Approach to the International Traveler With Neurological Symptoms

Kiran T Thakur; Joseph R Zunt


Future Neurology. 2015;10(2):101-113. 

In This Article

Abstract and Introduction


International travelers commonly contract illnesses while abroad, with the highest risk in those who spend extended time in developing countries. As travel to worldwide destinations becomes more accessible, neurologists should be aware of travel-related infections and noninfectious conditions presenting with neurological manifestations. Travelers may present with a myriad of neurologic symptoms, including confusion, headache, weakness and sensory symptoms. In this review, we discuss the general approach to the returning traveler with neurological symptoms and discuss the differential diagnosis of symptoms commonly encountered in practice.


Travel-related illness is reported in over a quarter of global travelers, and although most illnesses are mild, some are accompanied by serious neurological manifestations.[1] In the most recent GeoSentinel survey on travel-related illnesses acquired abroad, approximately 75% of post-travel illness was caused by gastrointestinal, febrile or dermatologic disease.[2] While neurological diagnoses were seen in only 2% of cases, there was a substantial proportion with life-threatening conditions, including over 100 cases of meningoencephalitis (Table 1). Travel over longer distances has increased significantly in the last decade, especially to countries in developing regions of Asia and Africa, and associated with an increased risk of severe illness.[3] Importantly, travel frequency is increasing in high-risk populations including individuals with co-morbid medical conditions and those traveling for business or visiting friends and relatives.[4]

In particular, travelers visiting friends and relatives are emerging as a group at substantial risk for serious illness, as a significant portion do not seek preventive healthcare advice prior to travel.[6,7]

When a traveler returns home ill from a journey abroad it can be difficult to decipher whether the condition is the result of a disease acquired locally or while traveling. This challenge is compounded as neurological symptoms are often nonspecific or when the patient is unable to provide a full history. Detailed history from fellow travelers can be particularly helpful in these circumstances. The practicing neurologist should be aware of travel-related neurological conditions, both as primary illnesses and as secondary manifestations of systemic disease (Figure 1).[8] In this review we discuss the general approach to the returning traveler with neurological symptoms. We focus on short-term travelers, and ex-patriates, rather than immigrants from endemic regions. We discuss various etiologies, workup and management of common neurological symptoms a clinician may encounter, including headache, confusion and seizures, weakness and sensory loss.

Figure 1.

Worldwide map of infectious organisms.
Reproduced with permission from [98].
For color figure, please see online at