Posted on 04/12/2020 3:52:59 PM PDT by BlueStateRightist
So for what it's worth, this was just posted on a neuro MD site:
The author is a triple board certified Neurologist. He has published in Proc Natl Acad Sci U S A. and Cell Mol Neurobiol. He trained at Memorial Sloan Kettering Cancer Center, New York Presbyterian, Hospital for Special Surgery, Montefiore, Northwell and Mount Sinai. He has been in Private Practice for the past 12 years in New York.
Surviving COVID-19 with Neurological Involvement from the perspective of a Neurologist
"To be honest, it was very scary to go through no matter how much specialized medical training one has, but I was fortunate to have far less anxiety observing my own neurologic deterioration with an academic interest and an appreciation of the neuroanatomy involved.
After 17 days of mild lower respiratory symptoms, I lost all sense of smell and taste. This was likely the introduction of the virus into my brain traversing the cribriform plate via my olfactory bulb (Reference #1). The SARS-COV-2 Virus likely damaged my olfactory receptor neurons directly.
The same day I had a syncopal episode followed by a bizarre frightening well-formed visual hallucination that my fiancé turned into a monster (FYI she is an angel not a monster) and climbed out of my couch to get me. This was likely the earliest involvement of my reticular activating system. The reticular activating system, or RAS, is a piece of the brain that starts close to the top of the spinal column and extends upwards around two inches. It has a diameter slightly larger than a pencil. All of your senses (except smell, which goes to our brain's emotional center) are wired directly to this bundle of neurons that's about the size of your little finger (Reference #2). It also helps maintain consciousness and will be most affected over the next couple of days. At this point my sleep was being interrupted, but I had not yet fully understood why. The understanding as to why will become existentially painful, almost nightmarish to me in the next few days.
Three days later, I started to develop auditory hallucinations, some kind of Russian music playing in a loop. I don’t speak Russian, but I expect if I did he was singing “Everything is going to be alright, don’t worry, but it is about to get much, much scarier”. Again, likely my RAS acting up. I then became paranoid and started acting irrationally. Perhaps the communication with my RAS and my limbic system. I was also filled with boundless energy which made the next four days of insomnia more tolerable. Perhaps my RAS protecting itself.
The next three nights I did not sleep more than 30 seconds. Any attempt at sleep would result in overwhelming rigor. This was likely due to “cytokine storm” (Reference #3). I was also beginning to realize that my primitive respiratory center was starting to fail me. If I did not consciously focus on breathing then I would stop and die.
As a Neurology Resident almost 20 years earlier I was fascinated by the condition, Ondine’s Curse. In the ancient mythical story, a young nymph named Ondine falls in love and marries. Upon discovering that her husband has been unfaithful to her, she uses her supernatural powers to set a curse on him. Ondine’s curse is an unusual spell that sneakily robs her disloyal husband of rest. He is doomed to a life in which he retains the ability to breath-but only when he is awake and conscious. Once afflicted by Ondine's curse, the victim cannot breathe if he falls asleep—and therefore must choose between sleeping and remaining alive (Reference #4). This localizes to the lower lateral medulla.
Four days later, I was ready to give up entirely. I voluntarily stopped breathing and lost consciousness. I was ready to embrace death with open arms. The nurse who was monitoring my vitals at the desk rushed in and woke me up and connected me to oxygen. But death will not come that easily.
That evening I started steroids, hydroxychloroquine and azithromycin and slept 1 hour and the next morning woke up and 99% of my Neurologic symptoms had resolved. Two days later my sense of smell and taste returned."
[Name Withheld], DO Board Certified in Neurology Subspecialty Certified in Pain Management Subspecialty Certified in Hospice and Palliative Medicine
References: #1 The Neuroinvasive Potential of SARS-CoV2 in Respiratory Failure https://www.practiceupdate.com/journalscan/67381/1/24?elsca1=emc_enews_daily-digest&elsca2=email&elsca3=practiceupdate_neuro&elsca4=neurology&elsca5=newsletter&rid=MTY0NTQwNzUwODExS0&lid=10332481
#2 Introduction to Psychology: Tutoring Solution / Psychology Courses, Study.com Instructor: Sharon Linde https://study.com/academy/lesson/reticular-activating-system-definition-function.html
#3 COVID 19 induced Acute necrotizing encephalopathy (ANE) within the bilateral medial temporal lobes and thalami associated with Cytokine storm syndrome https://www.diagnosticimaging.com/covid-19/brain-images-reveal-possible-covid-19-related-cytokine-storm
#4 Ondine's Curse: Causes, Symptoms, and Treatment https://www.neurologytimes.com/stroke/ondines-curse-causes-symptoms-and-treatment
Compelling account, for sure.
First I’ve heard of visual and auditory hallucinations associated with this.
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Absolutely fascinating. Horrible, but fascinating. There’s no telling what will happen when a virus invades the brain.
“So for what it’s worth, this was just posted on a neuro MD site: “
you need to post a link so we can verify that this isn’t just something you or someone else made up ... until we see such a link, we can only assume that it’s not true ...
I had read of the loss of taste and smell, but not the hallucinations!
Thanks for posting.
You would think he (or someone else) would have his doctor get them into him a lot earlier. Odd.
Anosmia occurs in 30% of cases. But hardly surprising as this virus is related to the common cold. Anyone who has had a cold will verify they can’t taste much
This smacks of the ER drivel that was running around a few weeks ago. If an adult has a temperature > 102 hallucinations are possible and in fact probable. So I am not sure this gets blames on neurological involvement
There is enough to make this sound scary and valid but there are several statements that smack of someone knows how to write very well and synthesized so stuff to sound legit.
Bottom line. I don’t buy it
"I realized that my primitive respiratory center was starting to fail me. If I did not consciously focus on breathing then I would stop and die...I was fascinated by the condition Ondine’s Curse...Once afflicted by Ondine's curse, the victim cannot breathe if he falls asleep—and therefore must choose between sleeping and remaining alive. This localizes to the lower lateral medulla.This description immediately made me think of Central Sleep Apneas. I looked up Ondine's Curse and sure enough, it popped up in Wiki at "Central hypoventilation syndrome":
Central hypoventilation syndrome (CHS) is a respiratory disorder that causes ineffective breathing, apnea, or respiratory arrest during sleep (and during wakefulness in severe cases). CHS can either be congenital (CCHS) or acquired (ACHS) later in life. The condition can be fatal if untreated. CCHS was once known as Ondine's curse.How do you like that? Severe progression of COVID can cause the same problem I've got, except that COVID can entirely shut down your breathing and you have to consciously breathe or be on a machine (in sleep apnea, you get 30 - 50 second periods of no breathing).
I wonder how many people have died from COVID without them or their doctor recognizing that the virus had compromised their Autonomic Nervous System and their breathing has become irregular or stopped?
He is definitely a neurologist. Scary. Thanks for the ping.
Neuro involvement
There is a lot of over-the-top stuff, isn’t there, that calls veracity into question...
* the hallucination that his “fiancé had turned into a monster and climbed out of my couch to get me.”
* auditory hallucinations of “some kind of Russian music playing in a loop.”
* “The next three nights I did not sleep more than 30 seconds. Any attempt at sleep would result in overwhelming rigor.”
It almost seems like he’s trying to see how much outlandish stuff he can get away with before being called on it. That visual hallucination sounds like LSD territory.
That evening I started steroids, hydroxychloroquine and azithromycin and slept 1 hour and the next morning woke up and 99% of my Neurologic symptoms had resolved. Two days later my sense of smell and taste returned."
Viruses can do very weird things. When I got swine flu/H1N1 there were all kinds of unusual and highly unpleasant symptoms that were not like "regular" flu.
Steroids aren’t good when having a cytokine storm.
+1
Re-read it carefully. He says the steroids were administered four days after the cytokine storm.
“Steroids aren’t good when having a cytokine storm.”
I thought the same. There have been reports that giving corticosteroids to COVID-19 patients in ARDS is a bad move.
Happy ending .. move on!
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