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Covid-19 Primary Care Resources

What are the neurological manifestations of Covid and how do they present?

Advice from a Consultant Neurologist

This information is sourced from Dr Michael Zandi, Consultant Neurologist

Q. What are the common neurological manifestations of Covid and how do they present?


  • Difficulty in thinking, which is often referred to as ‘brain fog’ is a common symptom. This can occur during the acute infection when the patient has fever/cough, or during the aftermath when they are recovering. Although this has not been established by robust epidemiological studies, the evidence from case series reports and anecdotal reports from expert discussion groups and patient forums is compelling
  • Loss of smell and taste is also common and this seems to improve with time
  • We also know that some patients experience tachycardias and autonomic symptoms – how much of that is due to neurological involvement of the autonomic nervous system remains to be seen

There are some big studies underway and we will know more in a year or two about the natural course of the illness. For now, I would advise GPs to listen and accurately record patients’ report  on their symptom profiles. I would encourage GPs to regularly monitor the progress of their patients, so GPs know who to help as treatment evidence evolves.

Q. What are some of the more unusual neurological manifestations of Covid that you are seeing?


  • First, it is important to know that severe neurological and neuropsychiatric complications of Covid are very rare
  • The cases we described in our paper were unusual and all the patients we reported on had been admitted to secondary care
  • Just to reassure GPs, we haven’t seen many patients with strokes due to Covid. The vascular events will, by definition, start abruptly as TIA and strokes do
  • I have heard reports from colleagues that some patients have complained of non-specific neuropathic symptoms such as burning, numbness, tingling and quite uncomfortable pain in their feet or in their arms – these symptoms are different from common post-viral arthralgia and myalgia

Q.  Do these symptoms fluctuate or do you see progressive deterioration?


We don’t know.  Guided by my knowledge of other medical conditions, I would expect significant impairment is persistent rather than waxing and waning. At the moment, at UCLH we are setting up Long Covid and post Covid neurology clinics. We are auditing patient presentation to determine where to put the threshold for neurological referral. If a GP is worried about their patient I would refer, even if impairment severity is more episodic rather than persistent or progressively worsening