211 - Coincidence or Consequence?: A Case Report on the Neurological Effects of Long-COVID

Case Diagnosis: Polyneuropathy secondary to post-acute sequelae of SARS-CoV-2 infection (PASC)

Case Description: 56-year-old male with a history of smoking, asthma and hypertension was hospitalized due to malaise in March 2020. His condition worsened, leading to intubation and respiratory failure. He was diagnosed with COVID-19 requiring mechanical ventilation. He developed complications, including pneumothoraces, decubiti and presumed post-critical care myopathy or neuropathy, resulting in paraplegia. Wheelchair-dependent, he underwent rehabilitation in August 2020, but mobility remained impaired. Given his persistent left arm and bilateral leg weakness, he was admitted to Burke Rehabilitation Hospital in April 2023 for multidisciplinary rehabilitation to address ongoing mobility impairment.

Discussions: Long COVID, or PASC, causes persistent symptoms after COVID-19 recovery. It affects various organs, but neurological effects of PASC are especially debilitating, affecting both central and peripheral nervous systems.



Neurological effects of PASC include brain fog, cognitive impairment, headaches, vertigo, neuropathic pain, sleep disturbances, depression, anxiety, and seizures.



Our patient presented with all the neurological effects, except seizure, and an unusual distribution of weakness and deformity in his left upper and bilateral lower extremities prompting electrodiagnostic evaluation done at Burke. Electrodiagnostic testing was suggestive of chronic peripheral polyneuropathy in the lower extremities and chronic left radial motor neuropathy. There was no evidence of an acute process.

Conclusions: Long-term effects of PASC are concerning, with some patients facing persistent symptoms and disability after initial recovery. Mechanisms behind PASC include ongoing viral replication, chronic inflammation, autonomic dysfunction, and brain damage. Neurological symptoms could result from direct or indirect viral effects on the brain.

In the case, our patient's atypical weakness prompted electrodiagnostic evaluation for diagnosis and management. Symptoms can also be unrelated to PASC and ongoing research is needed to comprehend PASC's full impact. Physiatrists must be aware of their role in diagnosing and treating patients with persistent symptoms and disabilities due to PASC.