/ Health Articles / Diseases & Treatments /
COVID-19 and neurological conditions

As the COVID-19 pandemic has continuously produced devastating effects on people’s health, disease severity worldwide has drastically increased due to several variants caused by vital mutations. As a highly contagious and potent disease, COVID-19 can cause a wide range of symptoms, extending from mild to fatal, affecting different organs in the body. The most common symptoms, either with or without fever involve the upper and lower respiratory systems, such as cough, sore throat, shortness of breath or breathing difficulties, fatigue, muscle pain and malaise can also be found, similar to those present in influenza. Besides respiratory system, COVID-19 symptoms are also associated with other systems including neurological manifestations, although COVID-19 related neurological problems seem to rarely develop.

COVID-19 and nervous system

A clinical study conducted in China, Neurologic Manifestations of Hospitalized Patients with Coronavirus Disease 2019 in Wuhan, China, indicates that neurologic symptoms were seen in 36% of COVID-19 patients. These involved both central nervous system and peripheral nervous system. It is believed that the pathologic mechanisms can be derived from both direct and indirect ways. SARS-CoV-2 can directly invade the central nervous system while activating immune response through different mechanisms, leading to severe inflammation and neuronal cell damages. According to this research, patients with COVID-19 experienced neurological problems with a broad spectrum of severity, ranging from dizziness, headache, taste or smell impairment, nerve pain to fatal symptoms, such as altered level of consciousness, seizure and acute cerebrovascular events. In fact, patients with severe infection were more likely to develop neurologic manifestations. Moreover, growing evidence suggest that COVID-19 can cause severe forms of neurological conditions, including encephalitis, meningitis, Guillain-Barré syndrome (GBS) and acute ischemic stroke in young adults.

COVID-19 กับอาการและโรคทางระบบประสาท

COVID-19 and patients with neurological conditions

As regards to current information and literature reviews, there seems to be no firm evidence to assuredly indicate that patients with neurological diseases, such as seizure, stroke, dementia or Alzheimer’s disease and Parkinson’s disease have a greater risk to develop COVID-19, compared to people without neurological disorders. In addition, no relevancy has not been found yet whether medications used to treat those conditions increase the risk of COVID-19 infection.

Nevertheless, patients with neurological disorders tend to be the elderly which pose more chance of getting infection with COVID-19. Furthermore, whilst most of the young patients succeed in overcoming the infection, if elderly patients become infected, they are more susceptible to develop severe symptoms with poor disease prognosis and higher chance of death. Therefore, patients with neurological diseases are highly recommended to remain as healthy as they can while complying with preventive measures and taking all medications to control their symptoms as prescribed.

Immunosuppressant drugs that suppress or reduce the strength of the body’s immune system might be required in some patients to treat certain neurological conditions, especially chronic autoimmune neurological diseases, such as myasthenia gravis and multiple sclerosis as well as chronic inflammatory demyelinating polyneuropathy (CIDP). Although the long-term use of immunosuppressant drugs can substantially lead to impaired immune system to fight against the virus, there is no conclusive evidence to indicate how these medicines affect the chance of infections. However, discontinuing medication without being instructed by the neurologists certainly aggravate the symptoms of diseases, resulting in serious complications including disability. Thus, patients must not adjust their dosage regimens unless advised by the doctors.

Not only respiratory symptoms, but COVID-19 can also cause different forms of neurological abnormalities. Nonetheless, these symptoms are unspecific to SARS-CoV-2 infection. If abnormal sign or symptom arises, immediate medical attention needs to be sought in order to get an accurate diagnosis and effective treatment in a timely manner.

Article By:

Dr. Chaisak Dumrikarnlert
Neurologist (Cognitive and Behavioral Neurology), Neuroscience Center, Bangkok International Hospital.

  1. Coronavirus disease 2019 (COVID-2019). U.S. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/index.html
  2. Zhu J, Ji P, Pang J, et al. Clinical characteristics of COVID-19: a meta-analysis. J Med Virol 2020
  3. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020
  4. Madjid M, Safavi-Naeini P, Solomon SD, et al. Potential Effects of Coronaviruses on the Cardiovascular system: A Review. Lancet Cardiol 2020
  5. Mao L, Jin H, Wang M, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol 2020
  6. Xu Z, Shi L, Wang Y, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med 2020
  7. Li YC, Bai WZ, Hashikawa T. The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. J Med Virol 2020
  8. Helms J, Kremer S, Merdji H, et al. Neurologic Features in Severe SARS-CoV-2 Infection. NEJM 2020
  9. Xiang P, Xu XM, Gao LL, et al. First Case of 2019 Novel Coronavirus Disease with encephalitis. ChinaXiv 2020
  10. Ye M, Ren Y, Lv T. Encephalitis as a clinical manifestation of COVID-19. Brain Behav Immun 2020
  11. Moriguchi T, Harii N, Goto J, et al. A first case of meningitis/encephalitis associated with SARS-Coronavirus-2. Int J Infect Dis 2020
  12. Poyiadji N, Shahin G, Noujaim D, et al. COVID-1-associated Acute Hemorrhagic Necrotizing Encephalopathy: CT and MRI features. Radiology 2020
  13. Zhao H, Shen D, Zhou H, et al. Guillain-Barre syndrome associated with SARS-CoV-2 infection: causality or coincidence? Lancet Neurol 2020
  14. Oxley TJ, Mocco J, Majidi S, et al. Large-Vessel Stroke as a Presenting Feature of Covid-19 in the Young. NEJM 2020
  15. Onder G, Rezza G, Brusaferro S. Case-Fatality rate and characteristics of patients dying in relation to COVID-19 in Italy. JAMA 2020
Manji H, Carr AS, Brownlee WJ, et al. Neurology in the time of COVID-19. J Neurol Neurosurg Psychiatry 2020