Neurologic Symptoms in Lyme Disease and COVID-19
Neurologic symptoms from Lyme disease and COVID-19 show striking overlap. Patients with either infection may develop headaches, brain fog, encephalopathy, dizziness, fatigue, and cognitive symptoms after infection. In a study of 509 patients with confirmed COVID-19, more than 80% experienced neurologic complications — symptoms Lyme disease patients have reported for decades. This overlap can create diagnostic confusion when clinicians attempt to distinguish Long COVID from neurologic Lyme disease.
These neurologic complications are well described in
neurologic Lyme disease.
Patients may experience persistent brain fog, cognitive dysfunction, dizziness, headaches, and fatigue following infection.
COVID-19 Study Reveals Major Neurologic Impact
In their study,
“Frequent neurologic manifestations and encephalopathy-associated morbidity in Covid-19 patients,”
Liotta and colleagues evaluated neurologic manifestations in 509 hospitalized COVID-19 patients.
Key Findings
The study found:
- More than 80% of COVID-19 patients experienced neurologic symptoms.
- Nearly one-third developed headaches, dizziness, or encephalopathy.
- Myalgia and fatigue occurred in 43% of patients at illness onset and in 79% during disease.
- Patients with encephalopathy were less likely to experience good clinical outcomes.
- Hospitalization lasted nearly three times longer in patients with encephalopathy.
These findings highlight the significant neurologic involvement that can occur during COVID-19 infection.
Common Neurologic Symptoms Seen in Both Infections
Although COVID-19 and Lyme disease are different infections, both can affect the nervous system. In some patients, inflammation and immune activation following infection may lead to persistent neurologic symptoms and cognitive impairment.
- Brain fog and slowed thinking
- Headaches
- Dizziness or balance problems
- Fatigue
- Difficulty concentrating
- Memory problems
These symptoms represent neurologic involvement affecting brain function rather than vague complaints.
The Lyme Disease Parallel
Nearly one-third of COVID-19 patients in the study experienced headaches, encephalopathy, and dizziness. These same neurologic symptoms have long been reported in
Lyme disease patients.
Both infections may cause:
- Severe headaches
- Brain fog and cognitive dysfunction
- Encephalopathy (altered mental status)
- Dizziness and balance problems
- Fatigue and myalgia
These symptoms reflect neurologic complications related to infection-associated inflammation and immune activation.
Understanding Encephalopathy
Encephalopathy refers to altered brain function involving confusion, difficulty concentrating, impaired memory, or changes in consciousness. It represents brain dysfunction from infection, inflammation, or metabolic disturbances.
There is no single diagnostic test for encephalopathy. In the Liotta study, the diagnosis was made using clinical judgment.
Patients with encephalopathy experienced worse outcomes and longer hospitalizations. Similar challenges have been observed in patients with Lyme encephalopathy.
The Brain Fog Connection
The authors encouraged further study of patients who report persistent cognitive symptoms such as difficulty concentrating and short-term memory problems — commonly described as “brain fog.”
Brain fog is now recognized as a hallmark of
Long COVID.
However, Lyme disease patients have reported similar cognitive symptoms for many years.
The COVID-19 pandemic has increased awareness that post-infectious neurologic symptoms can be real, measurable, and disabling.
Multiple Possible Causes
The cause of encephalopathy in COVID-19 remains uncertain. Potential contributors include systemic inflammation, vascular injury, immune responses, direct viral effects on the nervous system, ICU-related delirium, medication effects, and disrupted sleep cycles.
Similarly, neurologic symptoms in Lyme disease may involve several mechanisms including inflammatory cytokines, immune dysregulation, vascular inflammation, direct infection of nervous tissue, and
autonomic dysfunction.
The Diagnostic Challenge
Because COVID-19 and Lyme disease share many neurologic symptoms, distinguishing between the two conditions can be challenging.
Patients with persistent symptoms after infection may be diagnosed with Long COVID when Lyme disease has not been considered. Conversely, Lyme disease patients may be told their symptoms reflect Long COVID. In some cases, individuals may experience both infections.
Clinical history, geographic exposure, tick exposure, and diagnostic testing may help guide evaluation.
Clinical Takeaway
Persistent neurologic symptoms after infection deserve careful evaluation. Both COVID-19 and Lyme disease can affect the nervous system and produce symptoms such as brain fog, headaches, dizziness, fatigue, and cognitive dysfunction.
Recognizing these neurologic complications early may improve the likelihood of recovery and prevent unnecessary suffering.
Frequently Asked Questions
Can COVID-19 and Lyme disease both cause brain fog?
Yes. Both infections can produce cognitive symptoms including brain fog, difficulty concentrating, and short-term memory impairment.
Why do infections cause neurologic symptoms?
Some infections trigger inflammation or immune responses that affect the brain and nervous system. This may lead to headaches, cognitive dysfunction, dizziness, and fatigue.
Can Lyme disease be misdiagnosed as Long COVID?
Yes. Because symptoms overlap, Lyme disease may be overlooked in patients diagnosed with Long COVID. Physicians should consider both conditions when evaluating persistent neurologic symptoms.
Related Reading:
Long COVID and Lyme Disease: What Patients Need to Know
References:
- Liotta EM et al. Frequent neurologic manifestations and encephalopathy-associated morbidity in Covid-19 patients. Ann Clin Transl Neurol. 2020.
- Johnson L et al. Antibiotic treatment response in chronic Lyme disease. Healthcare (Basel). 2020.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
I am suffering with Chronic Lyme–every day is a different combination of symptoms. I have been reading with interest the recent articles on COVID “long-haulers” and have been amazed at how similar their symptoms and experiences are to mine. In fact, there was one description from a COIVD Long-hauler that precisely captured what I go through every day: they said, (paraphrasing) “…imagine a shopping bag full of all the different, indivdual symptoms you experience. Each day, you reach into that shopping bag and grab a handful of symptoms and throw them on the table–and that is what you experience for that day. The next day, you reach into that bag and grab another handful of symptoms…and again, and again, each day…” That is exactly what I go through day in, and day out with no end in sight. It is so frustating, depressing, isolating and discouraging. Maybe with all these new COVID patients, there will be greater reasearch into why this is happening and what can be done to address it; and hopefully that will benefit the Lyme community as well
Thanks for sharing the story. Let me know the source of the article if you can.