COVID-19 and your brain

Posted on 1 October 2021

Neurological symptoms may not be as common as respiratory issues amongst COVID-19 patients, but there is now overwhelming evidence in literature published by researchers indicating that COVID-19 impacts directly on both the central and peripheral nervous system. Here’s what you need to know.

According to Dr Zanele Makasi, a neurologist at Mediclinic Morningside, more needs to be clarified on how COVID-19 comes to affect the nervous system. “That said, any foreign organism that invades the body has the potential to cross the blood brain barrier; viruses included,” she says.

Acute cases

Dr Makasi reports that, amongst her patients still infective and in the acute phase of COVID-19, , the most common signs of neurological fallout include confusion, seizures and stroke. These conditions, particularly stroke, tend to occur in patients who already display signs of other cardiovascular risk factors such as high blood pressure and obesity– although, she says, there is not sufficient data available to conclude that this is definitively the case.

The long-term symptoms

It’s far more common for people to experience neurological issues after infection. However, Dr Makasi says, it’s worth noting that neurological symptoms are less frequent than respiratory ones. Once again, knowledge in this area is still developing, as is doctors’ understanding of the best way to treat symptoms.

Brain fog is a case in point. Dr Makasi explains that many patients experience this to some degree; it may be mild, moderate or severe. Interestingly, the treatment of severe brain fog – also known as encephalopathy, which presents clinically as a depressed level of consciousness – is more clear than for mild or moderate cases: here, intravenous immunoglobulins often have good results. The forgetfulness associated with mild brain fog, while incredibly debilitating and frustrating, can be less simple to address, because results and the time required to clear symptoms, vary between individuals. It can be difficult to determine how long patients will suffer from this condition. Often, finding the solution is a matter of trial and error, says Dr Makasi, but it may help to consult an occupational therapist or try cognitive therapy.

Headaches are also common amongst COVID-19 survivors. Although this is often one of the first signs of an infection, headaches often persist long after the ‘active’ period of illness. The good news is that headaches can usually be treated with painkillers.

Finally, many patients find themselves grappling with anxiety, even long after infection. This isn’t surprising, Dr Makasi acknowledges; after all, people who have made it through a case of COVID-19 have survived an illness that has claimed the lives of millions around the world, and this is bound to bring some intense emotions to the surface. It may be a good idea to book an appointment with a psychotherapist. A prescription for anti-anxiety medication is a possibility, especially if you have a history of anxiety or depression.

When to see a doctor

The problem with COVID-19 is its extreme variability: it can start with a sneeze, and end on a ventilator, and the huge array of symptoms that exist in between these extremes can often be easily explained away. That said, any unusual or persistent sensations are worth checking out, says Dr Makasi, especially if they occur in the wake of an infection, as there may be opportunistic viral infections taking advantage of an already immuno-compromised body. Viral encephalitis is an example here, and is often seen as part of the post-COVID-19 syndrome. Most often, you will undergo a series of tests, including an MRI, an EEG and a lumbar puncture, to see if an alternative cause may be found. Treatment is most often symptomatic but, says Dr Makasi, as doctors’ understanding of this disease increases, treatment, care, therapies and medication will become more targeted and effective. “It’s clear that more research about these neurological complications and manifestations is required for us to understand the effects of COVID-19 on this complex system,” she concludes.