Brain fog, headache and altered smell/taste most frequently reported

The widely reported death of the founder of a nationwide chain of steak houses last week put the spotlight on prolonged neurological symptoms linked to Covid-19.

After experiencing a mild case of the coronavirus last November, entrepreneur W. Kent Taylor developed tinnitus so debilitating he reportedly told a friend that he had not slept more than two hours a night for several months.

The CEO of the Texas Roadhouse chain died by suicide March 25 in Louisville, Kentucky, and in a statement to the local paper the company attributed his death to the relentless ringing in his ears that had become “unbearable.”

Early recognition of lasting neurologic symptoms associated with Covid-19 led specialists at Northwestern Medicine, Chicago, to open one of the nation’s first clinics devoted to treating neurological long haulers in May of 2020.

In a study published March 23 in the journal Annals of Clinical and Translational Neurology, clinic director Igor Koralnik, MD, and colleagues reported on 100 consecutive patients treated at the clinic between May and November of 2020 who had relatively mild initial Covid-19 presentations.

The study findings add to the growing anecdotal evidence suggesting that persistent neurologic symptoms may be common among patients without severe initial symptoms.

None of the patients included in the analysis were hospitalized for pneumonia or hypoxemia during their initial illness, and all reported neurologic symptoms lasting at least six weeks. Their average age was 43 years and 70% were female.

Patient-reported symptoms were confirmed during clinic visits through detailed neurologic exams, diagnostic testing, validated quality of life questionnaires, and cognitive function testing.

Because patients with mild disease often did not qualify for nasal swab or serology testing in the early months of the pandemic, not all patients included in the analysis had laboratory confirmed Covid-19. All had clinical symptoms consistent with Covid-19, however, but their initial respiratory symptoms were transient.

Overall, the patients reported a median of five neurologic symptoms related to Covid-19 which impacted their quality of life, and 85% reported at least four symptoms, with the most frequent complaints being:

  • “Brain fog” (81%).
  • Headache (68%).
  • Numbness/tingling (60%).
  • Altered sense of taste [dysgeusia] (59%).
  • Loss of sense of smell [anosmia] (55%).
  • Myalgia (55%), dizziness (47%), pain (43%).
  • Blurred vision (30%).
  • Tinnitus (29%).

Many patients treated at the clinic reported that these symptoms came and went, but most were still experiencing some of the symptoms at the time of their clinic visit.

When asked to estimate their recovery as a percentage of their pre-Covid baseline health, study participants reported feeling only 64% recovered after an average of five months.

“A main message from our study is that even in patients with mild initial disease, the potential for long-lasting neurologic symptoms is there, and these symptoms can be debilitating,” study co-author and Northwestern medical student Jeffry R. Clark, told BreakingMED.

The Northwestern group previously reported on lasting neurologic symptoms among a group of patients who had been hospitalized for Covid-19, finding that 82% experienced such symptoms.

Clark said the recognition that a significant percentage of patients seeking treatment at the Covid-19 neurology clinic had not been hospitalized with Covid-19 led to the newly published study.

Frequent non-neurological symptoms experienced by the long haulers included fatigue (85%), depression/anxiety (47%), shortness of breath (46%), chest pain (37%), and insomnia (33%). Common comorbidities prior to the diagnosis of Covid-19 included depression/anxiety (42%), autoimmune disease (16%), insomnia (16%), and lung disease (16%).

Although the study was not designed to explore potential mechanisms causing neurologic long-hauler symptoms following Covid-19, the researchers noted that the fact that more than three times as many women as men sought treatment at their clinic may offer an important clue.

They noted that the female to male ratio was similar to that reported with autoimmune diseases such as multiple sclerosis, rheumatoid arthritis, and systemic lupus erythematosus.

“The prevalence of pre-existing autoimmune disease and elevated ANA titer >1:160 in our cohort of ’long haulers’ compared to the general population (16% versus 7% and 33% of those tested versus 5%, respectively) suggests the possibility of an autoimmune contribution,” they wrote.

“Moreover, contributions from hypoxemia or chronic vascular disease seem unlikely to explain the ’long haulers’ phenomena given that our cohort did not experience respiratory symptoms requiring hospitalization and had lower rates of comorbid cardiovascular disease, diabetes, and hyperlipidemia than are reported in severe Covid-19. Premorbid depression/anxiety was also prevalent in our cohort (42% versus 21.4% of U.S. adults with mood disorder), suggesting a possible neuropsychiatric vulnerability to becoming a ’long hauler’ after SARS-CoV-2 infection.”

They concluded that the long-term impact of long-haul symptoms related to Covid-19 “on quality of life and potential return to normalcy, through lost productivity and lingering cognitive dysfunction, may be substantial as the pandemic continues to escalate.”

“Further longitudinal studies are needed to evaluate the cognitive effect of SARS-CoV-2 infection on non-hospitalized individuals, as they comprise the majority of Covid-19 patients and may significantly impact workforce productivity,” they wrote.

  1. Overall, patients with mild initial Covid-19 symptoms seeking treatment reported a median of five neurologic symptoms related to Covid-19 which impacted their quality of life, and 85% reported at least four symptoms.
  2. The most frequently reported neurologic symptoms included brain fog, headache, numbness/tingling, dysgeusia, and anosmia.

Salynn Boyles, Contributing Writer, BreakingMED™

The researchers reported no funding source nor relevant conflicts related to this study.


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