COVID in the last 18 months has shown a devastating effect on human life. Apart from affecting the lung, it also affected different parts of the body. It mainly affects lung and increases level of ferritin, D-Dimer, CRP and cytokines eg IL-6. High levels of all these chemicals may have catastrophic effect on vital organs. Neurological involvement is a spectrum of loss of olfactory senses to necrotising encephalitis and involving almost every aspect of central (CNS) and peripheral nervous system (PNS). Prevalence is around 0.1-1% of COVID infections. Most of the complications are seen by 2nd to 4th week of COVID infection. CNS-related events were more common than PNS manifestations.
Some common CNS symptoms are headache, problems in consciousness, dizziness, mild cerebrovascular disease, ataxia, and seizures. PNS symptoms are impairment in taste, smell, and vision. Musculoskeletal symptoms were also observed in the form of myalgias and nonspecific pain. Even stroke comprises of 60-70%, encephalopathy 30-40% and neuropathy around 6% and all other neurological complications in 0.1% cases of neurological cases related to COVID. Onlymyhealth editorial team spoke to Dr. Shailesh Jain, Principal Consultant, Neurosciences, Max Hospital, Shalimar Bagh, New Delhi, about the neuro ailments that smokers are vulnerable to amid Covid era.
Brain disorders smokers are vulnerable to amid Covid
Neurological involvement is mainly categorised into CNS and PNS involvement. CNS involvements are in the form of stroke, encephalopathy, delirium, psychoses, necrotising encephalitis and fungal infections eg. Fungal abscess or rhinocerebral mucormycoses. PNS involvements are facial palsy, acute inflammatory demyelinating neuropathy (AIDP) and paraesthesia in all limbs and myalgia. According to Dr. Shailesh, the neurological ailments that smokers are vulnerable to during Covid pandemic are:
Strokes are ischemic type usually due to large vessel occlusion with high degree of morbidity or mortality and it is more prevalent with diabetic, hypertensive and Coronary artery disease. It is also associated with large coronary occlusion or sudden cardiac death upto 6-8 weeks after COVID. Most of the patients were found to be in a hypercoagulable state.
Encephalopathy or delirium or psychoses were seen by 3rd to 4th week of COVID. It is a non-specific term used to describe the acute impairment of brain function which presents clinically as alteration in the level of consciousness and triggered by viral infections. It is completely reversible with appropriate medications.
3. G B syndrome
Neuropathy may be in the form of facial palsy or severe weakness of all limbs in form of G B Syndrome. Both are completely reversible with medications. Headache, myalgia and paresthesia and fatigue are minor symptoms and it disturbs sleep but didn’t cause any disability. These recover with time and medications. Fungal abscess and mucormycosis are seen with COVID and uncontrolled diabetes. They are usually fatal but may get cured with combination of debridement surgery and long term medications.
Some unusual complications are necrotising encephalitis and myelitis. They have high level of morbidity and mortality. Encephalitis is a serious health problem that can have a major effect and burden. About 20–50% of encephalitis cases are caused by viruses, and half of the cases have no known etiology. The disease leads to several neurological abnormalities, such as altered consciousness, hallucination, confusion, abnormal movement, and aphasia.
Seizures can occur as a sequel of encephalopathy or because of the severe illness associated with non-epileptic seizure without brain injury. Seizures can also be the early presenting manifestation of COVID-19. Smoking accelerates the process of atherosclerosis all over the body and leads to endothelial dysfunction, thrombus formation and hypercoagulable state. It also aggravates dyslipidemia. It increases the chances of cardiovascular disease in all forms eg CAD, CVA, PVD. It locally affects the lung parenchyma and makes it vulnerable to COVID related lung damage and oxygenation of body. Coexistence of smoking related atherosclerosis and COVID induced hypercoagulable state increases the chances of large vessel stroke.
Smoker, COVID positive and Stroke – Why?
There are many potential risk factors for a stroke, one of which is smoking tobacco products. Smoking significantly raises the risk of blood clots and artery blockages, both of which are linked with stroke. Several studies have been conducted in order to find out the root cause of the problem. One of the reasons is though is that there is increased level of certain chemicals (protein fragments in the body called as D-Dimer) that is responsible for increasing the clotting tendency of the blood.
Tobacco addiction can be very impactful on your health and life. One needs to make up their mind as the first step towards quitting smoking. Smoking regularly or occasionally both can have a severe impact on the physical well-being of an individual. If you are not able to control the craving or urge, do not indulge yourself in smoking even one. Instead of just doing it, wait for 15 minutes and try to engage yourself in some other activity. Drink lots of water, keep chewing gums handy with you to crush the craving of smoking cigarettes or other tobacco products.
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