Smokers vulnerable to various neuro-ailments amid the COVID era
By: Dr Shailesh Jain
COVID in last 18 months has shown a devastating effect on human life. Apart from affecting the lung, it also affected different part of 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 complications are seen by 2nd to 4th week of COVID infection.
CNS-related events were more common than PNS manifestations. Common CNS manifestations are headache, disturbance in consciousness, dizziness, acute cerebrovascular disease, ataxia, and seizures. PNS symptoms are impairment in taste, smell, and vision. Musculoskeletal symptoms were observed in form of myalgias and nonspecific pain.
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.
Neurological involvement is mainly categorised into CNS and PNS involvement. CNS involvements are in 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.
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 patients were found to have 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.
Neuropathy may be in 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 mucormycoses 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 condition with significant impact and burden. About 20–50% of encephalitis cases are caused by viruses, and half of the cases have no known etiology. The disease causes a variety of 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 could be the initial presenting manifestation of COVID-19.
Smoking accelerate the process of atherosclerosis all over body and leads to endothelial dysfunction, thrombus formation and hypercoagulable state. It also aggravates dyslipidemia. It increases chances of cardiovascular disease in all forms eg CAD, CVA, PVD.
It locally affects the lung parenchyma and make it vulnerable to COVID related lung damage and oxygenation of body. Coexistence of smoking related atherosclerosis and COVID induced hypercoagulable state increases chances of large vessel stroke.
Smoker, COVID positive and Stroke – Why?
There are many potential risk factors for 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. Many 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.
Quit Smoking Today!
Tobacco addiction is more of a psychological game; mind make up is the first step towards quitting smoking. Smoking on a regular basis or occasionally both has severe effects on the physical well-being of an individual. If you are unable to control the craving don’t fool yourself by saying just one. Instead of doing it wait for 15 minutes and try to indulge yourself in some activity. Drink plenty of water, have chewing gums with you in order suppress craving for cigarette or other tobacco products.
The writer is Principal Consultant, Neurosciences, Max Hospital, Shalimar Bagh, New Delhi.