Vestibular Dysfunctions Related to COVID-19 Infection: A Clinical Case Report

ABSTRACT

Objective: NA Introduction: Vertigo is an unusual presentation of COVID infection about which there have been only a few case reports focusing on peripheral vestibular dysfunctions. Accumulation of clinical experiences is needed to improve our knowledge and clinical practice. We report a recent encounter with predominant and persistent vestibular symptoms from COVID-19 infection. Design/Methods: NA Case Presentation A 31 y/o otherwise healthy male suffered rapidly onset severe non-positional vertigo, disequilibrium, and nystagmus associated with nausea and vomiting, which were followed in a few hours with high fever, diarrhea, and generalized fatigue. He and his wife were then both tested positive for SARS CoV-2 by PCR. He denied having other common COVID-19 symptoms. All his systemic symptoms resolved in 2 weeks after treatments. However, he remained having persistent severe and subjectively progressive vertigo and disequilibrium upon the first office encounter 2 months later. Symptoms were enhanced by head pitching and were reduced by maintaining head stationary in supine position with eyes closed. Examination was unremarkable except the findings of slight left-sided peripheral vestibular weakness and mild deviation with Fukuda stepping. Further vestibular studies showed normal water caloric irrigation, impaired vertical gaze holding, abnormal subjective visual vertical testing, and delayed bilateral vestibular evoked myogenic potentials. COVID-19 infection-related peripheral and central vestibular complications were suspected. The patient was referred to vestibular rehabilitation. Discussion: COVID-19 virus is known to cause acute and long-term injuries of peripheral and central nervous systems. Although uncommon, COVID-19 infection can present with acute vestibular symptoms. Like the other reports, our case showed no profound peripheral vestibular losses after recovery from acute COVID-19 infection. However, his debilitating vestibular discomforts have persisted long after the recovery. Our observations suggest that the mechanisms for COVID-19-related vestibular dysfunctions are more complicated and may involve both peripheral and central vestibular systems.