You are leaving Medscape Education
Cancel Continue
Log in to save activities Your saved activities will show here so that you can easily access them whenever you're ready. Log in here CME & Education Log in to keep track of your credits.


How Long Is Long? Neurologic Symptoms in COVID-19 "Long-Haulers"

  • Authors: News Author: Megan Brooks; CME Author: Charles P. Vega, MD
  • CME / ABIM MOC / CE Released: 7/1/2022
  • Valid for credit through: 7/1/2023
Start Activity

  • Credits Available

    Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™

    ABIM Diplomates - maximum of 0.25 ABIM MOC points

    Nurses - 0.25 ANCC Contact Hour(s) (0 contact hours are in the area of pharmacology)

    Pharmacists - 0.25 Knowledge-based ACPE (0.025 CEUs)

    Physician Assistant - 0.25 AAPA hour(s) of Category I credit

    IPCE - 0.25 Interprofessional Continuing Education (IPCE) credit

    You Are Eligible For

    • Letter of Completion
    • ABIM MOC points

Target Audience and Goal Statement

This activity is intended for primary care physicians, infectious disease specialists, nurses, pharmacists, physician assistants, and other members of the healthcare team who care for patients with long COVID.

The goal of this activity is for learners to be able to analyze the prognosis of neurologic symptoms of long COVID.

Upon completion of this activity, participants will:

  • Distinguish the prevalence of symptoms of long COVID
  • Analyze the prognosis of neurologic symptoms of long COVID over 9 months
  • Outline implications for the healthcare team


Medscape, LLC requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated according to Medscape policies. Others involved in the planning of this activity have no relevant financial relationships.

News Author

  • Megan Brooks

    Freelance writer, Medscape


    Megan Brooks has no relevant financial relationships.

CME Author

  • Charles P. Vega, MD

    Health Sciences Clinical Professor of Family Medicine
    University of California, Irvine School of Medicine


    Charles P. Vega, MD, has the following relevant financial relationships:
    Advisor or consultant for: GlaxoSmithKline; Johnson & Johnson Pharmaceutical Research & Development, L.L.C.

Editor/Nurse Planner

  • Leigh A. Schmidt, MSN, RN, CMSRN, CNE, CHCP

    Associate Director, Accreditation and Compliance
    Medscape, LLC


    Leigh A. Schmidt, MSN, RN, CMSRN, CNE, CHCP, has no relevant financial relationships.

Compliance Reviewer

  • Yaisanet Oyola, MD

    Associate Director, Accreditation and Compliance
    Medscape, LLC


    Yaisanet Oyola, MD, has no relevant financial relationships.

Peer Reviewer

This activity has been peer reviewed and the reviewer has no relevant financial relationships.

Accreditation Statements

In support of improving patient care, Medscape, LLC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

This activity was planned by and for the healthcare team, and learners will receive 0.25 Interprofessional Continuing Education (IPCE) credit for learning and change.

    For Physicians

  • Medscape, LLC designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 0.25 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

    Contact This Provider

    For Nurses

  • Awarded 0.25 contact hour(s) of continuing nursing education for RNs and APNs; none of these credits is in the area of pharmacology.

    Contact This Provider

    For Pharmacists

  • Medscape, LLC designates this continuing education activity for 0.25 contact hour(s) (0.025 CEUs) (Universal Activity Number JA0007105-0000-22-189-H01-P).

    Contact This Provider

  • For Physician Assistants

    Medscape, LLC has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 0.25 AAPA Category 1 CME credits. Approval is valid until 7/1/2023. PAs should only claim credit commensurate with the extent of their participation.

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]

Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 75% on the post-test.

Follow these steps to earn CME/CE credit*:

  1. Read the target audience, learning objectives, and author disclosures.
  2. Study the educational content online or printed out.
  3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. We encourage you to complete the Activity Evaluation to provide feedback for future programming.

You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print out the tally as well as the certificates from the CME/CE Tracker.

*The credit that you receive is based on your user profile.


How Long Is Long? Neurologic Symptoms in COVID-19 "Long-Haulers"

Authors: News Author: Megan Brooks; CME Author: Charles P. Vega, MDFaculty and Disclosures

CME / ABIM MOC / CE Released: 7/1/2022

Valid for credit through: 7/1/2023


Note: The information on the coronavirus outbreak is continually evolving. The content within this activity serves as a historical reference to the information that was available at the time of this publication. We continue to add to the collection of activities on this subject as new information becomes available. It is the policy of Medscape Education to avoid the mention of brand names or specific manufacturers in accredited educational activities. However, manufacturer names related to COVID-19 vaccines may be provided in this activity to promote clarity. The use of manufacturer names should not be viewed as an endorsement by Medscape of any specific product or manufacturer.

Clinical Context

Postacute sequelae of COVID-19, or "long COVID," is one of the most important consequences of infection with SARS-CoV-2, and a systematic review and meta-analysis by Lopez-Leon and colleagues sought to determine the prevalence of different symptoms of long COVID. The results of their research were published in the August 9, 2021 issue of Scientific Reports.[1]

The meta-analysis included 15 studies, with a total of nearly 48,000 patients. Eighty percent of patients with SARS-CoV-2 infection developed symptoms that lasted more than 2 weeks. The most common symptoms were fatigue (58% of patients), headache (44%), attention-deficit/hyperactivity disorder (ADHD) (27%), hair loss (25%), and dyspnea (24%). Joint pain, cough, memory loss, and mood disorders were less common symptoms of long COVID, with prevalence rates less than 20%.

There are many unknown issues regarding long COVID, including the prognosis of common symptoms over time. The current study by Ali and colleagues addresses this subject, with a focus on neurologic symptoms.

Study Synopsis and Perspective

Most COVID-19 long-haulers continue to have brain fog, fatigue, and compromised quality of life (QoL) more than a year after the initial infection show results from the most extensive follow-up to date of a group of patients with long COVID.

Most patients continue to experience debilitating neurologic symptoms an average of 15 months from symptom onset, Igor Koralnik, who oversees the Neuro COVID-19 Clinic at Northwestern Medicine in Chicago, Illinois, said during a press briefing.

Surprisingly, in some cases, new symptoms appear that did not exist before, including variation of heart rate and blood pressure (BP) and gastrointestinal (GI) symptoms, indicating a possible late appearance in dysfunction of the autonomic nervous system in those patients, Koralnik said.

The study was published online May 24 in Annals of Clinical and Translational Neurology.[2]

Evolving Symptoms

The investigators evaluated the evolution of neurologic symptoms in 52 adults who had mild COVID-19 symptoms and were not admitted to the hospital.

Their mean age was 43 ± 11.5 years, 73% were women, and 77% had received a COVID-19 vaccine. These patients have now been followed for between 11 and 18 months since their initial infection.

Overall, between first and follow-up evaluations, there was no significant change in the frequency of fatigue (87% vs 81%) and most neurologic symptoms, including brain fog (81% vs 71%), numbness/tingling (69% vs 65%), headache (67% vs 54%), dizziness (50% vs 54%), blurred vision (37% vs 44%), and tinnitus (33% vs 42%).

The only neurologic symptoms that decreased over time were loss of taste (63% vs 27%) and smell (58% vs 21%).

Conversely, heart rate and BP variation (35% vs 56%) and GI symptoms (27% vs 48%; P = .04) increased at follow-up evaluations.

Patients reported subjective improvements in their recovery, cognitive function, and fatigue, but QoL measures remained lower than the average population of the United States.

There was a neutral effect of COVID-19 vaccination on long COVID symptoms: It did not cure long COVID or make long COVID worse, which is a reason given by some long-haulers for not getting vaccinated, Koralnik told the briefing.

Therefore, we continue to encourage our patients to get vaccinated and boosted according to the Centers for Disease Control and Prevention recommendation, he said.

Escape From the 'Pit of Despair'

The Northwestern Medicine Neuro--COVID-19 Clinic has treated many COVID-19 long-haulers from across the United States.

A physical therapist from Wheaton, Illinois, is one of them.

Speaking at the briefing, the 36-year-old described her saga and roller coaster of recovering from long COVID in 3 acts: her initial infection, followed by a descent into a pit of physical and emotional despair, followed by her eventual escape from that pit more than 2 years later.

After a fairly mild case of COVID -19, she said worsening neurologic symptoms forced her to take medical leave from her very physical and cognitively demanding job. 

She also experienced crushing fatigue and brain fog, as well as rapid heart rate and BP changes going from sitting to standing position. She went from being a competitive athlete to someone who could barely get off the couch or empty the dishwasher. With the ongoing help of her medical team, she slowly returned to daily activities and eventually to work on a limited basis. Today, she says she's 90% to 95% better but still has some lingering symptoms and does not yet feel like her pre--COVID-19 self.

This study has no specific funding. The authors disclosed no relevant conflicts of interest.

Study Highlights

  • The study cohort was first identified as having possible COVID-19 between May 13 and November 11, 2020 in one US academic medical center. All patients had neurologic symptoms associated with infection, but none had hypoxemia or were hospitalized for pneumonia.
  • The sample included patients with and without positive laboratory tests for SARS-CoV-2. The study authors noted that the sensitivity of testing for SARS-CoV-2 was substantially less compared with current test accuracy.
  • At a mean of 9 months after their initial study intake, patients completed a survey to elucidate their symptoms, treatment tried, and their COVID-19 vaccination status.The main study outcome was the prevalence of neurologic symptoms in comparing baseline and follow-up examinations.
  • Of 100 patients in the original cohort, 52 provided data for the current study. The mean age of patients was 42.8 ± 11.5 years, and 73% were female. 90.4% of participants were White. 77% of patients had been vaccinated since their initial intake encounter.
  • 27 patients had positive testing for SARS-CoV-2 whereas 25 had a negative test. The median time from the onset of symptoms to the second survey was 14.8 months.
  • Participants reported a median of 5 neurologic symptoms at baseline, which was similar at follow-up testing. The rate of experiencing ≥ 4 neurologic symptoms fell from 81% at baseline to 62% at follow-up, and this was driven by the SARS-CoV-2-positive cohort.
  • Most specific symptoms had not substantially abated by the time of follow-up, as the following prevalence table illustrates:
    Symptom Baseline Prevalence Follow-Up Prevalence
    Brain fog 81% 71%
    Numbness/tingling 69% 65%
    Headache 67% 54%
    Dizziness 50% 54%
    Blurred vision 37% 44%
    Tinnitus 33% 42%
    Fatigue 87% 81%
  • In contrast, dysgeusia improved during the study period (prevalence 63% at baseline and 27% at follow-up), as did anosmia (prevalence 58% at baseline and 21% at follow-up).
  • Still, BP and pulse variation and GI symptoms increased during follow-up.
  • The results for symptoms were generally similar in the SARS-CoV-2-positive and -negative groups.
  • 54% of participants used new medications for their neurologic symptoms. The most common drugs used were for neuropathic pain, followed by alternative medicine/supplements and antidepressants.
  • Generally, patients reported improvement in symptoms between the first and second surveys, with better self-rating scores for cognition and fatigue; however, QoL scores remained below those of the general population at follow-up.
  • The rate of subjective recovery was higher among unvaccinated vs vaccinated participants; However, there was an increase in cognitive scores related to QoL only in the vaccinated cohort.

Clinical Implications

  • In a previous meta-analysis by Lopez-Leon and colleagues, 80% of patients with SARS-CoV-2 infection had symptoms that lasted > 2 weeks. The most common symptoms were fatigue (58% of patients), headache (44%), ADHD (27%), hair loss (25%), and dyspnea (24%). Joint pain, cough, memory loss, and mood disorders were less common symptoms of long COVID, with prevalence rates < 20%.
  • The current study by Ali and colleagues demonstrates that most neurologic symptoms associated with long COVID do not improve over a mean of 9 months. Dysgeusia and anosmia were exceptions. Vaccination during long COVID did not significantly speed recovery from neurologic symptoms.
  • Implications for the healthcare team: The healthcare team should prepare for a long chronicity of neurologic symptoms among patients with long COVID and utilize all interprofessional members to coordinate appropriate care and resources.


Earn Credit

  • Print