Autoimmune Brain Inflammation After COVID-19 - Warning Signs Doctors Must Not Miss
Nikhil Prasad Fact checked by:Thailand Medical News Team Feb 12, 2026 1 hour, 53 minutes ago
Medical News: A new scientific letter published in a leading medical journal is urging doctors worldwide to take a closer look at patients who develop persistent headaches, dizziness, and subtle brain inflammation after recovering from COVID-19. Researchers from the Institute Pasteur of Tunis, University of Tunis El Manar and Genomic Platform in Tunis, Tunisia, and the Neurology & Neurophysiology Center in Vienna, Austria, are warning that autoimmune encephalitis may be overlooked in such cases.
Doctors urged to investigate hidden autoimmune brain inflammation in post-COVID patients with persistent neurological symptoms.
Their concerns were detailed in a recent correspondence that critically examined a previously published case involving a 75-year-old woman who died suddenly weeks after a SARS-CoV-2 infection.
Why This Case Raised Concerns
The patient had initially recovered from COVID-19 but began experiencing holocranial headaches, dizziness, weakness in her arms, and unusual glove-like sensory disturbances about seven weeks later. Medical examinations revealed weakness in all four limbs, signs of nerve damage, a prior small stroke, a blood clot in the heart’s left atrium, and mild pleocytosis — a slight increase in white blood cells in the cerebrospinal fluid, suggesting inflammation.
Despite treatment with prednisolone, her condition did not significantly improve. Twelve days after being admitted to hospital, she died suddenly. An autopsy showed an acute myocardial infarction without major coronary artery blockage, T-lymphocyte infiltration in the brain, and inflammatory damage to the diaphragm muscle.
The authors of the letter pointed out several unanswered questions that they believe are crucial for understanding what truly happened.
Possible Missed Brain Inflammation
One of the major concerns raised was the apparent contradiction in the original case report. While the abstract stated that there was no central nervous system involvement during the patient’s lifetime, the woman clearly experienced headaches and dizziness — both recognized neurological symptoms.
The researchers emphasized that mild pleocytosis should have triggered a broader search for infectious and autoimmune causes of encephalitis. They questioned whether a comprehensive list of viral and bacterial pathogens had truly been ruled out. Numerous viruses such as herpes simplex virus, Epstein-Barr virus, cytomegalovirus, West Nile virus, measles, mumps, rubella, and Japanese encephalitis virus can cause brain inflammation. Other infections like Lyme disease, syphilis, tuberculosis, fungal infections, and parasitic infections must also be excluded.
Equally important, they noted that autoimmune encephalitis — a condition in which the body’s immune system mistakenly attacks the brain — was not thoroughly investigated. Since autoimmune encephalitis has been documented as a complication following SARS-CoV-2 infection, both cerebrospinal fluid and blood should ideally be tested for specific antibodies associated with this condition.
Im
aging and Diagnostic Gaps
Another issue highlighted was the use of brain MRI without contrast. Experts have long warned that certain forms of encephalitis can be missed if contrast-enhanced imaging is not performed. Without contrast, subtle inflammatory changes may remain invisible.
The researchers also questioned whether heart rhythm disturbances such as atrial fibrillation were adequately investigated, as these could explain the atrial clot and stroke findings. They further suggested evaluating for myocarditis, endocarditis, pericarditis, and coagulation disorders, all of which have been reported after COVID-19.
Sudden Death Not Always What It Seems
The letter also raised the possibility of sudden unexpected death in epilepsy (SUDEP), Takotsubo syndrome, or neurogenic pulmonary edema as alternative explanations for the sudden fatal event. The authors stressed that sudden cardiac death in a patient with myocardial infarction is not always due to blocked coronary arteries.
This
Medical News report highlights the growing recognition that post-COVID complications can be complex, multi-systemic, and sometimes subtle.
Conclusions
The researchers conclude that infectious or autoimmune encephalitis following SARS-CoV-2 infection can easily be overlooked if clinicians do not actively search for it. Even mild symptoms such as headaches, dizziness, and slight cerebrospinal fluid abnormalities should prompt thorough investigations. They emphasize that comprehensive testing, including antibody screening and contrast-enhanced imaging, may prevent misdiagnosis and potentially fatal outcomes.
The study findings were published in the peer reviewed journal: Neurological Research and Practice.
https://link.springer.com/article/10.1186/s42466-026-00469-5
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Read Also:
https://www.thailandmedical.news/articles/coronavirus
https://www.thailandmedical.news/articles/long-covid
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