Annals of Clinical and Translational Neurology (ACTN)Neurologic Manifestations of Long COVID Affect Adult Females More Severely Than Males

ℹ️ Observational Association Only Evidence

This cross-sectional study compared 261 posthospitalization and 2,068 nonhospitalized Neuro-PASC patients evaluated at one Neuro-COVID clinic from 2020 through 2025. Females in both cohorts reported a higher median neurologic symptom count and more frequently had at least four symptoms. The findings identify clinically relevant sex-associated patterns but do not establish causality, biological mechanisms, or population prevalence.

Clinical Considerations

• At least four neurologic symptoms affected 79.6% of posthospitalization females versus 64.9% of males.
• Among nonhospitalized patients, the corresponding rates were 76.1% versus 64.6%, with broader symptom differences.
• Females more frequently reported headache, dizziness, numbness or tingling, pain, fatigue, dyspnea, chest pain, and dysautonomia.
• Nonhospitalized females also reported more brain fog, myalgias, smell or taste disturbance, and gastrointestinal symptoms.
• PROMIS results showed worse subjective fatigue in females; nonhospitalized females performed worse on an objective attention task.
• Interpretation is limited by specialty-clinic referral bias, self-reported symptoms, absent contemporaneous controls, and multiple comparisons without study-wide adjustment.

Practice Applications

• Recognize that persistent Neuro-PASC may present with a broader symptom constellation in female patients.
• Evaluate cognition, fatigue, autonomic symptoms, pain, headache, and sensory complaints without relying on examination findings alone.
• Interpret sex differences as observational associations rather than evidence of distinct causal mechanisms.
• Avoid dismissing persistent multisystem complaints when routine neurologic findings are limited or inconsistent.