Prof. Dr. Ümit Hıdır Ulaş stated that the Covid-19 outbreak did not mainly affect the nervous system, indirectly, neurological complications were rarely seen in some patients, and the increase in neurological cases reported in parallel with the increase in Covid-19 cases was observed. Ulaş stated that in the latest case reports, it was seen that neurological complications occurred without being related to the severe or mild course of the Covid-19 infection. Ulaş noted that the most common neurological symptoms on admission to the hospital are altered mental status, muscle pain, fatigue and headache complaints. Cases of peripheral neuropathy and hemorrhagic stroke have been reported, and there are increasing case reports that these cases sometimes occur in patients with mild disease. The risk of severe neurological disease is higher in those with a history of chronic neurological disease over the age of 60 and before, the disease itself or the drugs used increase the risk of more severe disease in patients with chronic neurological disease. Patients with diseases such as Parkinson’s disease, stroke and myasthenia gravis may rapidly deteriorate lung function, and patients with immune-mediated disorders taking immunosuppressant medications are at risk of more serious complications of the disease. Neurological findings can be monitored in different ways. If we briefly review the findings, loss of smell (Anosmia) is a common finding that can be seen in any upper respiratory tract infection. However, Covid-19 is one of the most common symptoms and usually occurs in the absence of rhinorrhea (runny nose). This shows that the olfactory nerve or pathway is taken up by the virus, ”he said.
Stating that muscle pains (myalgia) often accompany the disease, Ulaş stated that most of the viral diseases can cause body aches, however, he emphasized that in some patients with Covid-19, muscle pain can also be quite severe. Reminding that muscle sensitivity may last a few days after all other symptoms have improved, Ulaş said:
“They can hold back muscles. It should be kept in mind that potential drugs used in the treatment of Covid-19 can cause patients to be prone to muscle damage. Headaches are common and typically occur at the onset of the disease and go away within a few days. It is not accompanied by any signs of meningeal irritation. Numbness, tingling, and pain in the hands and feet are rarely seen more frequently in the recovery period, and the number of patients who complain of findings consistent with fine fiber neuropathy in which electrophysiological examinations are found to be normal is substantially high. Meningitis and encephalitis are very rare, cases beginning with seizures and coma have been reported. Fever can cause mental status disorder and delirium in advanced ages. Although cases of stroke are rare in young people, they increase with age. Post-viral syndromes occur during the recovery period, approximately one to three weeks after the onset of the viral syndrome. A few cases of an isolated acute necrotizing hemorrhagic encephalopathy, transverse myelitis, Guillain Barre Syndrome, acute disseminated encephalomyelitis have been described.
Evaluating that there may be symptoms of anxiety, post-traumatic stress disorder ranging from memory impairment, cognitive slowdown and activities of daily living and depression, especially in patients hospitalized in intensive care, Ulaş said:
“During the course of the disease or after the recovery period, the virus can damage the lungs, heart and brain, increasing the risk of long-term health problems. Symptoms are more pronounced in older people and people with many serious medical conditions, but even young and healthy people may show some neurological findings weeks or months after infection. The most common signs and symptoms that occur over time include: fatigue, shortness of breath, cough, joint pain, chest pain. Other long-term symptoms may include muscle pain, headache, palpitations, loss of smell or taste, memory, concentration or sleep problems, hair loss. Many long-term Covid-19 complications are still unknown. As neurologists, we need to be alert for possible complications. It is our duty to protect and watch over people who are vulnerable to disease. “