One year after the start of the pandemic, reports began to arrive on the "damage" from inflammatory and/or protein infiltration of SARS-CoV-2 which seem to have mostly been accompanied by thromboembolic phenomena in the first wave, intestinal infarctions in the second and pulmonary and pneumothorax in the third.
For those who deal with these patients, however, the presence of several cases now showing brainstem and specifically bulbar lesions does not go unnoticed.
Ex-COVID intensive care patients (some of these had also undergone tracheostomy) with clear and documented deficits in CN X, CN , and manifestations of hoarseness and airy voice, dysphagia and weakness of the soft palate, weakness of trapezius and SCOM, lingual deviation.
Patients during therapy (integrated respiratory, speech therapy, osteopathic) improved, thus addressing these deficits to the fact that it is probably not a progressive neurological motor damage.
At a scientific level, it is not yet proven whether or not these deficits are directly (due to viral or immune-mediated causes) effects of SARS-CoV-2.
According to some scholars, bulbar paralysis could also be a local variant of Guillain-Barré Syndrome associated with COVID.
The neuropathy could also be related to the prolonged and abnormal position of pronation, by a malposition or displacement of the ventilation tube, by excessive inflation of the cuff during orotracheal intubation or tracheotomy.
Surely these, like other elements, will find a more correct analysis and explanation once the pandemic is over. In the meantime, the exchange of information between clinicians remains fundamental.