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

TL;DR

This study finds that neurological issues like muscle weakness and gait problems are common in COVID-19 survivors months after hospitalization.

Contribution

The study introduces a simplified neurological screening model for efficient post-COVID triage.

Findings

Muscle weakness, gait impairment, and paresthesias were the most frequent symptoms 6–11 months post-COVID-19.

Diabetes was associated with gait impairment and paresthesias, and longer hospital stays predicted all three symptoms.

A simplified screening model using five items from the WHO protocol was effective for neurological triage.

Abstract

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.

The online version contains supplementary material available at 10.1038/s41598-025-33779-w.