The Long COVID Neuro Differential Dx: Sometimes Tricky, Always Nuanced

"It can be very tricky to tease out what may be related to long COVID and what might be something separate," said physiatirst Leslie Rydberg, MD. "That's what this consensus statement is meant to address; it emphasizes that the number one most important step is to look for some of the red flag symptoms that may point to a brain problem, such as a stroke or a bleed, or a problem that affects the spinal cord or peripheral nerves."

Rydberg is associate professor of physical medicine and rehabilitation and medical education at Northwestern University Feinberg School of Medicine and is coauthor of the consensus statement she refers to, the Multidisciplinary collaborative consensus guidance statement on the assessment and treatment of neurologic sequelae in patients with post-acute sequelae of SARS-CoV-2 infection (PASC).

The guidance is the most recent in a series being created by the Multi-Disciplinary PASC Collaborative to provide best practices from established long COVID clinics in caring for patients with the wide array of symptoms. Rydberg spoke with Patient Care about the particular challenges in making a diagnosis based on neurologic sequelae.

Leslie Rydberg, MD, is associate professor of physical medicine and rehabilitation and medical education at Northwestern University Feinberg School of Medicine and the Henry and Monika Betts medical student education chair and assistant residency program director at the Shirley Ryan Ability Lab in Chicago, IL.

The new statement on diagnosis and management neurologic sequelae of COVID-19 is part of a multidisciplinary collaborative consensus guidance series addressing the most predominant long COVID symptoms, an effort led by the American Academy of Physical Medicine and Rehabilitation.

The first consensus guidance on fatigue was released in August 2021, followed by guidance on breathing discomfort and cognitive symptoms in December, cardiovascular complications in June 2022 and pediatrics and autonomic dysfunction in September. Links to all the current guidance statements can be found here. An additional consensus guidance statement on Long COVID in mental health will be published next.