New research published in the journal Internal and Emergency Medicine discusses the relationship between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and dizziness.
Study: Prevalence of symptoms in 1512 COVID-19 patients: have dizziness and vertigo been underestimated thus far? Image Credit: Dirima / Shutterstock.com
The SARS-CoV-2, which is the virus responsible for the coronavirus disease 2019 (COVID-19), has infected over 394 million people and caused over 5.7 million deaths worldwide. The elderly population and individuals with comorbidities are at a significantly higher risk of serious complications of COVID-19.
The symptoms of SARS-CoV-2 infection are often non-specific and range from very mild to severe illness with heterogeneous clinical manifestations. Some of the most common symptoms include fever, cough, anosmia (loss of sense of smell), dysgeusia (distorted sense of taste), fatigue, and breathlessness. In severe cases, COVID-19 can progress to pneumonia, acute respiratory distress syndrome (ARDS), multi-organ dysfunction, and death.
Dizziness if the most common neurological symptom reported in COVID-19 patients. Despite the extensive research into the pathophysiology of the COVID-19, the correlation between COVID-19 and dizziness remains unclear.
Importantly, the terms ‘dizziness’ and ‘vertigo’ are often used interchangeably, which is incorrect. The interchanging use of these terms is both misleading about the real prevalence of the actual symptom and can prevent the accurate identification of origin, vestibular or otherwise, of balance disorders.
Notably, neither the World Health Organization (WHO) nor the United States Centers for Disease Control and Prevention (CDC) have included dizziness in the list of COVID-19-related symptoms.
In the present study, researchers assess the prevalence and characteristics of vertigo and other nonvestibular causes of dizziness among patients with mild-to-moderate COVID-19 in Milan, Italy. These symptoms are traditionally classified as disequilibrium, presyncope, which is defined as near fainting or an early symptom of passing out, and light-headedness.
About the study
A total of 1,512 SARS-CoV-2-positive patients who were evaluated from October 1, 2020, to March 31, 2021, were included in the current study, a majority of whom were female and the median age was 51. All patients included in the current study were above the age of 18 and only experienced mild-to-moderate COVID-19, as defined by the absence of clinical or radiological evidence of pneumonia.
After the patients were discharged from the hospital, a virtual hospital model known as COD19 was used to allow physicians to follow up with these patients. To this end, the physicians were able to monitor the patients’ symptoms, identify critical clinical or social conditions, and provide psychological support.
In addition to monitoring a wide range of COVID-19-related symptoms, the clinicians were particularly interested in assessing the presence of dizziness. Importantly, the symptom of dizziness was distinguished into vertigo, disequilibrium, presyncope, and light-headedness.
Whereas the symptom of vertigo was reported when the patient experienced a spinning of their surrounding environment or themselves, disequilibrium was defined as when the patient reported feeling unsteady or wobbly while walking. Comparatively, presyncope was reported when a sudden onset of near-fainting or blackouts lasting for seconds to minutes, without actual loss of consciousness, occurred. Light-headedness was used to describe non-specific dizziness.
Patients who suffered severe COVID-19 requiring hospitalizations, those with a recent history of dizziness within the past year, and those with other pathologies such as neoplasia or neurological or cardiovascular disease that were not directly attributable to COVID-19 were excluded from this study. Furthermore, patients with symptoms that were being caused by medications, head trauma, or surgical interventions were not included.
The most prevalent symptom reported by 85.4% of patients was asthenia, which was followed by 60% of the patients reporting rhinitis and cough. Other commonly reported symptoms included fever, anosmia, dysgeusia, anorexia, myalgia, and headache, in decreasing order.
Furthermore, 16.6% of patients included in the current study reported dizziness. Among these patients, 43.8% complained of lightheadedness, whereas the remainder of patients complained of disequilibrium (27.9%), presyncope (16.3%), and vertigo (12%).
While disequilibrium was more common in former smokers and older adults, a higher prevalence of syncope was observed in obese patients. Overall, dizziness was more frequently reported among females and former smokers. Complaints of light-headedness were significantly correlated with fever, headache, cough, dyspnea, psychiatric symptoms, pharyngodynia, myalgia, dysgeusia, and anorexia.
The researchers attributed the high prevalence of light-headedness to psychophysical stress and metabolic causes that were likely exacerbated following the acute infection and mandatory quarantine.
Because specific symptoms concerning balance disorders were investigated by daily telephone consultation, the observations made in this study are based on patient reports rather than on objective clinical examinations. Furthermore, patients might omit or emphasize their symptoms while reporting on their medications.
Importantly, the current study was only conducted when the SARS‐CoV‐2 nasopharyngeal swab result was positive. The researchers, therefore, call for extending this research to involve clinical evaluation of the long-term consequences of COVID-19 on the vestibular system.
The current study analyzed the prevalence and pathophysiological mechanisms of different types of balance disorders that were reported in a large sample of COVID-19 patients. Taken together, the study findings suggest that dizziness should be included among the main symptoms of acute SARS-CoV-2 infection.
Importantly, disequilibrium in the elderly, especially in the presence of myalgia, arthralgia, asthenia, and ocular symptoms, should be carefully monitored, as they are at a greater risk of accidental falls.
- Aldè, M., Barozzi, S., Di Berardino, F. et al. (2022). Prevalence of symptoms in 1512 COVID-19 patients: have dizziness and vertigo been underestimated thus far? Internal and Emergency Medicine. doi:10.1007/s11739-022-02930-0.