Journal Article

Neurological symptoms and physical exam findings 6–11 months post-COVID-19: a cohort study

Iepsen, Bruno Diógenes, Ritto, Ana Paula, Marques, Marcos Vinícius Oliveira, Rodrigues, Julia Chartouni, Zanoteli, Edmar, Baima, José Pedro Soares, de Holanda Mendonça, Rodrigo, de Luca eTuma, Raphael, Pereira, Cristiana Borges, de Araújo Martins Moreno, Cristiane, Castro, Luiz Henrique Martins, Guedes, Bruno Fukelmann, Marie, Suely Kazue Nagahashi, Filho, Antonio Edvan Camelo, Filho, Geraldo Busatto, da Silveira, Mariana Ribeiro Marcondes, da Silva Aquino, Emanuelle Roberta, Nitrini, Ricardo, Silva, Andre Macedo Serafim, Costa, Barbara Leite, Wayhs, Sâmia Yasin

2026

Overview

Somatic neurological complications are an underexplored component of post-acute sequelae of SARS-CoV-2 infection. We evaluated long-term somatic neurological symptoms, examination findings, and suspected diagnoses among adults hospitalized for COVID-19. A total of 708 survivors were assessed 6–11 months after discharge using a structured three-step neurological evaluation based on the World Health Organization Protocol for Epidemiologic Studies of Neurologic Disorders : an adapted symptom questionnaire, a brief standardized neurological examination, and a full neurological consult. Muscle weakness, gait impairment, and paresthesias remained the most frequent symptoms at follow-up. Longer hospital stay predicted all three symptoms, and diabetes was associated with both gait impairment and paresthesias. Common examination findings included monoparesis, hemiparesis, and gradient-pattern sensory loss. Clinically suspected diagnoses included neuromuscular disease in 26%, cerebrovascular disease in 10%, and epilepsy in only 2.7% of cases. Logistic regression linked neuromuscular disease to paresthesias and tandem-walk failure, cerebrovascular disease to facial paralysis, and epilepsy to loss-of-contact episodes. A simplified screening model derived through best-subsets selection identified five informative items from the WHO protocol: paresthesias, facial paralysis, tandem walk, index–nose test, and loss-of-contact episodes. These findings indicate that somatic neurological abnormalities remain frequent months after severe COVID-19 and that a brief bedside subset may support efficient post-COVID neurological triage.

• Publisher: Nature Publishing Group UK,Nature Publishing Group,Nature Portfolio
• Subject: 631/326/596/4130 / 692/1807/1693 / 692/617 / 692/617/375/1370 / 692/617/375/178 / 692/617/375/430 / Adult / Cerebrovascular disease / Cerebrovascular diseases / Cohort Studies / COVID-19 / COVID-19 - complications / Diabetes mellitus / Epidemiology / Epilepsy / Facial paralysis / Female / Gait / Guillain-Barre syndrome / Hospitalization / Humanities and Social Sciences / Humans / Intensive care / Long COVID / Male / Middle Aged / multidisciplinary / Nervous system / Nervous System Diseases - diagnosis / Nervous System Diseases - epidemiology / Nervous System Diseases - etiology / Neurologic Examination / Neurologic manifestations / Neurological complications / Neuromuscular diseases / Neuromuscular Diseases - diagnosis / Neuromuscular Diseases - etiology / Neurophysiology / Paralysis / Paresis / Peripheral nervous system diseases / Physical Examination / Post-Acute COVID-19 Syndrome / SARS-CoV-2 - isolation & purification / Science / Science (multidisciplinary) / Severe acute respiratory syndrome coronavirus 2