myriad of presentations .
Although predominantly , we expect the respiratory symptoms , we are now increasingly seeing a kaleidoscope of neurological and psychiatric manifestations of this condition . Some of these conditions observed are ; myalgias , headaches , altered sensoriums of smell and taste , hyposmia and hypogosnia , ischaemic strokes , intracellular haemorrhages , coma , transient ischemic attacks , encephalomyelitis , PNS lesions like Guillian Barre syndrome , Bell ' s palsy , skeletal muscle disorders , and rhabdomyolysis .
The above data is from numerous multicentre , mainly retrospective databases and few prospective studies and case reports ( from China , USA , Italy , Iran , Japan and Europe ).
A fifth ( 20 percent ) of patients reported headache as their initial presenting symptom . Encephalitis is a rare but more serious complication seen in about 8.8 per cent of patients . It ' s linked to ARDS ( acute respiratory distress syndrome ), renal , heart failure and increased fatality .
Observations of 3 to 5 per cent in studies showed Ischemic stroke with hemiplegia and speech or visual symptoms . Evidently more in elderly patients with comorbidities like diabetes , hypertension and dyslipidemia .
Covid-19 predisposed to a hypercoagulable state with increased DDimers CRP levels and other inflammatory markers . It is probably the aetiopathogenetic culprit in ischaemic strokes .
Intracerebral haemorrhage prevalence as a manifestation has also been reported in Covid-19 patients but is less common , albeit it has a worse prognosis . Encephalitis and encephalomyelitis are preceded by fever , cough and rapidly deteriorating consciousness . EEG and prompt specialist referral and treatment are vital . Acute myelitis is extremely rare .
Regarding the PNS , loss of sense of smell and taste are very commonly reported , up to about 60 percent of patients , and may persist for many weeks postulated due to olfactory nerve involvement .
Guillan Barre syndrome is a demyelinating neuropathy that requires prompt diagnosis and treatment with intravenous immunoglobulin and other supportive management .
Myalgia and myositis present with painful muscles and raised CPK levels , paracetamol is adequate , and avoid NSAIDs .
Psychiatric manifestations have been noted in Covid-19 patients , especially anxiety depression and acute psychosis requiring psychiatric intervention . The mechanisms of these are not yet well understood .
A cytokine storm , being in ICU , ventilation , metabolic derangements , neurologic manifestations with chronic , often lifelong sequelae pose new challenges ; personal , socio-economic , global and with every new wave , the virus is showing us new frightening faces . We must keep our guard up . Even with vaccines , our battle is not over - it may have just begun .
Psychiatric manifestations have been noted in Covid-19 patients , especially anxiety depression and acute psychosis requiring psychiatric intervention .
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