COVID-19 COVID-19 COVID-19 is an acute respiratory illness that can be severe and is caused by a newly identified coronavirus officially named SARS-CoV-2. COVID-19 was first reported in late 2019 in Wuhan, China... read more causes mainly cold and flu-like symptoms (such as fever, cough, chills, sore throat), but unlike most colds, COVID-19 can cause loss of taste and smell. However, as more and more people are infected, it is becoming clear that COVID-19 sometimes affects many parts of the body and cause many other symptoms. It can affect the brain and nerves, causing neurologic symptoms Introduction to Symptoms of Brain, Spinal Cord, and Nerve Disorders Disorders that affect the brain, spinal cord, and nerves are called neurologic disorders. Neurologic symptoms—symptoms caused by a disorder that affects part or all of the nervous system—can... read more , such as confusion. COVID-19 can also cause disturbances in thinking, emotion, mood, and/or behavior, causing mental health (psychologic) symptoms.
Neurologic and psychologic symptoms may occur when people are first infected with COVID-19, while people are recovering, and/or after people have recovered from the initial infection.
People who become critically ill with COVID-19 can, as with other infections, develop delirium and become agitated or drowsy.
After recovering from the initial infection with COVID-19, many people have at least one persistent symptom, such as fatigue, impaired memory and cognition, headache, numbness and tingling, and/or loss of smell.
Doctors may do magnetic resonance imaging to check for changes in the brain and do blood and urine tests to rule out other disorders that can cause similar symptoms.
The main treatment for neurologic and psychologic symptoms is supportive care, but for people with depression, antidepressants may be useful.
Neurologic and psychologic symptoms may last a long time—for many weeks to months. Symptoms that occur during the first 4 weeks after the initial infection are called acute COVID-19. Symptoms that last for 12 weeks or more are called chronic COVID-19 (post–COVID-19 syndrome).
How the virus that causes COVID-19 (SARS-CoV-2) causes neurologic and psychologic symptoms is unclear. These symptoms may result from
The infection itself
Problems that are common during severe illness or that result from hospital care Problems Due to Hospitalization Just being in the hospital can cause certain problems, particularly infections (called hospital-acquired infections). Other problems include Problems associated with extended bed rest, including... read more , particularly in an intensive care unit (ICU)
An autoimmune reaction—when the immune system malfunctions and attacks its own tissues—triggered by the virus
For example, if COVID-19 (or any respiratory illness) is severe, it may reduce the level of oxygen in the blood. If the oxygen level is very low, the brain may not get enough oxygen and may malfunction, causing problems with thinking, memory loss, personality changes, difficulty walking, and lack of coordination.
Risk factors for developing neurologic and psychologic symptoms (such as delirium Delirium Delirium is a sudden, fluctuating, and usually reversible disturbance of mental function. It is characterized by an inability to pay attention, disorientation, an inability to think clearly... read more and agitation) due to COVID-19 include
Being critically ill, especially if treatment in an ICU Confusion and Mental Decline Due to Hospitalization Being ill, particularly when it involves taking drugs for pain or anxiety, can make anyone confused. The hospital environment adds to the problem. There, people give up their personal effects... read more is required
Having another disorder such as cerebrovascular disease Overview of Stroke A stroke occurs when an artery to the brain becomes blocked or ruptures, resulting in death of an area of brain tissue due to loss of its blood supply (cerebral infarction) and symptoms that... read more , heart failure Heart Failure (HF) Heart failure is a disorder in which the heart is unable to keep up with the demands of the body, leading to reduced blood flow, back-up (congestion) of blood in the veins and lungs, and/or... read more , or high blood pressure High Blood Pressure High blood pressure (hypertension) is persistently high pressure in the arteries. Often no cause for high blood pressure can be identified, but sometimes it occurs as a result of an underlying... read more
In an ICU Confusion and Mental Decline Due to Hospitalization Being ill, particularly when it involves taking drugs for pain or anxiety, can make anyone confused. The hospital environment adds to the problem. There, people give up their personal effects... read more , people are easily disoriented and confused. They are often alone and frightened in a strange place without familiar landmarks and usual routines. There are often no windows or clocks, and they have none of their possessions to help orient them. Older people, whether they have dementia or not, are particularly affected when they are taken out of their usual environment and do not have the support of family and friends. People in an ICU tend to be drowsy because they are often given sedatives and their sleep is constantly interrupted by beeping monitors and by staff members checking on them, taking blood, and giving them drugs. People who are tired are more easily confused, sometimes leading to delirium Delirium Delirium is a sudden, fluctuating, and usually reversible disturbance of mental function. It is characterized by an inability to pay attention, disorientation, an inability to think clearly... read more .
About 80% of people hospitalized with COVID-19 have neurologic symptoms. Many people have neurologic and psychologic symptoms in the 6 months after being hospitalized for COVID-19, especially if it is severe.
During the first 4 weeks of infection, neurologic symptoms of COVID-19 may include headache, dizziness, muscle aches, fatigue, and the more specific symptom of COVID-19—loss of smell and taste.
Several days after they are first infected, some people continue to become sicker and may become critically ill. They commonly become delirious Delirium Delirium is a sudden, fluctuating, and usually reversible disturbance of mental function. It is characterized by an inability to pay attention, disorientation, an inability to think clearly... read more . People with delirium cannot concentrate, and they become confused. They may alternate between being alert one moment and drowsy the next. Delirious people may be agitated and hostile or sluggish and subdued.
Occasionally, COVID-19 causes severe neurologic problems such as ischemic stroke Ischemic Stroke An ischemic stroke is death of an area of brain tissue (cerebral infarction) resulting from an inadequate supply of blood and oxygen to the brain due to blockage of an artery. Ischemic stroke... read more , bleeding within the brain Overview of Hemorrhagic Stroke Hemorrhagic strokes include bleeding within the brain (intracerebral hemorrhage) and bleeding between the inner and outer layers of the tissue covering the brain (subarachnoid hemorrhage). ... read more , meningitis Overview of Hemorrhagic Stroke Hemorrhagic strokes include bleeding within the brain (intracerebral hemorrhage) and bleeding between the inner and outer layers of the tissue covering the brain (subarachnoid hemorrhage). ... read more , encephalitis Encephalitis Encephalitis is inflammation of the brain that occurs when a virus directly infects the brain or when a virus, vaccine, or something else triggers inflammation. The spinal cord may also be involved... read more , and seizures Seizure Disorders In seizure disorders, the brain's electrical activity is periodically disturbed, resulting in some degree of temporary brain dysfunction. Many people have unusual sensations just before a seizure... read more . Some symptoms persist for weeks to months. Persistent problems may require extensive rehabilitation.
Disorders that affect nerves and muscles, such as Guillain-Barré syndrome Guillain-Barré Syndrome (GBS) Guillain-Barré syndrome is a form of polyneuropathy causing muscle weakness, which usually worsens over a few days to weeks, then slowly returns to normal on its own. With treatment, people... read more , may occur in people with COVID-19.
During recovery and/or as part of post-COVID syndrome, many people have at least one long-lasting neurologic symptom, such as chronic fatigue, general muscle aches, numbness and tingling, and unrefreshing sleep. Some people, even those with a mild case of COVID-19, have brain fog, which may involve problems with concentration, memory, understanding spoken and written language, and planning and making decisions. Many people have migraine-like headaches (which often do not respond to treatment). Loss of taste and smell may persist for several months or longer after other symptoms resolve.
Mood disorders, mainly anxiety and depression, are common.
Posttraumatic stress disorder Posttraumatic Stress Disorder (PTSD) Posttraumatic stress disorder (PTSD) involves intense, unpleasant, and dysfunctional reactions beginning after an overwhelming traumatic event. Events that threaten death or serious injury can... read more (PTSD) may develop. People with PTSD may have recurring intrusive memories.
More study is needed to determine how long neurologic and psychologic symptoms last and how well people recover from them.
A doctor's evaluation
Testing for other causes
Magnetic resonance imaging (MRI) or computed tomography (CT) of the brain is done to evaluate neurologic and/or psychologic symptoms due to COVID-19 (or other causes). These tests can detect swelling in the brain, brain tumors, infection, and other abnormalities. Blood and urine tests are done to check for metabolic disorders and infections. Neuropsychologic testing Diagnosis Agnosia is loss of the ability to identify objects using one or more of the senses. Symptoms vary depending on where the brain is damaged. Doctors determine whether people have agnosia by asking... read more is done to evaluate problems with thinking and behavior.
Doctors use the same specific criteria to diagnose mood disorders (such as depression), anxiety disorders, and PTSD in people with COVID as used in other people. Standard screening tools should be used to identify depression, anxiety disorders, sleep disturbances, PTSD, and fatigue. More extensive neuropsychologic evaluation may be needed in people with problems with thinking that persist after the initial infection resolves.
Supportive care is the main treatment for people with neurologic and psychologic symptoms due to COVID-19. Supportive care involves relieving symptoms and may include full life support in an ICU. It includes
Closely monitoring people to identify problems as they occur
Helping them breathe by giving them supplemental oxygen
Keeping them hydrated by giving them fluids by vein (intravenously)
Providing intensive care, including mechanical ventilation, as needed
If people have depression or anxiety, certain antidepressants may help. Select serotonin-reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) may reduce the inflammation caused by COVID-19 as well as treat depression.
Treatments for COVID-19 are continually being developed and are rapidly evolving. However, currently, none specifically targets neurologic and psychologic symptoms.