COVID 19 took the world by storm. It forced us inside our homes and turned our lives upside down. It manifested in different people in different ways. While fever, cough, and tiredness emerged as the most common symptoms, the virus presented several other body symptoms.

The latest study conducted in Italy showed that COVID 19 also presents neurological symptoms, the most common being stroke, and altered mental status.

Listed below are the neurological symptoms people with COVID 19 are experiencing, as reported in studies carried across the world.

Olfactory and gustatory issues

Olfactory and gustatory issues are more common in mild patients. Studies conducted in Europe showed that more than 80 percent of patients presented with olfactory and gustatory dysfunctions. In several cases, olfactory issues persisted even after primary symptoms subsided.
Another study revealed that young patients are more likely to lose their sense of smell than older patients. This symptom was more prevalent in females than males.

The taste and smell dysfunctions reported in patients subsided by themselves without requiring any specific treatment.

Headache

Fever, muscle pain, fatigue, and cough were the most commonly presented COVID 19, followed by headache.

A study performed on mild COVID 19 patients revealed a high prevalence of headache, accounting for 70 percent. Young patients were more affected than olds, and it was prevalent in females compared to males. The study also suggested that various kinds of headaches appeared during the disease. However, the symptom resolved without treatment.

Delirium and impaired consciousness

Several patients reported severe neurological symptoms, including delirium and impaired consciousness. A study reported the presence of ARDS in several patients. Agitation due to hyperkinetic delirium was present in many patients.

A few patients reported dysexecutive syndrome after discharge from the hospital. Brain MRI and EEG (electroencephalography) of some showed non-specific findings. The findings were more prevalent in patients suffering from severe infections.

According to doctors, delirium and impaired consciousness may be due to pyramidal signs (enhanced ankle clonus, tendon reflexes, bilateral extensor plantar reflexes), reported in several ARDS patients.

COVID 19-related delirium and consciousness impairment can be associated with infectious, toxic encephalopathy, a kind of reversible brain dysfunction syndrome. It could be due to systemic inflammatory response syndrome-related toxemia and hypoxia during acute pulmonary infection.

A study conducted in a palliative care hospital suggested that benzodiazepines worked effectively in patients presenting with agitation. However, this drug can be hazardous for patients suffering from respiratory failure who aren’t ventilated. These patients need special attention.
Hyperactive delirium, on the other hand, needs aggressive management in patients.

Ischemic stroke

Ischemic stroke is a rare symptom. Studies conducted in different parts of the world highlight the connection between ischemic stroke and covid presented different results.

A study reported this symptom in severely ill patients. The presence of this symptom was associated with a higher D-dimer level, suggesting a consumptive coagulation system. Another study conducted in Milan also suggested the same rate of this neurological symptom. A survey conducted in the USA reported this symptom in 1.1 percent of hospitalized patients.

Another study reported a few cases of large-vessel stroke in SARS-Cov-2 patients. A study in Italy compared COVID 19 patients and neurological patients admitted to the hospital during the same period. Patients suffering from COVID 19 had a varied distribution, including cerebrovascular disorders.

A study suggested that coagulation dysfunction is widespread in patients suffering from COVID 19, especially D-dimer and fibrinogen elevation. The degree of elevation can be associated with the severity of the dysfunction. However, the study also showed that activated partial thromboplastin and fibrinogen return to normal as they recover.

The cases of stroke in SARS-Cov-2 patients are still a matter of debate.

Rarer central neurological features

Some reports have shown rare patients suffering from neurological issues during infection. They include cerebral venous thrombosis, intracerebral hemorrhage, generalized myoclonus, status epilepticus, slight neck stiffness, acute epileptic encephalopathy, seizure, white matter, globus pallidum inflammatory lesions, and diffused leukoencephalopathy with microhemorrhages. They also include hemorrhagic posterior reversible encephalopathy syndrome, acute necrotizing encephalopathy, neuroleptic malignant syndrome, post-infectious acute transverse myelitis, and steroid-responsive encephalitis.

The latest neuropathological case report showed several neuropathological lesions that possess vascular and demyelinating etiologies.
A study suggested that seizures are sporadic in patients suffering from COVID 19. There is still a lack of evidence suggesting the risk of seizures in COVID 19 patients.

The doctors are cautious about using antiepileptic drugs and medications used in COVID 19 infection due to the risk of pharmacological interactions. Particular attention should be taken when administering medications like primidone, phenobarbital, phenytoin, and carbamazepine.

Muscular involvement

The incidences of muscle pain are high in patients suffering mild COVID 19 symptoms. A study reported skeletal muscle pain and an elevated serum CK in patients suffering from severe infection compared to patients with a less painful condition. These are the common neurological symptoms in patients suffering from COVID 19. Several patients are coming to a neuro hospital in India to address these neurological infections.