Neurologist: COVID-19 is highly traumatic, patients are like soldiers returning from missions

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Coronavirus infection causes a wide spectrum of neurological complications – from the well-known ones – loss of taste, smell and brain fog, to strokes or subarachnoid hemorrhages. Although the highest percentage of patients experience dysgeusia and smell, it is those with pocovid fog that have the most difficult problems to function normally. Lodz neurologist, Dr. Łukasz Jasek, emphasizes the role of the psychogenic component of COVID-19. It carries huge psychiatric burdens. Cerebral fog may not result from somatic damage at all, but may be a post-traumatic stress disorder.

1. Even 40 percent. survivors may suffer from long covid, i.e. long-term health problems related to coronavirus infection
2. Dr. Jasek explains the most common neurological complications after COVID-19
3. Most people who have passed the infection complain of the so-called brain fog, but there are also much more serious disorders, such as strokes, encephalitis
4. According to the doctor, some convalescents struggle with trauma after illness, which should be treated by a psychiatrist
5. Check your health. Just answer these questions
6. You can find more such stories on the TvoiLokony home page

Monika Zieleniewska, MedTvoiLokony: Is it true that COVID-19 most often causes complications from the respiratory system, followed by cardiovascular complications, and the central nervous system comes third?

Dr. Łukasz Jasek: Definitely. Long covid affects the respiratory and cardiovascular systems much more often and in a much larger group of people than neurological complications.

Has it been estimated what percentage of patients suffer from them?

I think it is difficult to quantify exactly. I have not seen such statistics, but we have studies that say that between 30 and 40 percent. patients do not return to the level of well-being they enjoyed prior to infection. This applies to the entire disease picture, all types of complications, both pulmonary, cardiological and neurological.

And what does it look like in your hospital, how many patients have you treated?

I had well over a hundred such patients, maybe even almost two hundred.

In what period?

I am talking about 2021, because few patients came last year. I associate this with the fact that the first and second waves of the pandemic were quite severe, which unfortunately resulted in a high percentage of deaths. In 2021, especially in the pre-vacation period and immediately after the summer holidays, I had more patients with neurological complications after being infected with the SARS-CoV-2 virus. However, there are now a little less of them again. However, it is difficult to predict what it will look like in the future, because the number of people visiting a neurologist depends on the type of complications – early or late.

The rest of the interview is under the video.

Are early complications the ones that appear during the infection?

We know that in its acute phase, neurological complications occur quite often. These complications are more common in the brain than in the peripheral categories. Most often we deal with ischemic strokes, hemorrhages or subarachnoid hemorrhages. A large group of patients had various types of encephalitis, either autoimmune or infectious, although SARS-CoV-2 virus is found in the brain very rarely in postmortem studies.

Patients with acute complications from coronavirus infection are guided by us like everyone else, suffering from the same diseases for different reasons. On the other hand, symptoms of the peripheral nervous system occur in a small group of patients. Mainly polyneuropathies should be mentioned here, with the most common Guillain-Barré syndrome.

What is this ailment manifested?

Muscle weakness in the limbs that progresses quite acutely and occurs in all four limbs. Most often it starts in the lower limbs and goes upward. Some patients, apart from paresis, also have symmetrical sensory disturbances in all limbs. Only the nerves in the extremities are damaged, not the brain or the central nervous system. It is largely self-limiting, although it may be severe. The disease process is autoimmune. Antibodies raised against SARS-CoV-2 are likely to cross-link with some of the myelin proteins found on peripheral nerve cells, causing symptoms to appear.

Coming back to the group of patients who report symptoms that persist after taking covid …

The various types of late symptoms can again be divided into two large groups – non-specific for a specific brain injury, i.e. headaches that persist for a long time, dizziness, concentration disorders and complications resulting from the initially severe COVID-19 disease.

The mechanisms of these ailments are not fully understood. We know for sure that the period of hypoxia (oxygen deficiency) and electrolyte disturbances during the acute phase of infection are of great importance here. It is not that the brain of these patients is severely hypoxic, while low saturation causes chronic hypoxia. Less oxygen reaches the brain, causing microdamages. It is likely that many patients develop microbleeds, which are not visible in imaging tests, but which nevertheless cause various types of deficits. We have a lot of such patients.

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Is the brain fog so much talked about belongs to this group of symptoms?

Pocovid fog or memory fog is not a phenomenon we have not known before. This phenomenon has been known in neuropsychiatry for a very long time. In patients with a history of SARS-CoV-2 infection, it occurs quite often, however, there is an ongoing discussion as to whether these ailments result from somatic damage. Research and the percentage of patients indicate that we are dealing with neuropsychiatric, neuropsychological or simply psychological disorders.

COVID-19, even if it was not severe and did not cause significant somatic symptoms, exposes the patient to enormous trauma, stress related to the very fact of being infected, imagining what is wrong during the disease – possible life-threatening complications, and finally isolation . So in a large percentage of patients, what we call POCOVID fog is actually PTSD. Just like in the case of soldiers returning from missions or trauma patients.

What most associate with neurological damage, i.e. pocovid fog, concentration disorders, attention disorders, and sleep disorders, often fit into a broader psychological, psychiatric, and not neurological process. The proper management of such patients is a two-way approach, i.e. neurology and psychiatry at the same time.

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Are we able to apply such two-track treatment?

It depends on who the patient goes to. Seeing the psychological component, I redirect it further, because I believe that a psychiatrist in the field of affect and anxiety disorders (post-traumatic stress disorder belongs to the category of anxiety disorders, formerly called neuroses) is the most appropriate specialist. It has a wider range of therapeutic and diagnostic possibilities, it can refer the patient to psychological therapy, psychotherapy, behavioral therapy or choose a course of treatment other than pharmacological, which is dominant in the case of post-traumatic stress therapy.

Of course, a neurologist usually starts this path, because the patient approaches him with more freedom and courage than to a psychiatrist. Sometimes it turns out that we are actually dealing with brain damage that affects memory. However, most often we do MRI of the head, and we do not find the pathology directly causing the pocovid fog.

I wonder what your patients complain about the most: loss of taste and smell or brain fog?

They are worried about brain fog and because of it they go to the doctor the fastest. Taste and smell disorders have the highest percentage, but most agree with them. On the other hand, pocovid fog, especially young people who want to function normally, definitely prompts them to seek help.

Smell and taste are said to come back on their own.

We observe that these symptoms actually regress. However, many times they do not completely regress. We are not entirely sure what pathomechanism we are dealing with. Some studies show that the olfactory nerve cells do not have to be affected by the virus. Probably during infection, when the virus is located in the epithelium of the nasal cavity, the cells locally produce cytokines and in the course of autoimmune processes, secondary damage to the olfactory nerves occurs. We don’t have tools to treat an olfactory disorder. Various methods are proposed, such as the B vitamins favored by neurologists, sometimes with medication support.

Or maybe smell training would bring results?

It’s hard to say, most patients complain of what we call parosmia, which is bad feeling, or cakosmia, which is unpleasant smells. Training in their case is difficult because smelling alone causes them unpleasant sensations. Patients who have lost their sense of smell will probably train it faster. However, those with parosmiami and kakosmiami definitely not. They come to terms with some of the dysfunctions over time, because it’s possible to live with them.

So, for the time being, we focus on vitamins?

At the moment, we do not have registered drugs, and B vitamins, both B6, B1 and B12, are actively involved in the metabolism of neurons and have been used to “stimulate” the proper functioning of nerves for a long time.

Were neurologists surprised by any symptoms of long covid?

Not really, because we knew all the symptoms beforehand. Coronavirus infections have always been around, and when we got to know SARS and MERS, we guessed what the symptoms of SARS-CoV-2 infection might look like, but the group of patients was much smaller. We are not surprised by the nature of the symptoms, but rather by their intensity and duration.

In my opinion, emphasis must be placed on the enormous psychogenic component of COVID-19. This disease, due to its infectivity, severity and number of victims, causes enormous psychiatric burdens, which is not mentioned enough. This aspect is completely overlooked, so patients can feel confused. Unfortunately, little is said about psychiatry in Poland, especially in smaller centers, it is a taboo subject. And in this regard, COVID-19 surprised us a bit, but when it comes to the nature of the symptoms, not necessarily. Both strokes, encephalitis and demyelinating diseases (diseases of the nervous system in which the nerve’s myelin sheaths are damaged) were complications after SARS and MERS, so we knew we should take them into account.

Do you observe any characteristic complications after infection with the Delta variant?

As a neurologist, I don’t see anything new, but fortunately I don’t have a large group of newly infected patients either. The theoretically low incidence remains in the country all the time. It seems to me that it results from a completely incomprehensible way of checking if someone is infected, because only those who report symptoms are tested. No one reported symptoms during the holidays, and now people tend to stay at home rather than register for a doctor. In my opinion, our covid statistics are not reliable. If we tested everyone who wanted to, tested more widely, we would get completely different data.

In addition, infection with the Delta variant in vaccinated persons is mild, and vaccination has changed the picture of this disease. I hope more people than the statistics say have already contracted COVID-19 and herd immunity is higher despite hopelessly low vaccination levels. In fact, the second half of autumn and winter (December, January) will show us what these complications look like. Then the patients will start reporting.

We must also not forget that the deadly toll of the coronavirus, i.e. over 75 people who died of COVID-19 and another 150 – 160 thousand. surplus deaths, people who died because they could not get to doctors during the pandemic, caused that patients exposed to complications naturally disappeared. Not because they were secured by medics, but because they died. And for this reason there may be fewer complications.

1. See also: The number of deaths after the pandemic scares doctors. «Whoever survived, survived. And whoever was weaker died »

How long does it take for a long covid patient to seek help from the end of the infection?

Patients usually report relatively quickly, because most symptoms appear during or immediately after an infection and do not disappear. Some of them wait for them to pass spontaneously, and in fact some do. Covid fog, headaches, and dizziness generally persist from the beginning of the infection and drag on after it has resolved.

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Finally, let us remind you why one of the most dangerous postovid complications cannot be underestimated – a stroke? ‘

As a complication, acute stroke most often occurs during the infection phase. We know for sure that the presence of a virus and a cytokine storm have a procoagulatory effect, i.e. they increase clotting and cause a higher risk of thromboembolism. Therefore, patients with a previous predisposition, i.e. with risk factors for cardiovascular disease, hypertension, atrial fibrillation, obesity, and type 2 diabetes – are at a greater risk of developing a stroke.

The clinical course of a stroke is the same as that of a patient who does not have covid. However, because it is accompanied by symptoms of a severe infection, with fever and respiratory failure, its course is much more severe. You should pay attention to symptoms such as sudden hemiparesis, sudden speech disorders, sudden loss of visual field.

Neurologists treat patients infected with the coronavirus exactly the same as they treat patients who are not infected. Therefore, I am asking you not to be afraid, even if you have an infection, to call an ambulance and go to the hospital. Time is of the essence in stroke, so the sooner we respond and treat it, the better.

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