New Onset Vertigo After COVID-19 Infection. A Case Report

Abstract

In addition to the known pathophysiological sequelae of the SARS-COV-2 virus and its related respiratory symptoms, several studies have recently reported cardiovascular, gastrointestinal, and neurological symptoms of new-onset after a history of infection. Vertigo is a symptom indicating dysfunction of the vestibular system and this report of a 60-year-old female patient points out the possible association between new-onset vertigo and SARS-COV-2 infection. A 60-year-old diabetic and hypertensive female patient with a 9-days history of COVID-19 symptoms presented to the emergency department with acute vertigo attack without nausea or vomiting. A full physical examination showed no other auditory or neurological symptoms and she never experienced vertigo before. Laboratory findings confirmed a current COVID-19 infection. The patient was managed with antihypertensive, anti-vertigo medications, and COVID-19 protocol for mild cases. After discharge, the patient was advised to continue the anti-vertigo drugs and COVID-19 medications. SARS-COV-2 may lead to vestibular neuritis causing vertigo and other related symptoms, but more well-designed observational studies with a large sample size are needed to establish a definite association between COVID-19 and vertigo.

Therapeutic Approaches to the Neurologic Manifestations of COVID-19

“…Vestibular symptoms are less reported than other neurologic symptoms of PASC, but tend to be quite debilitating when they do occur. Post COVID-19 vestibular neuronitis and BPPV have been reported [202,203]. In our experience, some patients may report a persistent feeling of unsteadiness with normal vestibular testing, similar to Persistent Postural Perceptual Dizziness (PPPD).…”

Neuro-otological Symptoms: An Atypical Aspect of COVID-19 Disease

“…[ 59 ]. Karam et al reported a case study of 60-year-old diabetic and hypertensive female patient with a 9-days history of COVID-19 symptoms who presented to the emergency department with acute vertigo attack without nausea or vomiting [ 60 ].…”

Letter to the Editor in Reference to “New Onset Vertigo After COVID-19 Infection” – COVID-19-related Vestibular Neuritis: Case Series and Review of the Literature

“…We read with interest the article by Motawea et al reporting the case of a sudden vertigo in a 60-year-old woman with a confirmed Coronavirus-Disease-19 (COVID-19) [ 1 ]. The authors concluded that Severe-Acute-Respiratory-Syndrome-Coronavirus-2 (SARS-COV-2) may lead to vestibular neuritis (VN), but more well-designed observational studies with a larger sample size are needed to establish a definite association between COVID-19 and vertigo.…”

“…Motawea et al supported viral and post-viral inflammatory disorders. [ 1 ] Indeed, the cell receptor angiotensin-converting enzyme 2 (ACE2), which allows intracellular entry of SARS-CoV-2, has been found in nasal tissues in murine and human model and in Eustachian tube, middle ear and cochlear tissues in murine model. On the other hand, physical and emotional stress experienced by infected people could play a role in the expression of vestibular symptoms – as occurred for headache patients – or could have triggered the reactivation of possible latent viruses (e.g., HSV-1).…”