the official magazine of the brain injury association of california

SEVERE POST-COVID COSTOCHONDRITIS Although children comprise the fewest cases of COVID-19 infection, symptoms and complications among the various age groups affected, new long-term consequences a e being reported including severe costochondritis. Post-COVID costochondritis (PCC) is an inflammation of the cartilage that connects a rib to the breastbone. The syndrome causes pain and tenderness on the breastbone, pain in more than one rib, or pain that gets worse with deep breaths or coughing. Patients will experience sharp or aching pain which can start suddenly or develop slowly and spread across the chest. Because of the location of the pain, the symptoms are sometimes misinterpreted as a heart attack. Costochondritis usually goes away on its own, although it might last for several weeks or longer. Treatment focuses on pain relief with traditional treatments including injections to relieve pain and medications — though PCC, in many cases, is unresonsive to these treatments. Physical therapy in the form of gentle stretching exercises for the chest muscles might be helpful. Medications used to treat PCC may include nonsteroidal anti-inflammatory d ugs. Some of these drugs, such as ibuprofen

(Advil, Motrin IB) or naproxen sodium (Aleve), can be purchased over the counter. Stronger versions are available by prescription. Side effects of these medicines can include damage to th stomach lining and kidneys. Narcotics may also be used if pain is severe, however, are avoided when possible because they can be habit-forming. Antidepressants such as amitriptyline are often used to control chronic pain — especially if the pain interferes with sleep and anti-seizure medication such as gabapentin (Gralise, Neurontin) has also proved successful in controlling chronic pain caused by PCC. In a study conducted at the School of Medicine, Texas Tech University Health Sciences Center in Lubbock, Texas, researchers found that PCC in some cases may respond to treatment with colchicine, an anti-inflammator . Another option is a procedure called transcutaneous electrical nerve stimulation (TENS), in which a device sends a weak electrical current via adhesive patches on the skin near the area of pain. The current is thought to possibly interrupt pain signals, preventing them from reaching the brain. If conservative measures are not successful, the injection of numbing medication and a corticosteroid directly into the painful joint is also an option.


A study published in Nature Medicine by researchers at the Veterans Affairs ( A) St Louis Health Care System, found that in the year after recovering from the illness’s acute phase, patients had increased risks of an array of cardiovascular problems, including abnormal heart rhythms, heart muscle inflammation, blood clots, st okes, myocardial infarction, and heart failure. What’s more, the heightened risks were evident even among those who weren’t hospitalized with acute COVID-19. Patients with more severe disease—determined by whether they recuperated at home, were hospitalized, or were admitted to the intensive care unit—had higher risks. But the risks were evident even among those who were not hospitalized with COVID-19. Other subgroup analysis found increased risks regardless of age, race, sex, obesity, smoking, hypertension, diabetes, chronic kidney disease, hyperlipidemia and preexisting cardiovascular disease.


Severe cases of COVID-19 can produce scarring and other permanent problems in the lungs. This is likely due to a combination of the body’s exaggerated immune system reaction to the virus, and the lung inflammation it triggers. Even mil infections can result in persistent respirtory distress — causing shortness of breath after even light exertion. Lung recovery after COVID-19 is possible, but takes time. Experts say it can take months for a person’s lung function to return to pre-COVID-19 levels. Breathing exercises and respiratory therapy can help. Researchers from the University of Iowa recently conducted a study to understand the long-term effects of COVID-19 on lun function. The study enrolled 100 adults with a confirmed SARS CoV-2 infection who remained symptomatic for more than 30 days following the diagnosis, with a control group of 106 healthy participants. The results provided evidence of airway damage many months after the initial SARS CoV-2 infection.


A team of researchers, including two from Johns Hopkins Medicine, have published a review article highlighting similarities between certain lingering symptoms following COVID-19 illness — a condition called “long COVID” — and myalgic encephalomyelitis/chronic fatigue syndrome (ME/ CFS), a debilitating, complex disorder previously known as chronic fatigue syndrome. The researchers say the symptoms shared by the two conditions may involve a biological response that goes haywire when the body encounters certain infections or other environmental hazards. “The body’s response to infection and injury is complex and covers all body systems,” says the study’s lead author Bindu Paul, Ph.D., assistant professor of pharmacology and molecular sciences at the Johns Hopkins University School of Medicine. “When that response is in disarray — even just one aspect of it — it can cause feelings of being tired, brain fog, pain and other symptoms.”


The senses of smell and taste are related, and because the coronavirus can affect cells in the nose, having COVID-19 can result in lost or distorted senses of smell (anosmia) or taste. Before and after people become ill with COVID-19, they might lose their sense of smell or taste entirely, or find that familiar things smell or taste bad, strange or diffe ent. For about a quarter of people with COVID-19 who have one or both of these symptoms, the problem resolves in a couple of weeks. But for most, these symptoms persist. Though not life-threatening, prolonged distortion of these senses can be devastating and can lead to lack of appetite, anxiety and depression. Some studies suggest that there’s a 60% to 80% chance that these people will see improvement in their sense of smell within a year


Recent studies have suggested that musculoskeletal symptoms, including joint and muscle pain, are present in many COVID-19 patients after the acute phase of infection, persisting for weeks or even months after the initial infection. Comprising 40% of the human body weight, the skeletal muscle is an important organized tissue composed by numerous bundles of myofibers. It has a crucial mechanical role, generating force and power through the conversion of chemical to mechanical energy, which yields movement, facilitating our daily activities. Furthermore, skeletal muscle can store energetic substrates (carbohydrates and amino acids) for the basal metabolism and it can contribute to heat production, stabilizing the body’s temperature. Considering the multiple functions of the musculoskeletal system and the fact that COVID-19 is a multi-organic disease, it isn’t surprising that musculoskeletal issues may arrise from infection.


 “Sleep disorders are one of the most common symptoms for patients who’ve had COVID-19,” says sleep medicine specialist Cinthya Pena Orbea, MD. “They report insomnia, fatigue, brain fog and sometimes we even see circadian rhythm disorders.” Coined “coronasomnia,” COVID-19- induced insomnia is often attributed to pandemic-related stress, anxiety, depression and other mental health conditions. According to Dr. Orbea, many people have a delayed sleep cycle, causing them to fall asleep much later in the evening or earlier in the morning. This delayed cycle extends into the following day, causing people to feel groggy, have chronic fatigue or wake up later than they prefer. “Sleep is extremely important for the overall function of our bodies, including our metabolic systems and our immune systems,” explains Dr. Orbea. “Since sleep is important for concentration and memory function, it will enhance how patients recover from the disease and impact their quality of life.” During illness, the immune system’s response to an infection can have a profound effect on sleep. Likewise, getting adequate, good quality sleep is crucial for your immune system to work optimally. In long COVID, if the immune system is still not functioning normally, the body will be constantly trying its hardest to reduce the inflammation. This could explain why so many people with long COVID report fatigue and sleep difficulties as major symptoms. It’ also thought that inflammation can come and go during long COVID, which would mean that the body is constantly having to work to keep everything in balance. When the body is having to deal with chronic inflammation, sleep can be reduced and sleep quality can be compromised.


Some patients with long COVID may have long-lasting nerve damage resulting in weakness, numbness and pain, usually in the hands and feet. This condition , known as peripheral neuropathy, appears to be caused by immunity problems triggered by infection according to a new study published in the journal Neurology: Neuroimmunology & Neuroinflammation. “This is one of the early papers looking into causes of long COVID, which will steadily increase in importance as acute COVID wanes,” said Anne Louise Oaklander, MD, the lead study author and a neurologist at Massachusetts General Hospital. “Our findings suggest that some long COVID patients had damage to their peripheral nerve fibers and that damage to the small-fiber type of nerve cell may be prominent.” The study found that 10 patients — or 59% — had at least one test that confirmed neuropathy. Two patients had rare neuropathies that affected muscle nerves and 10 were diagnosed with small-fiber neuropathy, which is a cause of chronic pain. Common symptoms included fatigue, weakness, changes in their senses, and pain in their hands and feet.


 Post COVID neurological problems have been commonly reported and include cognitive or memory disturbances, headache and myalgia. Acute neurological diagnoses include encephalopathy, delirium, cerebrovascular disease, seizures, neuropathy and myopathy. Less frequently reported problems include abnormal movements, psychomotor agitation, syncope and autonomic dysfunction. Another common complaint amongst post COVID patients is brain fog, a term used to describe slow or sluggish thinking. Brain fog can occur under many different circumstances — for example, when someone is sleep-deprived or feeling unwell, or due to side effects from medicines that cause drowsiness. Brain fog can also occur following chemotherapy or a concussion. In many cases, brain fog is temporary and gets better on its own. However, we don’t really understand why brain fog happens after COVID-19, or how long these symptoms are likely to last. But we do know that this form of brain fog can affect different aspects of cognition.

Among patients hospitalized with COVID-19, 1 year after discharge, about half experienced clinically relevant moderate or worse diminished cognitive ability in verbal learning and executive function, according to study findings published in European Neuropsychopharmacology. Lingering cognitive, neurologic, psychiatric, and physical symptoms after COVID are estimated to affect as many as 40 of all patients who contracted COVID-19 and as much as 85% of those who have been hospitalized with COVID-19. Cognitive COVID (which is long-term) is characterized by brain fog, and memory and concentration struggles, and is recognizable in about 30% of patients previously hospitalized with the virus. COVID infection frequently leads to brain damage — particularly in those over 70. While sometimes the brain damage is obvious and leads to major cognitive impairment, more frequently the damage is mild, leading to difficulties with sustained atte ion. Although many people who have recovered from COVID can resume their daily lives without difficulty — even if they ha some deficits in attention — the e are a number of people who may experience difficulty for an extended period