Case Report: Overlap Between Long COVID and Functional Neurological Disorders

Abstract

Long lasting symptoms have been reported in a considerable proportion of patients after a severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) infection. This condition, defined as either “post-acute coronavirus disease (COVID),” “long COVID,” or “long-haul COVID,” has also been described in outpatients and in individuals who are asymptomatic during the acute infection. A possible overlap exists between this condition and the functional neurological disorders (FNDs). We report a 23-year-old man who developed, after asymptomatic COVID-19, a complex symptomatology characterized by fatigue, episodic shortness of breath, nocturnal tachycardia, and chest pain. He also complained of attention and memory difficulties, fluctuating limb dysesthesia, and weakness of his left arm. After neurological examination, a diagnosis of FND was made. Notably, the patient was also evaluated at a post-COVID center and received a diagnosis of long COVID-19 syndrome. After 4 months of psychoanalytic psychotherapy and targeted physical therapy in our center for FNDs, dysesthesia and motor symptoms had resolved, and the subjective cognitive complaints had improved significantly. However, the patient had not fully recovered as mild symptoms persisted limiting physical activities. Long-term post COVID symptoms and FNDs may share underlying biological mechanisms, such as stress and inflammation. Our case suggests that functional symptoms may coexist with the long COVID symptoms and may improve with targeted interventions. In patients presenting with new fluctuating symptoms after SARS-CoV-2 infection, the diagnosis of FNDs should be considered, and the positive clinical signs should be carefully investigated.

Diagnostic challenges of functional neurological disorders after covid-19 disease or vaccination: case series and review of the literature

“…These were characterized by fluctuating muscle strength with impaired voluntary movements but normal motor function during neurological examination or distraction maneuvers; dissociation between severe motor impairment in the lower limbs in sitting or supine position and preserved walking ability, similar to previous reports [ 12 ]. Other functional motor symptoms described in post Covid-19 patients, such as external rotation of the foot and leg-dragging gait pattern functional hemiplegia [ 8 ], drift without pronation in functional upper limb paresis [ 7 ] may support the functional nature of motor impairment.…”

“…The prevalence of FND in the general population vary across studies, including approximately 12% of new neurology outpatient referrals in a large (3781 patients) prospective cohort study in the UK [4]. However, despite the global magnitude of Covid-19 pandemic and the high prevalence of neurological symptoms in patients with acute and long Covid-19, cases of FND have rarely been reported in this population [5][6][7][8]. The diagnosis of functional neurological symptoms may be specifically challenging in people with post Covid-19 condition, which is characterized by newly onset, fluctuating, or relapsing symptoms several months after initial recovery from Covid-19 [9].…”

The onset of functional movement disorders after COVID-19: A case series

“…Gilio et al . [ 10 ] reported a case of a 23-year-old man who developed a complex of symptoms characterized by fatigue, episodic shortness of breath, and chest pain. He similarly had a loss of attention and memory, fluctuating limb dysesthesia, and weakness of his left arm.…”

“…The abstract screening was done after searching. Three clinical cases[ 8 9 10 ] and one cohort study[ 6 ] reported functional movement impairments in patients after COVID-19 infection. A flowchart diagram is presented in Figure 1 .…”

COVID-19 2022 update: transition of the pandemic to the endemic phase

“…In addition to these complications. we urge the scientific community to deeply investigate mood disorders that might develop on a psychological substrate in response to stressors established during the pandemic period [ 46 , 52 , 60 , 61 ]. Various mechanisms may underlie the neurological implications of SARS-CoV-2 [ 35 , 62 ].…”