1. A 48-year-old male who recovered from severe COVID-19 presented to our clinic 16 months after onset of initial illness. The patient sustained significant lung damage during acute phase of infection and had required supplemental oxygen for more than a year. Due to deconditioning, he completed six months of physical therapy in order to resume activities of daily living. While he had intermittently regained some ability to detect smell and taste, these senses were distorted and generally unpleasant. The patient reported severe mental fogginess and deficits including difficulty retrieving words, recalling numbers, difficulty recognizing familiar faces, and episodes of topographical disorientation in familiar places.
We performed right-sided SGB and observed the expected physiological responses (e.g., Horner’s syndrome). Within hours, the patient reported reduction in mental fogginess and partial restoration of taste. The following day, left-sided stellate ganglion block was performed. The patient reported additional improvement in his mental clarity and sense of taste. On follow-up at 11 days after his second SGB, the patient noted “incredible” durable improvement in his mental clarity and concentration, specifically citing restoration of numerical recall ability, word-finding capacity, and facial recognition. He had experienced no episodes of disorientation since treatment, and reported normal ability to smell and taste.
2. A 42-year-old female who recovered from a mild course of COVID mainly presenting as low oxygen saturation, fatigue, anosmia and dysgeusia, presented to our clinic eight months after onset of initial illness. Since recovering from acute illness, she continued to experience debilitating fatigue, mental fogginess, difficulty concentrating, elevated resting heart rate, sleep disturbance, lack of appetite and food aversion due to diminished and altered sense of taste and smell. Due to decrement in performance, she had been let go from her job and was teaching 4-hour CPR courses with difficulty, relying on her teaching manual to recall facts and procedures previously well known to her. The unpalatability of any food had led to a 30-pound weight loss that was continuing to progress. Patient charts indicated a resting HR in the 60s prior to COVID-19; at presentation she reports that it had not been less than mid-80s since recovering from acute COVID-19.
We performed right-sided SGB. The patient noted immediate improvement in her dysgeusia and marked improvement in mental clarity and concentration. She later recalled being able to drive home without conscious effort to recall the route, demonstrating noticeable improvement in procedural memory. Two days later we performed left-sided SGB. On follow-up at 22 days after her second SGB, the patient reported that her sleep had returned to normal and she felt rested upon awakening. Her resting HR was measured at 69, and she reported restoration of taste and smell. Since her treatment, she was able to teach a 9-hour course for CPR instructors without the need to reference the teacher’s manual or written notes, demonstrating a drastic improvement in declarative memory. These improvements in symptoms were durable at 30-day follow-up.
3. A 44-year-old female contracted COVID-19 approximately eight months prior to her presentation for treatment of PASC. Her initial COVID-19 symptoms were loss of smell and taste, mental fogginess, headache, and dyspnea. Approximately one week after onset of symptoms her headache worsened, prompting evaluation in the ER but not hospitalization. Her headache symptoms dissipated over the following two weeks, but she experienced declining cognitive function and developed stuttering speech, significant cognitive impairment, and hemi-sided paralysis, prompting hospitalization and evaluation for MCV. Her MRI demonstrated inflammation, but neither stroke nor viral encephalitis. She was discharged with a diagnosis of brain injury secondary to COVID-19 and prescribed intense occupational, physical, and speech therapy for profound deficits in procedural and declarative memory, speech impediment, impaired coordination, inability to concentrate, and debilitating fatigue. She was unable to continue her work as a special education teacher.
She presented to the clinic after approximately seven months of slow but steady improvement in her physical and mental condition with the help of intense daily physical, occupational, and speech therapy. She continued to experience debilitating fatigue and speech impediment, and had returned to limited duties and shortened hours at work. She reported that ongoing dysgeusia had led to food aversion and significant unintentional weight loss. She was experiencing generalized body pain (4/10) described as dull with pins and needles. When exacerbated, her pain reached 10/10 and she was unable to get out of bed. She noted that acute stress exacerbated her right-sided motor deficits. She also experienced intermittent headaches described as “crawling pain in my brain.”
We performed right-sided SGB followed by left-sided SGB the following day. Within hours of the first procedure, the patient reported drastic improvement in smell and taste. At three-day follow-up she indicated that her physical and mental stamina had improved significantly, allowing her to perform routine household activities without debilitating lapses in procedural memory. She began a new job as a high-school teacher and was able to teach a full day of classes, which she states would have been “impossible” prior to treatment. On follow-up at 15 days, the patient reported durable resolution of stuttering and 75% improvement in all other symptoms.