Neurological masks of post-COVID syndrome

Post-COVID syndrome (PCS) refers to a constellation of signs and symptoms that develop during or after a coronavirus infection, persist for more than 12 weeks, and cannot be explained by an alternative diagnosis. Neurological manifestations of PCS may include cognitive impairment (CI), dizziness, headaches, and musculoskeletal pain. However, several neurological conditions can mimic PCS, including neurodegenerative diseases with CI, persistent postural-perceptual dizziness (PPPD), chronic migraine (CM), and chronic non-specific back pain. This article presents case reports of patients with Alzheimer's disease, PPPD, CM, medication-overuse headache (MOH), and chronic musculoskeletal pain (CMSP), who were misdiagnosed with PCS and did not receive effective treatment for their underlying conditions. Targeted therapy for PPPD, CM, MOH, and CMSP led to regression of symptoms and rapid improvement in the patients' condition. The persistence of cognitive dysfunction, dizziness, and chronic pain syndromes warrants thorough evaluation to identify alternative diagnoses that may be masked by PCS. Early diagnosis and appropriate treatment of these conditions can significantly improve outcomes for many patients who otherwise receive prolonged and ineffective treatment for PCS.