Neurologic Symptoms in Lyme Disease and COVID-19
Lyme disease and COVID-19 can produce overlapping neurologic symptoms
Brain fog, headaches, dizziness, and fatigue may occur with either illness
Clinical history and exposure risk can help distinguish between them
Neurologic symptoms in Lyme disease and COVID-19 can overlap. Patients with either infection may experience headaches, brain fog, dizziness, fatigue, and cognitive difficulties. In a study of 509 hospitalized patients with confirmed COVID-19, 82.3% experienced at least one neurologic manifestation during their illness. This overlap can complicate efforts to distinguish COVID-19, Long COVID, and neurologic Lyme disease.
Neurologic Symptoms in Hospitalized COVID-19 Patients
In their study, Frequent neurologic manifestations and encephalopathy-associated morbidity in COVID-19 patients, Liotta and colleagues reviewed 509 patients hospitalized with laboratory-confirmed COVID-19.
Neurologic manifestations were present in 42.2% of patients at the onset of COVID-19, 62.7% at hospital admission, and 82.3% at some point during the illness.
Key Findings
The most frequently reported neurologic manifestations were:
- Myalgia: 44.8%
- Headache: 37.7%
- Encephalopathy: 31.8%
- Dizziness: 29.7%
- Altered taste: 15.9%
- Loss of smell: 11.4%
Patients with encephalopathy were more likely to experience poor functional outcomes and had longer hospital stays. However, the study did not establish that encephalopathy directly caused those outcomes.
These findings apply to patients hospitalized during acute COVID-19. They should not be interpreted as the prevalence of neurologic symptoms among everyone who develops COVID-19 or Long COVID.
How Lyme Disease and COVID-19 Symptoms Overlap
COVID-19 and Lyme disease are different infections, but either illness may be associated with symptoms involving the brain, peripheral nerves, or autonomic nervous system.
Overlapping symptoms may include:
- Brain fog and slowed thinking
- Headaches
- Dizziness or impaired balance
- Difficulty concentrating
- Memory problems
- Fatigue and myalgia
- Tingling, burning, or other neuropathic sensations
- Exercise intolerance or lightheadedness
The presence of these symptoms does not establish which infection is responsible. Their onset, pattern, accompanying signs, exposure history, physical findings, and test results must be considered.
Understanding Encephalopathy
Encephalopathy refers to altered brain function. It may involve confusion, impaired attention, memory difficulties, disorientation, or a change in consciousness.
In the Liotta study, encephalopathy was identified through clinical evaluation rather than a single diagnostic test. Potential contributors included severe systemic illness, inflammation, metabolic abnormalities, medication effects, respiratory failure, and ICU-related delirium.
Encephalopathy should not be used interchangeably with brain fog. Encephalopathy generally describes a more substantial alteration in mental status, while brain fog commonly refers to problems with attention, memory, word retrieval, or mental processing.
Brain Fog After Infection
Brain fog is now widely recognized among patients with Long COVID. Patients with Lyme disease have also reported slowed thinking, impaired concentration, word-finding difficulty, and short-term memory problems.
The Liotta study examined neurologic manifestations during acute hospitalization and did not determine how frequently symptoms persisted after discharge. Nevertheless, its findings demonstrate that COVID-19 can involve the nervous system during acute illness.
Is It Lyme Disease or Long COVID?
Distinguishing Lyme disease from Long COVID can be difficult when the predominant symptoms are brain fog, dizziness, headaches, and fatigue.
Symptoms beginning after a documented COVID-19 infection may support Long COVID. Loss of smell or taste during the acute illness may provide an additional clue.
Features that may raise concern for Lyme disease include:
- Exposure to ticks in an endemic area
- A known tick bite
- An expanding erythema migrans rash
- Facial nerve palsy
- Migratory musculoskeletal pain
- New joint swelling
- Radicular or shooting nerve pain
Many patients with Lyme disease do not recall a tick bite or recognize a rash. Conversely, not every symptom appearing after COVID-19 is necessarily caused by Long COVID.
Some individuals may have experienced both infections. A history of COVID-19 should not automatically exclude Lyme disease, and a history of Lyme disease should not exclude Long COVID or another neurologic condition.
Multiple Possible Causes
Neurologic symptoms following infection may have more than one contributing mechanism. Researchers have investigated inflammation, immune responses, vascular injury, autonomic dysfunction, metabolic abnormalities, sleep disruption, medication effects, and direct effects of infection.
The importance of these mechanisms can differ among patients and remains under investigation. Symptoms such as dizziness may also result from autonomic dysfunction, vestibular disorders, medication effects, anemia, dehydration, or other medical conditions.
The Diagnostic Challenge
Evaluation may include the timing of symptom onset, previous infections, geographic and tick exposure, accompanying clinical signs, physical examination, and appropriately selected testing.
Lyme antibody testing can be negative early in infection. At the same time, a positive antibody result does not by itself establish that current neurologic symptoms are caused by active Lyme disease.
New confusion, facial weakness, difficulty speaking, loss of consciousness, severe imbalance, or weakness on one side requires prompt medical evaluation rather than being attributed automatically to Lyme disease or Long COVID.
Frequently Asked Questions
Can COVID-19 and Lyme disease both cause brain fog?
Yes. Patients with either illness may report difficulty concentrating, memory problems, word-finding difficulty, and slowed mental processing. Brain fog alone cannot determine which condition is responsible.
Can Lyme disease and COVID-19 both cause dizziness?
Yes. Dizziness may occur with either illness. Possible contributors include neurologic involvement, autonomic dysfunction, vestibular problems, medication effects, dehydration, and other medical conditions.
Is encephalopathy the same as brain fog?
No. Encephalopathy usually involves a more significant alteration in brain function, such as confusion, disorientation, or a change in consciousness. Brain fog generally describes less severe problems with memory, attention, or mental processing.
Can Lyme disease be mistaken for Long COVID?
Yes. Their symptoms can overlap, particularly when patients experience fatigue, brain fog, headaches, or dizziness. Exposure history, symptom timing, clinical findings, and appropriately interpreted testing may help distinguish them.
Can a patient have both Lyme disease and Long COVID?
Yes. Previous COVID-19 does not prevent someone from acquiring Lyme disease, and a history of Lyme disease does not prevent the development of Long COVID.
Clinical Takeaway
Lyme disease, acute COVID-19, and Long COVID may all be associated with brain fog, headaches, dizziness, fatigue, and cognitive difficulties.
Because these symptoms are not specific to one condition, persistent neurologic symptoms deserve a careful evaluation based on the complete clinical history rather than a single symptom or test result.
Related Articles
Is It Long COVID or Lyme Disease?
Lyme Disease Test Accuracy
Lyme Disease and POTS
Recovery From Lyme Disease
References:
- Liotta, E. M., Batra, A., Clark, J. R., et al. Frequent neurologic manifestations and encephalopathy-associated morbidity in COVID-19 patients. Annals of Clinical and Translational Neurology. 2020;7(11):2221–2230.
- Graham, E. L., Clark, J. R., Orban, Z. S., et al. Persistent neurologic symptoms and cognitive dysfunction in non-hospitalized COVID-19 “long haulers.” Annals of Clinical and Translational Neurology. 2021;8(5):1073–1085.
- Logigian, E. L., Kaplan, R. F., & Steere, A. C. Chronic neurologic manifestations of Lyme disease. New England Journal of Medicine. 1990;323(21):1438–1444.
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.