225 - Vestibular Migraine Following COVID-19 Infection

Friday, February 23, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

DM

Diane N. Moya, DO

Resident Physician
Nassau University Medical Center
East Meadow, New York, United States

Co-Author(s)

SB

Samira Bahrami Tabar, MBBS

Medical Student
New York Institute of Technology College of Osteopathic Medicine
Sea Cliff, New York, United States
KK

Karthik B. Kamath, DO

PM&R Resident
Nassau University Medical Center
Coram, New York, United States
KS

Kanwardeep Singh, MD

Resident Physician
Nassau University Medical Center
East Meadow, New York, United States
TP

Thomas Pobre, MD

Attending Physician
Nassau University Medical Center
East Meadow, New York, United States

Case Diagnosis: 38-year-old female with vestibular migraine following COVID-19 infection

Case Description: A 38-year-old female patient with a history of Hashimoto’s thyroiditis, endometriosis, and recent COVID-19 infection presented with symptoms of imbalance, brain fog, diplopia, and mild upper and lower extremity weakness. Initially the patient was diagnosed with vertigo, for which she was given Meclizine without any improvement of her symptoms. Subsequent evaluations focused on left eye nystagmus, vestibular migraines, and binocular vision issues. Treatment included Erenumab and occupational therapy involving vision and cognitive training, as well as upper extremity strengthening. The patient continued to experience intermittent dizziness, which improved when lying on her right side, along with diplopia and proprioceptive deficits. Cranial nerve examination revealed horizontal nystagmus during right gaze, convergence issues, and exophoria. EMG indicated left upper extremity carpal tunnel syndrome. Brain MRI/MRA results were normal, and vestibular assessment suggested central nervous system dysfunction. Transcranial Doppler results were negative.

Discussions: Neurological complications have been widely reported concerning SARS-CoV-2 despite it primarily affecting the respiratory system. The presence of SARS-CoV-2 in the cerebrospinal fluid (CSF) of COVID-19 patients was confirmed through genome sequencing, indicating direct viral invasion of the brain and clinical encephalitis. The involvement of the central nervous system (CNS) in COVID-19 infection is believed to happen through the bloodstream and retrograde axonal transport. Vestibular rehabilitation (VR) is a therapeutic approach to treating dizziness and balance dysfunction. It focuses on central mechanisms of neuroplasticity, such as adaptation, habituation, and substitution, to facilitate vestibular compensation. Rehabilitation has been proven to significantly reduce balance and dizziness symptoms in patients with vestibular disorders.

Conclusions: Antivertiginous drugs can offer temporary relief from vertigo, but research indicates that they may have counterproductive effects. It is advised to stop using these drugs once the severe acute symptoms improve and instead consider vestibular rehabilitation therapy (VRT) for patients.