Dizziness and COVID-19

Bashar MA

Published on: 2021-05-30

Abstract

Dizziness as one of the main clinical manifestation of COVID-19. This is not surprising as dizziness has also been associated with many viral infections in past. An earlier published study from China found dizziness to be the most common neurological manifestation -of COVID-19.

Keywords

Dizziness; Patient; COVID-19

Introduction

Coronavirus disease 2019, also known as COVID-19, is a novel disease which has posed many challenges for the physicians due to its rapidly evolving nature. Vertigo or dizziness has recently been described as a clinical manifestation of COVID-19. Numerous studies, emerging on a daily basis from different parts of the world, have revealed dizziness as one of the main clinical manifestation of COVID-19. This is not surprising as dizziness has also been associated with many viral infections in past. An earlier published study from China found dizziness to be the most common neurological manifestation -of COVID-19.[1] Dizziness was proposed to occur ensuing the neuroinvasive potential of severe acu/te respiratory syndrome coronavirus 2 (SARS-CoV-2 virus), the virus causing the COVID-19. Baig et al. [2] postulated that the virus enters the neural tissue from circulation and binds to the angiotensin-converting enzyme 2 receptors found in the capillary endothelium. Apart from that, direct invasion, hypoxia, hyper-coagulopathy, as well as immune-mediated insult were among the postulated mechanism of neuroinvasion leading to dizziness. [3]A literature search was performed for articles published in PubMed on January 21^st, 2020, to identify dizziness as a clinical symptom of COVID-19. The keywords used for the literature search included giddiness, dizziness, vertigo, COVID-19, SARS CoV 2, Coronavirus disease, COVID-19. We obtained 14 articles, which include 3 case reports and 11 studies. All the patients included in this review had dizziness/vertigo as a symptom of COVID-19. Dizziness was the first presenting symptom of COVID-19 in 3 out of the 141 patients (2.13%) pooled for this review[4,5,6] whereas in other patients, it was detected later in the course of the disease.7-16Further, in 2 of the patients having dizziness as the initial presentation, it was later followed by respiratory symptoms.[4,6] Most of the studies i.e. 11 out of 14, reporting dizziness as a clinical feature of COVID-19 were from China, the epi-centre of the COVID-19 pandemic. Of the 14 studies included, dizziness was specifically investigated and treated only in 2 studies [4, 5]whereas dizziness was not investigated or described thoroughly in rest of the studies. Additionally, the outcome of dizziness was mentioned only in 1 study i. e. the case report by Malayala. from the United States, [7-16] wherein vestibular rehabilitation was carried out for the patient with dizziness successfully.Dizziness, despite being a nonspecific COVID-19 symptom, necessitates thorough investigation particularly to determine its underlying cause such as acute labyrinthitis, vestibular neuritis, acute otitis media, or secondary to stroke following infection with COVID-19.

Conclusions

Unexplained dizziness in a person with no previous history should rise the suspicion of COVID-19 infection as it has been established through many studies that dizziness is a notable clinical manifestation among COVID-19 patients. Apart from that, association with other audio-vestibular manifestations such as hearing loss and tinnitus ought to be determined. Persistent dizziness posttreatment from COVID-19 requires referral to the Otorhinolaryngology Department for thorough examination and investigation. Additionally, we recommend vestibular rehabilitation therapy, which has revealed promising results, to be carried out for stable COVID-19 patients with dizziness. Lastly, it is crucial that attending physicians should remain vigilant, especially when managing nonspecific symptoms such as dizziness, which could be due to COVID-19, as it can be easily, be overlooked.

International Journal of Rhinology and Otology