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Surviving COVID-19 with Neurological Involvement from the perspective of a Neurologist

Dr. Andrew Faskowitz

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).

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.

Dr. Andrew Faskowitz

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

#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 1

#4 Ondine’s Curse: Causes, Symptoms, and Treatment

https://www.neurologytimes.com/stroke/ondines-curse-causes-symptoms-and-treatment 2

Neurologist describes his own ‘horrifying battle’ with Coronavirus — until he began taking HCQ…

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