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Tata G, Isik S, Diktas H, Genc G, Bulut S. Abducens Nerve Palsy in a Patient with COVID-19: A Case Report. SISLI ETFAL HASTANESI TIP BULTENI 2024; 58:131-134. [PMID: 38808042 PMCID: PMC11128696 DOI: 10.14744/semb.2023.55491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 03/09/2023] [Accepted: 04/28/2023] [Indexed: 05/30/2024]
Abstract
Numerous neurological manifestations associated with COVID-19 have been reported. However, abducens nerve palsy (ANP) associated with COVID-19 is very rare and mostly related to accompanying respiratory symptoms. Here we present a 29-year-old woman with unilateral ANP manifesting with diplopia and positive SARS-CoV-2 S antibodies, which were checked later. On admission, she had signs of viral pneumonia in thorax CT without any respiratory symptoms. Her cranial neuroimaging revealed no abnormality. Following treatment with favipiravir 2x1600 mg loading dose and then 2x600mg daily maintenance, dexamethasone 8 mg/day and enoxaparin 6000 IU/day, her CT findings recovered completely whereas her ANP only partially resolved. One week after the end of COVID-19 treatment, she also developed Herpes simplex keratitis which was successfully treated with valacyclovir. It should be kept in mind that isolated abducens nerve palsy may be the only finding of COVID-19 cases without any respiratory symptoms.
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Affiliation(s)
- Gulten Tata
- Department of Neurology, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Sahin Isik
- Department of Neurology, Batman Training and Research Hospital, Batman, Türkiye
| | - Husrev Diktas
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Gencer Genc
- Department of Neurology, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Serpil Bulut
- Department of Neurology, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
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2
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Baldwin G, Gaier ED, Hennein L. SARS-CoV-2-Related Cranial Nerve-6 Palsy Should Not Be Confused With Orbital Myositis Affecting the Lateral Rectus Muscle: Response. J Neuroophthalmol 2024:00041327-990000000-00592. [PMID: 38457265 DOI: 10.1097/wno.0000000000002126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
Affiliation(s)
- Grace Baldwin
- Harvard Medical School (GB, EDG), Boston, Massachusetts; Department of Ophthalmology (EDG, LH), Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Picower Institute of Learning and Memory (EDG), Massachusetts Institute of Technology, Cambridge, Massachusetts; and Department of Ophthalmology (LH), Rady Children's Hospital-San Diego; University of California, San Diego, LA Jolla, California
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Patel NT, Martinek A, Shaikh R, Kahar P, Khanna D. COVID-19 and Its Ophthalmic Manifestations: A Literature Review. Cureus 2024; 16:e55571. [PMID: 38576676 PMCID: PMC10993080 DOI: 10.7759/cureus.55571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 03/04/2024] [Indexed: 04/06/2024] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus discovered in late 2019 in Wuhan, Hubei Province, China. The virus has now developed into a full-scale global pandemic affecting hundreds of millions of people to date. A majority of cases present with nonspecific acute upper respiratory symptoms. A wide range of systemic symptoms has been reported, with some patients presenting with nonspecific extrapulmonary symptoms. Recently, there has been an increased association of COVID-19-positive patients presenting with ocular symptoms. As an increasing number of patients present with ophthalmic manifestations, recognizing these visual symptoms is of utmost importance. Some patients may present with ocular symptoms as the first indication of COVID-19 infection; quickly isolating and starting treatment can aid in stopping the spread of this novel coronavirus. This review will describe the current epidemiology and pathophysiology of SARS-CoV-2, emphasizing the ophthalmic manifestations and their clinical course progression. Further, we will be reporting on the growing number of rare ocular manifestations that have occurred in some COVID-19-positive patients, along with the route of transmission, specific manifestations, and the treatment methods for both these pulmonary and extrapulmonary symptoms, specifically the ocular manifestations.
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Affiliation(s)
- Neal T Patel
- Department of Foundational Sciences, Dr. Kiran C. Patel College of Osteopathic Medicine Nova Southeastern University, Fort Lauderdale, USA
| | - Alexander Martinek
- Department of Foundational Sciences, Morehouse School of Medicine, Atlanta, USA
| | - Raheel Shaikh
- Department of Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine Nova Southeastern University, Fort Lauderdale, USA
| | - Payal Kahar
- Department of Health Sciences, Florida Gulf Coast University, Fort Myers, USA
| | - Deepesh Khanna
- Department of Foundational Sciences, Dr. Kiran C. Patel College of Osteopathic Medicine Nova Southeastern University, Fort Lauderdale, USA
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Scorza CA, Finsterer J, Scorza FA. Long-term, unilateral third cranial nerve palsy, ocular myositis, and high CSF interleukine-2 persisting for 14 months after mild SARS-CoV-2 infection-case report. Clinics (Sao Paulo) 2024; 79:100331. [PMID: 38325022 PMCID: PMC10864832 DOI: 10.1016/j.clinsp.2024.100331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 12/21/2023] [Indexed: 02/09/2024] Open
Affiliation(s)
- Carla A Scorza
- Disciplina de Neurociência, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM). São Paulo, SP, Brazil
| | | | - Fulvio A Scorza
- Disciplina de Neurociência, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM). São Paulo, SP, Brazil
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Zhao D, Li X, Carey AR, Henderson AD. Optic Neuritis and Cranial Neuropathies Diagnosis Rates before Coronavirus Disease 2019, in the Initial Pandemic Phase, and Post-Vaccine Introduction. Ophthalmology 2024; 131:78-86. [PMID: 37634758 DOI: 10.1016/j.ophtha.2023.08.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/04/2023] [Accepted: 08/21/2023] [Indexed: 08/29/2023] Open
Abstract
PURPOSE To compare rates of diagnosis of neuro-ophthalmic conditions across the Coronavirus Disease 2019 (COVID-19) pandemic with pre-pandemic levels. DESIGN Multicenter, retrospective, observational study. PARTICIPANTS Patients seen for eye care between March 11, 2019, and December 31, 2021. METHODS A multicenter electronic health record database, Sight Outcomes Research Collaborative (SOURCE), was queried for new diagnoses of neuro-ophthalmic conditions (cranial nerve [CN] III, IV, VI, and VII palsy; diplopia; and optic neuritis) and new diagnoses of other ophthalmic conditions from January 1, 2016, to December 31, 2021. Data were divided into 3 periods (pre-COVID, pre-COVID vaccine, and after introduction of COVID vaccine), with a 3-year look-back period. Logistic regressions were used to compare diagnosis rates across periods. Two-sample z-test was used to compare the log odds ratio (OR) of the diagnosis in each period with emergent ocular conditions: retinal detachment (RD) and acute angle-closure glaucoma (AACG). MAIN OUTCOME MEASURES Diagnosis rate of neuro-ophthalmic conditions in each study period. RESULTS A total of 323 261 unique patients (median age 59 years [interquartile range, 43-70], 58% female, 68% White) across 5 academic centers were included, with 180 009 patients seen in the pre-COVID period, 149 835 patients seen in the pre-COVID vaccine period, and 164 778 patients seen in the COVID vaccine period. Diagnosis rates of CN VII palsy, diplopia, glaucoma, and cataract decreased from the pre-COVID period to the pre-vaccine period. However, the optic neuritis diagnoses increased, in contrast to a decrease in RD diagnoses (P = 0.021). By comparing the diagnosis rates before and after widespread vaccination, all eye conditions evaluated were diagnosed at higher rates in the COVID vaccination period compared with pre-COVID and pre-vaccine periods. The log OR of neuro-ophthalmic diagnosis rates across every period comparison were largely similar to emergency conditions (RD and AACG, P > 0.05). However, the log OR of cataract and glaucoma diagnoses were different to RD or AACG (P < 0.05) in each period comparison. CONCLUSIONS Neuro-ophthalmic diagnoses had a similar reduction in diagnosis rates as emergent eye conditions in the first part of the pandemic, except optic neuritis. After widespread COVID-19 vaccination, all ophthalmic diagnosis rates increased compared with pre-pandemic rates, and the increase in neuro-ophthalmic diagnosis rates did not exceed the increase in RD and AACG diagnosis rates. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- David Zhao
- Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland.
| | - Ximin Li
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Niazi M, Shankayi Z, Asadi MM, Hasanalifard M, Zahiri A, Bahrami F. Electrophysiological analysis of ENG signals in patients with Covid-19. IBRO Neurosci Rep 2023; 15:151-157. [PMID: 37664820 PMCID: PMC10470297 DOI: 10.1016/j.ibneur.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/09/2023] [Indexed: 09/05/2023] Open
Abstract
Background Currently, there is an increasing number of patients reporting dizziness, which has resulted in a positive COVID-19 PCR test. In this paper, we analyzed the ENG signals recorded from patients with a positive COVID-19 PCR test. Methods In this paper, both linear and nonlinear analyses of time series were employed to determine the regularity and complexity of a recorded ENG signal. Results The Wilcoxon rank-sum test indicated that the COVID-19 and non-COVID groups have significant differences based on different extracted features. Various machine learning methods including Linear Discriminant Analysis (LDA), Naïve Base (NB), K-nearest Neighbours (KNN), and Support Vector Machines (SVM) were used to classify COVID-19 and non-COVID groups. The best accuracy, precision and FCR achieved by SVM are 86%, 91% and 0.13. Conclusion In this study, ENG signals were recorded from COVID-19 and control groups. Linear and non-linear features were extracted from the recorded signals to identify significantly different features. Subjects were classified based on SVM and different classifiers. The SVM (polynomial kernel) classifier showed the best result. The proposed method had not been used for the classification of COVID-19 and non-COVID-19 subjects before. This work helps other researchers conduct more research on the development of machine learning methods to diagnose the COVID-19 virus using ENG and other physiological signals.
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Affiliation(s)
- Mehdi Niazi
- Neuroscience Research Centre, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Department of Physiology and Medical Physics, School of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Zeinab Shankayi
- Neuroscience Research Centre, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Department of Physiology and Medical Physics, School of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammad Mahdi Asadi
- Baqiyatallah University of Medical Sciences, Students’ Research Committee, Tehran, Iran
| | - Mahdieh Hasanalifard
- New Hearing Technologies Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ali Zahiri
- Baqiyatallah University of Medical Sciences, Students’ Research Committee, Tehran, Iran
| | - Farideh Bahrami
- Neuroscience Research Centre, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Department of Physiology and Medical Physics, School of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Han JY, Kim S, Han J, Kim SS, Han SH, Lee SW, Kim YJ. Neuro-Ophthalmic Adverse Events of COVID-19 Infection and Vaccines: A Nationwide Cohort Study. Invest Ophthalmol Vis Sci 2023; 64:37. [PMID: 38010696 PMCID: PMC10683766 DOI: 10.1167/iovs.64.14.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/03/2023] [Indexed: 11/29/2023] Open
Abstract
Purpose To evaluate the association of COVID-19 infection and vaccination with neuro-ophthalmic adverse events. Methods In this nationwide population-based retrospective cohort study, 8,498,353 patients were classified into three groups: control, COVID-19 infection, and COVID-19 vaccination. We conducted separate analyses for the early phase (within 60 days) and late phases (61-180 days) to estimate the incidence rates and hazard ratio (HR) for each neuro-ophthalmic adverse event. The adverse events included in this analysis were optic neuritis, papilledema, ischemic optic neuropathy, third nerve palsy, fourth nerve palsy, sixth nerve palsy, facial palsy, nystagmus, ptosis, blepharospasm, anomalies of pupillary function, and Guillain-Barré syndrome/Miller Fisher syndrome (GBS/MFS). Results Neuro-ophthalmic adverse events other than ptosis and GBS/MFS exhibited no significant increase after COVID-19, and their incidence was extremely low. The incidence rate of ptosis in both phases was significantly higher in patients administered COVID-19 vaccination (HR = 1.65 in the early phase and HR = 2.02 in the late phase) than in the control group. Additionally, BNT162b2 conferred a lower ptosis risk than ChAdOx1. GBS/MFS had a significantly higher incidence rate in the early phase (HR = 5.97) in patients with COVID-19 infection than in the control group. Conclusions Ptosis was associated with COVID-19 vaccination, particularly with the ChAdOx1 vaccine, while GBS/MFS was associated with COVID-19 infection. In contrast, no association was found between other neuro-ophthalmic adverse events and COVID-19 infection or vaccination. These results may provide helpful insights for diagnosing and treating the neuro-ophthalmological adverse events after COVID-19.
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Affiliation(s)
- Jae Yong Han
- Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sunyeup Kim
- Department of Medical AI, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
| | - Jinu Han
- Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Soo Kim
- Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sueng-Han Han
- Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Won Lee
- Department of Precision Medicine, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
| | - Yong Joon Kim
- Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Republic of Korea
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8
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Matsumoto C, Silverman E, Ma L, Wang HC. Abducens Nerve Palsy in a 4-month-old Girl. Pediatr Rev 2023; 44:S63-S65. [PMID: 37777223 DOI: 10.1542/pir.2022-005571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Affiliation(s)
| | | | - Lawrence Ma
- University of California, San Diego, School of Medicine, Department of Pediatrics, San Diego, CA
| | - Helen C Wang
- University of California, San Diego, School of Medicine, Department of Pediatrics, San Diego, CA
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Baldwin G, Gaier ED, Hennein L. Isolated Sixth Nerve Palsy and COVID-19: A Recurrent Case in a 7-Month-Old Child and Analysis of Reported Cases. J Neuroophthalmol 2023:00041327-990000000-00452. [PMID: 37647242 PMCID: PMC10902200 DOI: 10.1097/wno.0000000000001989] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
BACKGROUND With the SARS-CoV-2 pandemic (COVID-19), data on central and peripheral nervous system involvement, including those causing cranial nerve 6 (CN6) palsy, have been limited to case reports. To extract clinically relevant features of COVID-19-related CN6 palsy, we report on a recurrent pediatric case and analysis of reported cases associated with infection or immunization. METHODS A PubMed search revealed 18 cases of isolated CN6 palsy in addition to the index case (n = 19). Clinical characteristics, workup, and temporal associations between systemic symptoms onset or vaccination, symptoms onset, and resolution were compiled and analyzed. RESULTS The median age of CN6 onset was 43 years (interquartile range [IQR]: 28-52). Sixteen cases (84.2%) were associated with COVID-19 illness and 3 (15.8%) were associated with COVID-19 vaccination. Four cases (23.5%) had positive neuroimaging findings. The median latency from first COVID-19 symptoms or vaccination to onset of CN6 palsy was 6 days (IQR: 2.3-16), and the median time from onset to resolution was 30 days (IQR: 14-60). Latency to onset of CN6 palsy was significantly and directly associated with time to resolution (R2 = 0.401, P = 0.010). Patients who had a positive SARS-CoV-2 antibody test had significantly longer days from symptoms to onset (6.0 vs 24.5, P = 0.030), and patients with a positive SARS-CoV-2 polymerase chain reaction test had a significantly shorter time to resolution (17.50 vs 90, P = 0.042). CONCLUSIONS Isolated CN6 palsy from COVID-19 is rare, can occur in infants as young as 7 months, and can be recurrent. Longer latency from systemic symptoms onset portends greater recovery times, and this relationship may reflect multiple mechanisms by which COVID-19 (and/or an immune response thereto) causes cranial neuropathies with direct clinical relevance.
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Affiliation(s)
| | - Eric D. Gaier
- Harvard Medical School, Boston, Massachusetts
- Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
- Picower Institute of Learning and Memory, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Lauren Hennein
- Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Ophthalmology, Rady Children’s Hospital – San Diego; San Diego, California
- The Viterbi Family Department of Ophthalmology, University of California San Diego, San Diego, California
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Gullapalli D, Vangara A, Kolagatla S, Gorrondona N, Moon J, Ganti SS, Depa J. COVID-19-Related Left-Sided Ptosis. Cureus 2023; 15:e41574. [PMID: 37554604 PMCID: PMC10406393 DOI: 10.7759/cureus.41574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 08/10/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) infection commonly presents with symptoms of fever, cough, and anosmia. However, there have been case reports of unusual symptoms associated with COVID-19. We encountered one such case where a 55-year-old male who tested positive for COVID-19 was noted to have, along with cough and vomiting, a new onset of left eyelid ptosis. COVID-19 infection and ptosis association is seldom seen and very few similar studies are reported.
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Affiliation(s)
| | - Avinash Vangara
- Internal Medicine, Appalachian Regional Healthcare, Harlan, USA
| | | | | | - Jessica Moon
- Internal Medicine, Lincoln Memorial University, Harrogate, USA
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Khor HD, Lott PW, Daman Huri SNR, Singh S, Iqbal T. COVID-19 and Crossed Eye: A Case Report and Literature Review. Cureus 2023; 15:e42722. [PMID: 37654949 PMCID: PMC10466450 DOI: 10.7759/cureus.42722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 09/02/2023] Open
Abstract
This study aims to report a case of neuro-ophthalmic manifestation in a coronavirus disease 2019 (COVID-19) patient and a literature review of neuro-ophthalmological manifestation in COVID-19 patients. A 57-year-old male presented with headache, giddiness, and sudden onset of diplopia over two days after having a flu-like illness. Clinical examination revealed bilateral bizarre extraocular movement with right lower motor neuron facial nerve palsy. A polymerase chain reaction test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was positive. Computed tomography (CT) and contrast-enhanced CT of the brain and CT venography were unremarkable. Magnetic resonance imaging (MRI) of the brain, magnetic resonance angiography of the circle of Willis, and MRI of the internal auditory meatus revealed a subacute pontine infarction with no leptomeningeal or cranial nerve enhancement and a normal circle of Willis. The patient received a course of oral prednisolone and clinical symptoms improved gradually. Articles published between December 2019 and June 2022 were included. A total of 23 cases, with 14 male and nine female patients, were summarized. The mean age at presentation was 46.95 years (range = 9-71 years), with the most affected age group ranging from 31 to 70 years (17 of 23 cases, 73.91%). Neuro-ophthalmological symptoms and signs can be isolated or associated with neurological syndromes. The manifestations include optic neuritis, isolated or multiple cranial nerve palsies, acute vision loss, Miller Fisher syndrome, myasthenia gravis, acute disseminated encephalomyelitis, Guillain-Barré syndrome, internuclear ophthalmoplegia, and cerebrovascular events. Diagnosing neuro-ophthalmic complications secondary to SARS-CoV-2 infection is challenging, as there are no pathognomonic symptoms to detect the disease. High clinical suspicion aids in early diagnosis and initiation of treatment may help in relieving the symptoms.
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Affiliation(s)
- Hui Di Khor
- Department of Ophthalmology, Faculty of Medicine, Universiti Malaya Eye Research Centre, Kuala Lumpur, MYS
| | - Pooi Wah Lott
- Department of Ophthalmology, Faculty of Medicine, Universiti Malaya Eye Research Centre, Kuala Lumpur, MYS
| | | | - Sujaya Singh
- Department of Ophthalmology, Faculty of Medicine, Universiti Malaya Eye Research Centre, Kuala Lumpur, MYS
| | - Tajunisah Iqbal
- Department of Ophthalmology, Faculty of Medicine, Universiti Malaya Eye Research Centre, Kuala Lumpur, MYS
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Spiteri R, Barakat S, Vukicevic M. COVID-19 and sudden-onset ocular neurogenic palsy in prior healthy patients: a systematic review. Strabismus 2023; 31:145-151. [PMID: 37448224 DOI: 10.1080/09273972.2023.2232419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
BACKGROUND The aim of this systematic review is to identify cases of neurogenic ocular palsy in the presence of COVID-19 and to document patient characteristics, type of palsy and possible aetiologies. METHODS A systematic search of PubMed, Medline and CINAHL databases was conducted on the 6th of January 2023 to identify cases of neurogenic ocular palsy in patients with current or previous COVID-19 infection. Data were pooled to summarise the neurogenic palsy, patient clinical characteristics and proposed palsy mechanisms. RESULTS The combined database search yielded 1197 articles. Of these, 23 publications consisting of 25 patients met the inclusion criteria. Most patients were male (68%) and ranged in age from 2 to 71 years (median=32.7, SD=21.4). Seven patients (28%) were children aged 2 to 10 years old. Abducens palsies were most common (68%) and the most common ocular presentation was diplopia (76%) with an average time of onset 15 days from testing positive to COVID-19 or having symptoms of the virus. Proposed mechanism of development of a neurogenic palsy secondary to COVID-19 infection was classified into one of three categories: vascular/thrombotic, a viral neuro-invasive or inflammatory virus-mediated immune response. DISCUSSION This study suggests that COVID-19 infection may be linked to oculomotor, trochlear and abducens nerve palsies and the underlying mechanisms may vary but are difficult to definitively establish. Further studies investigating the onset of neurogenic palsy secondary to COVID-19 infection is required.
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Affiliation(s)
- Ryan Spiteri
- Discipline of Orthoptics, School of Allied Health Human Services and Sport, La Trobe University, Melbourne
| | - Sousann Barakat
- Discipline of Orthoptics, School of Allied Health Human Services and Sport, La Trobe University, Melbourne
| | - Meri Vukicevic
- Discipline of Orthoptics, School of Allied Health Human Services and Sport, La Trobe University, Melbourne
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Kurysheva NI, Evdokimova OA, Nikitina AD. Eye damage in COVID-19. Part 2: posterior segment complications, neuro-ophthalmic manifestations, vaccination and risk factors. RUSSIAN OPHTHALMOLOGICAL JOURNAL 2023. [DOI: 10.21516/2072-0076-2023-16-1-157-167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Abstract
Posterior eye segment involvement in COVID-19 has varied manifestations: vascular, inflammatory, and neuronal. All of them are triggered by SARS-CoV-2 virus but they cannot be viewed as exclusively specific to COVID-19. According to the literature, the mean age of the patients varies from 17 to 75 with the median of 50 years. The median duration between the appearance of ophthalmic symptoms and the detection of COVID-19 was 12 days. The disease affects both men and women equally. Direct exposure to the virus, immune-mediated tissue damage, activation of the coagulation system, the prothrombotic state caused by a viral infection, concomitant diseases and medications used in the treatment contribute to the development of eye pathologies. Ophthalmologists should be aware of the possible relations of posterior eye segment pathologies, orbit and neuro-ophthalmic disorders with SARS-CoV-2, as well as the possible exacerbation of chronic forms of inflammatory eye diseases and autoimmune disorders due to anti-COVID-19 vaccination.
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Affiliation(s)
- N. I. Kurysheva
- Medical Biological University of Innovations and Continuing Education — A.I. Burnazyan Medical Biophysical Center;
Ophthalmological Center, Federal Medical and Biological Agency
| | - O. A. Evdokimova
- Medical Biological University of Innovations and Continuing Education — A.I. Burnazyan Medical Biophysical Center; Ophthalmological Center, Federal Medical and Biological Agency
| | - A. D. Nikitina
- Medical Biological University of Innovations and Continuing Education — A.I. Burnazyan Medical Biophysical Center; Ophthalmological Center, Federal Medical and Biological Agency
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14
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Kang K, Lee SY, Lee DC. Neuro-ophthalmologic symptoms after coronavirus disease 2019 vaccination: a retrospective study. BMC Ophthalmol 2023; 23:11. [PMID: 36604664 PMCID: PMC9813886 DOI: 10.1186/s12886-022-02747-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 12/19/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND There have been several studies on inflammatory ophthalmic diseases; however, few studies have reported neuro-ophthalmological symptoms, such as diplopia and ocular motor nerve palsy, after coronavirus disease 2019 (COVID-19) vaccination. Therefore, this study aimed to report neuro-ophthalmological symptoms in patients after COVID-19 vaccination. METHODS This was a retrospective study based on the medical records of 10 patients who visited our ophthalmology clinic in 2021 with symptoms, such as diplopia (nine patients) and decreased visual acuity (one patient), and showed findings, such as ocular motor nerve palsy, after vaccination against COVID-19. RESULTS One patient had third nerve palsy, two had sixth nerve palsy, and five had fourth nerve palsy. One patient complained of subjective binocular diplopia but all test results were normal. One patient presented with decreased visual acuity accompanied by a sudden increase in intraocular pressure and orbital cellulitis in the other eye. The symptoms improved gradually in most patients. Compared with previous studies, this study reported three cases of antiplatelet therapy that was initiated due to the older age of the patients and underlying diseases. CONCLUSION As COVID-19 vaccines can cause neuro-ophthalmological diseases, such as ocular motor nerve palsy, patients' age and underlying diseases should be considered while administering them.
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Affiliation(s)
- Kyumin Kang
- grid.412091.f0000 0001 0669 3109Department of Ophthalmology, School of Medicine, Keimyung University, 1095 Dalgubeol-Daero, Dalseo-Gu, Daegu, 42601 Republic of Korea
| | - Se Youp Lee
- grid.412091.f0000 0001 0669 3109Department of Ophthalmology, School of Medicine, Keimyung University, 1095 Dalgubeol-Daero, Dalseo-Gu, Daegu, 42601 Republic of Korea
| | - Dong Cheol Lee
- grid.412091.f0000 0001 0669 3109Department of Ophthalmology, School of Medicine, Keimyung University, 1095 Dalgubeol-Daero, Dalseo-Gu, Daegu, 42601 Republic of Korea
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15
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Meshref M, Shaheen N, Swed S, Ibrahim M, Mostafa MR, Algazar MO, Dobs M, Elsayed SI, Amro Y, Afsa A, Morra ME. An overview of third, fourth and sixth cranial nerve palsies in the setting of COVID-19: A case report and systematic review. Medicine (Baltimore) 2022; 101:e32023. [PMID: 36626529 PMCID: PMC9750665 DOI: 10.1097/md.0000000000032023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/04/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Covid-19 has serious sequelae that may be poorly understood, underreported, and, as a result, not diagnosed promptly, such as variations in clinical manifestations of hyperinflammation among people infected with SARS-CoV-2. ophthalmoplegia can be one of these manifestations. METHODS We are reporting a 55-year-old male patient with unilateral diplopia considering it as a case of multisystem inflammatory syndrome in adults. We also reviewed the literature systematically for the previously reported studies/cases with third, fourth and sixth cranial nerve palsies due to or after Covid-19. RESULTS The literature search yielded 17 studies reporting 29 patients. 71.4% of the patients were males with a mean age of 42.23 years. Ophthalmological symptoms took 9.7 days to appear after the respiratory involvement. All patients had diplopia as part of their visual symptoms. 41.4% of the patients had unilateral sixth nerve palsy, 24% had bilateral sixth nerve involvement, 17% had fourth nerve involvement, and 27.6% had third nerve involvement. CONCLUSION Ophthalmoplegia is considered presenting symptom of Covid-19. Further research is needed to detect all neuro-ophthalmological manifestations of Covid-19.
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Affiliation(s)
| | - Nour Shaheen
- Alexandria University, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Sarya Swed
- Aleppo University, Faculty of Medicine, Aleppo, Syria
| | - Mohamed Ibrahim
- Essex Partnership University NHS Foundation Trust, Wickford, UK
| | | | | | - Monica Dobs
- University of Florida College of Medicine Jacksonville, Jacksonville, USA
| | | | - Yara Amro
- Pharmacist Ministry of Health, Cairo, Egypt
| | - Ahmed Afsa
- Emergency Department, Pilgrim Hospital, United Lincolnshire NHS Trust, Boston, UK
| | - Mostafa Ebraheem Morra
- Gastroenterology Department, Pilgrim Hospital, United Lincolnshire NHS Trust, Boston, UK
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16
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Dinkin M, Sathi S. Efferent neuro-ophthalmic complications of coronavirus disease 2019. Curr Opin Ophthalmol 2022; 33:471-484. [PMID: 36165417 DOI: 10.1097/icu.0000000000000904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW We set out to describe efferent neuro-ophthalmological complications that have been reported in association with coronavirus disease 2019 (COVID-19) infection. We describe syndromes affecting ocular motility and elaborate on mechanisms of disease, including para-infectious inflammation, hypercoagulability, endothelial damage, and direct neurotropic viral invasion. Despite global vaccination programs, COVID-19 continues to pose an international threat that may rarely result in diplopia or nystagmus. RECENT FINDINGS Efferent complications include cranial nerve palsies leading to diplopia, either isolated or in association with Miller Fisher syndrome. Nystagmus has been observed in the setting of hemorrhagic acute necrotizing encephalopathy and brainstem infarcts, and opsoclonus syndrome has been described. SUMMARY Observed neuro-ophthalmic associations need to be confirmed through larger comparative studies. Meanwhile, the range of possible complications should be recognized by neurologists and ophthalmologists alike, to facilitate faster diagnosis and treatment of both COVID-19 and its neuro-ophthalmic manifestations.
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Affiliation(s)
- Marc Dinkin
- Departments of Ophthalmology and Neurology, Weill Cornell Medical College
| | - Swetha Sathi
- M2, Weill Cornell Medical College, New York, New York, USA
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17
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Škunca Herman J, Marić G, Ravlić MM, Knežević L, Jerković I, Sušić E, Marić V, Vicković IP, Vatavuk Z, Polašek O. Diplopia, COVID-19 and Vaccination: Results from a Cross-Sectional Study in Croatia. Vaccines (Basel) 2022; 10:vaccines10091558. [PMID: 36146636 PMCID: PMC9503164 DOI: 10.3390/vaccines10091558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/30/2022] [Accepted: 09/16/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to explore diplopia as a symptom of undetected COVID-19 infection or as a possible side effect of COVID-19 vaccination. We examined 380 patients with diplopia admitted to the Department of Ophthalmology of the University Hospital Centre Sestre milosrdnice in Zagreb, Croatia, from July 2020 to June 2022. After excluding patients with confirmed organic underlying diplopia causes or monocular diplopia, we linked the patient information with the national COVID-19 and vaccination registries. Among the 91 patients included in this study, previously undetected COVID-19 infection as the possible cause of diplopia was confirmed in five of them (5.5%). An additional nine patients (9.9%) were vaccinated within one month from the onset of their symptoms, while the remaining 77 had neither and were therefore considered as controls. The breakdown according to the mechanism of diplopia showed no substantial difference between the vaccinated patients and the controls. We detected marginally insignificant excess abducens nerve affection in the COVID-positive group compared with that in the controls (p = 0.051). Post-vaccination diplopia was equally common in patients who received vector-based or RNA-based vaccines (21.4 vs. 16.7%; p = 0.694). COVID-19 testing should be performed for all cases of otherwise unexplained diplopia. The risk of post-vaccination diplopia was similar in both types of vaccines administered, suggesting a lack of evidence linking specific vaccine types to diplopia.
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Affiliation(s)
- Jelena Škunca Herman
- Department of Ophthalmology, University Hospital Centre Sestre Milosrdnice, 10000 Zagreb, Croatia
| | - Goran Marić
- Department of Ophthalmology, University Hospital Centre Sestre Milosrdnice, 10000 Zagreb, Croatia
| | - Maja Malenica Ravlić
- Department of Ophthalmology, University Hospital Centre Sestre Milosrdnice, 10000 Zagreb, Croatia
| | - Lana Knežević
- Department of Ophthalmology, University Hospital Centre Sestre Milosrdnice, 10000 Zagreb, Croatia
| | - Ivan Jerković
- Department of Ophthalmology, University Hospital Centre Sestre Milosrdnice, 10000 Zagreb, Croatia
| | - Ena Sušić
- Department of Ophthalmology, University Hospital Centre Sestre Milosrdnice, 10000 Zagreb, Croatia
| | - Vedrana Marić
- Croatian Institute of Public Health, 10000 Zagreb, Croatia
| | - Ivanka Petric Vicković
- Department of Ophthalmology, University Hospital Centre Sestre Milosrdnice, 10000 Zagreb, Croatia
| | - Zoran Vatavuk
- Department of Ophthalmology, University Hospital Centre Sestre Milosrdnice, 10000 Zagreb, Croatia
| | - Ozren Polašek
- Department of Public Health, University of Split School of Medicine, 21000 Split, Croatia
- Algebra LAB, Algebra University College, 10000 Zagreb, Croatia
- Correspondence:
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18
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Capponi M, Cinicola BL, Brindisi G, Guido CA, Torcé MC, Zicari AM, Spalice A. COVID-19 and abducens nerve palsy in a 9-year-old girl-case report. Ital J Pediatr 2022; 48:102. [PMID: 35717391 PMCID: PMC9206130 DOI: 10.1186/s13052-022-01298-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/12/2022] [Indexed: 01/08/2023] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) is a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Although many reports have detailed a range of neurological symptoms in SARS-CoV-2-infected patients, studies of neuro-ophthalmological manifestations are still scarce. Case presentation We report a 9-year-old girl with abducens nerve palsy after COVID-19 with no evidence of other neurological disease on neuroimaging. At 2-month follow-up clinical conditions were improved. Conclusions The palsy may have occurred due to a possible post-infectious immune-mediated mechanism underlying the neuropathy, as opposed to direct viral infiltration. Despite being rare, this complication must be taken into account.
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Affiliation(s)
- Martina Capponi
- Department of Maternal Sciences, Sapienza University of Rome, Italy Viale Regina Elena, 324 00161, Rome, Italy
| | - Bianca Laura Cinicola
- Department of Maternal Sciences, Sapienza University of Rome, Italy Viale Regina Elena, 324 00161, Rome, Italy.,Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Giulia Brindisi
- Department of Maternal Sciences, Sapienza University of Rome, Italy Viale Regina Elena, 324 00161, Rome, Italy
| | - Cristiana Alessia Guido
- Department of Maternal Sciences, Sapienza University of Rome, Italy Viale Regina Elena, 324 00161, Rome, Italy.,Department of Developmental and Social Psychology, Sapienza University of Rome, Rome, Italy
| | | | - Anna Maria Zicari
- Department of Maternal Sciences, Sapienza University of Rome, Italy Viale Regina Elena, 324 00161, Rome, Italy
| | - Alberto Spalice
- Department of Maternal Sciences, Sapienza University of Rome, Italy Viale Regina Elena, 324 00161, Rome, Italy.
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19
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Kakil SB, Kosker M. A Rare Side Effect of COVID-19 Vaccination: Abducens Nerve Palsy. Klin Monbl Augenheilkd 2022; 239:913-915. [PMID: 35584770 DOI: 10.1055/a-1814-4523] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Sule Barman Kakil
- Ophthalmology, Ankara Diskapi Yildirim Beyzat Training and Research Hospital, Ankara, Turkey
| | - Mustafa Kosker
- Ophthalmology, Ankara Diskapi Yildirim Beyzat Training and Research Hospital, Ankara, Turkey
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20
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Ung L, Chodosh J. COVID-19 and the eye: alternative facts The 2022 Bowman Club, David L. Easty lecture. BMJ Open Ophthalmol 2022; 7:bmjophth-2022-001042. [PMID: 35675203 PMCID: PMC9114314 DOI: 10.1136/bmjophth-2022-001042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 04/18/2022] [Indexed: 01/08/2023] Open
Abstract
In addition to catastrophic loss of life, and dramatic and unwanted alterations to the daily lives of those left behind, the COVID-19 pandemic has fostered the publication and dissemination of an unprecedented quantity of peer-reviewed medical and scientific publications on a single subject. In particular, the ophthalmic literature is now replete with clinical and laboratory studies on putative eye involvement by SARS-CoV-2, the aetiologic agent of COVID-19. In this review, we critically appraise the published literature on COVID-19, and suggest that the quality of scientific peer review and editorial decision-making also suffered during the COVID-19 pandemic.
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Affiliation(s)
- Lawson Ung
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard University T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - James Chodosh
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
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21
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Jahanbani-Ardakani H, Khorrami S, Khalili MR. Paralysie du sixième nerf après le vaccin Covid-19. J Fr Ophtalmol 2022; 45:e309-e310. [PMID: 35672156 PMCID: PMC9114148 DOI: 10.1016/j.jfo.2022.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 03/25/2022] [Indexed: 11/27/2022]
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22
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Manolopoulos A, Katsoulas G, Kintos V, Koutsokera M, Lykou C, Lapaki KM, Acquaviva PT. Isolated Abducens Nerve Palsy in a Patient With COVID-19: A Case Report and Literature Review. Neurologist 2022; 27:139-142. [PMID: 34855673 PMCID: PMC9066501 DOI: 10.1097/nrl.0000000000000382] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The pandemic of coronavirus disease 2019 (COVID-19) stands as a major global health and social burden. As cases are growing, several other symptoms, besides the typical respiratory ones, are emerging. The involvement of the nervous system is increasingly recognized with manifestations ranging from hyposmia to meningoencephalitis and cranial neuropathies. CASE REPORT We report the case of a 41-year-old female patient who presented to the emergency department complaining of diplopia and headache over the last 2 days. She denied any medical history, as well as any other neurological or respiratory symptom. A detailed neurological and ophthalmological examination revealed a limitation to the abduction of the right eye due to palsy of the right lateral rectus muscle causing painless, horizontal diplopia in the right gaze. The computed tomography of the brain was normal. Based on the detected lymphopenia, she was tested for COVID-19 and was positive. The cerebrospinal fluid analysis showed no abnormalities, while also a repeated head computed tomography was similarly normal. The patient received no specialized medical treatment, and after 6 days, she was discharged home having a minimal degree of persistent diplopia. Two weeks later, brain magnetic resonance imaging was performed that was similarly unrevealing. CONCLUSIONS Isolated abducens nerve palsy can be the only presenting symptom in COVID-19. Although several pathophysiological mechanisms have been proposed, the exact nature of this manifestation has not been clarified yet. Vigilance is required by neurologists to detect and manage patients with such subtle clinical presentations.
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23
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Yabanoğlu D, Taylan Şekeroğlu H. How to Manage a Strabismus Clinic During the COVID-19 Pandemic; What is Really Urgent, What is Not?: A Single-Center Case Series from Turkey. Turk J Ophthalmol 2022; 52:96-101. [PMID: 35481730 PMCID: PMC9069093 DOI: 10.4274/tjo.galenos.2021.69263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objectives: To evaluate the management of the pediatric ophthalmology and strabismus clinic when strict quarantine conditions were adopted during the coronavirus disease 2019 (COVID-19) pandemic in Turkey. Materials and Methods: The study presents a review of the patients examined during the quarantine period. All patients were assessed with the highest possible level of personal protection. Results: Ten patients (6 girls, 4 boys) with a mean age of 9 years (range: 2-16) were evaluated. The patients presented 3-20 days after symptom onset. Ocular misalignment and diplopia were the main symptoms. Four of the 10 patients were diagnosed with sixth cranial nerve palsy and three patients were diagnosed with acute-onset comitant esotropia. Six patients had significant cranial magnetic resonance imaging findings. Conclusion: Acute-onset neurological conditions are more common during the COVID-19 pandemic. These reports will contribute to global experience and understanding of COVID-19.
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Affiliation(s)
- Demet Yabanoğlu
- Hacettepe University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
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24
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Elhusseiny AM, Sanders RN, Siddiqui MZ, Sallam AB. Non-arteritic Anterior Ischemic Optic Neuropathy with Macular Star following COVID-19 Vaccination. Ocul Immunol Inflamm 2022; 30:1274-1277. [PMID: 35412946 DOI: 10.1080/09273948.2022.2059522] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE To report a case of non-arteritic anterior ischemic optic neuropathy (NAAION) with macular star after receiving the second dose of SARS-CoV-2 vaccination. METHOD Case report. OBSERVATION A 51-year-old male presented with acute visual disturbances one day after the second dose of BNT162b2 mRNA SARS-CoV-2 vaccination. At presentation, best corrected visual acuity (BCVA) was 20/25 right eye (OD) and counting fingers at 3 feet left eye (OS). Anterior segment examination was normal in both eyes. Dilated fundoscopy was unremarkable OD, however, it disclosed optic nerve swelling and subretinal fluid OS. Patient was treated with a gradual tapering dose of oral prednisone over 1 month. At the five-week follow-up visit, optic disc swelling and subretinal fluid resolved with minimal improvement in BCVA to 20/400 OS. CONCLUSION It is unclear whether COVID-19 vaccination was the triggering agent to the NAAION or just a coincidence, yet ophthalmologists should be aware of such a possible association.
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Affiliation(s)
- Abdelrahman M Elhusseiny
- Department of Ophthalmology, Bernice and Harvey Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Riley N Sanders
- Department of Ophthalmology, Bernice and Harvey Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Mohammad Z Siddiqui
- Department of Ophthalmology, Bernice and Harvey Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Ahmed B Sallam
- Department of Ophthalmology, Bernice and Harvey Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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25
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Estakhr M, Tabrizi R, Ghotbi Z, Shahabi S, Habibzadeh A, Bashi A, Borhani-Haghighi A. Is facial nerve palsy an early manifestation of COVID-19? A literature review. Am J Med Sci 2022; 364:264-273. [PMID: 35429449 PMCID: PMC9007824 DOI: 10.1016/j.amjms.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 03/04/2022] [Accepted: 04/08/2022] [Indexed: 11/01/2022]
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26
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Prajwal S, Ikechukwu A, Bharosa S, Benjamin M. Superior Divisional Palsy of the Oculomotor Nerve as a Presenting Sign of SARS-CoV-2 (COVID-19). J Investig Med High Impact Case Rep 2022; 10:23247096211058490. [PMID: 35225028 PMCID: PMC8891916 DOI: 10.1177/23247096211058490] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Although COVID is a predominantly respiratory disease, recent studies demonstrate variable and atypical presentations with multiorgan involvement. Neurological manifestations involving cranial nerves and the peripheral nervous system are more frequently being described. Although mechanisms are still under investigation, several studies demonstrate the neuroinvasive potential of COVID via angiotensin-converting enzyme 2 (ACE2) receptor interactions and postulate this mechanism to be the route of COVID central nervous system (CNS) infection. We present the rare case of a purely superior divisional palsy of the left oculomotor nerve in a 46-year-old woman with no medical history in the setting of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, confirmed by magnetic resonance imaging (MRI) findings of asymmetrical thickening and enhancement of the left oculomotor nerve. With this report, we hope to increase clinical suspicion for oculomotor nerve palsies as a manifestation of SARS-CoV-2 infection and also to inspire further studies investigating neurological manifestations of COVID.
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Affiliation(s)
| | | | - Sharma Bharosa
- John H. Stroger Jr. Hospital of Cook County, Chicago, IL, USA
| | - Mba Benjamin
- John H. Stroger Jr. Hospital of Cook County, Chicago, IL, USA
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27
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Kerbage A, Haddad SF, Haddad F. Presumed oculomotor nerve palsy following COVID-19 vaccination. SAGE Open Med Case Rep 2022; 10:2050313X221074454. [PMID: 35251658 PMCID: PMC8891821 DOI: 10.1177/2050313x221074454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 01/03/2022] [Indexed: 11/15/2022] Open
Abstract
We herein report the case of an 84-year-old female who presented to the outpatient clinic one day following her first dose of the Pfizer-BioNTech COVID-19 vaccine with mydriasis, ptosis, and a “down and out” gaze. She was subsequently diagnosed with oculomotor nerve palsy, and treated with corticosteroids and valacyclovir for a total of 7 days, with no clear improvement. On subsequent visits, ophthalmic examination improved steadily and showed complete resolution after 8 weeks. This article aims to report this unusual incidence that occurred following vaccination with the Pfizer-BioNTech COVID-19 vaccine. It is important for physicians to identify and report abnormal occurrences which may potentially be related to the COVID-19 vaccines, in order to reach a complete understanding of their possible side effects.
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Affiliation(s)
- Anthony Kerbage
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
- Hôtel-Dieu de France Hospital, Saint-Joseph University, Beirut, Lebanon
| | - Sara F. Haddad
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Fady Haddad
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
- Department of Internal Medicine and Clinical Immunology, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
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28
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Abstract
Although coronavirus disease-2019 (COVID-19) is mainly a respiratory system disease, neurological complications due to peripheral and central nervous system involvement may be seen in these patients. In this case report, we described a patient with isolated abducens nerve palsy after COVID-19. The patient was a healthy 28-year-old man who developed isolated abducens nerve palsy 10 days after COVID-19. He had no systemic risk factors. He had 20 PD left esotropia (ET) at distance and 16 PD left ET at near in primary position and ET increasing to 25 PD in left gaze. He had left abduction deficiency. His cranio-orbital magnetic resonance imaging findings were normal. He was diagnosed as left isolated abducens nerve palsy and his findings were recovered after 2 months. COVID-19 may cause ocular motor nerve palsies. Although the pathological mechanism remains unclear, direct viral invasion, inflammatory and immune mechanisms may play role. Further case reports and studies are needed to support these findings.
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Affiliation(s)
| | | | - Huban Atilla
- School of Medicine, Department of Ophthalmology, Ankara University, Ankara
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29
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Finsterer J. The Broad Spectrum of Neuro-Radiological Abnormalities in Patients Infected with SARS-CoV-2 Supports the Diagnosis of Neuro-COVID-19. Korean J Radiol 2022; 23:150-152. [PMID: 34983101 PMCID: PMC8743152 DOI: 10.3348/kjr.2021.0746] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 10/15/2021] [Indexed: 01/27/2023] Open
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30
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Soni R, Mamidi S, Dhull P, Singh S, Muthukrishan J. Post-COVID neurological complication; A case series and review of the literature. JOURNAL OF MARINE MEDICAL SOCIETY 2022. [DOI: 10.4103/jmms.jmms_132_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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31
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Kubota T, Sugeno N, Sano H, Murakami K, Ikeda K, Misu T, Aoki M. The Immediate Onset of Isolated and Unilateral Abducens Nerve Palsy Associated with COVID-19 Infection: A Case Report and Literature Review. Intern Med 2022; 61:1761-1765. [PMID: 35650115 PMCID: PMC9259311 DOI: 10.2169/internalmedicine.9308-22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Cranial nerve palsy associated with coronavirus disease 2019 (COVID-19) is rare. We herein report the first Asian case of the immediate onset of isolated and unilateral abducens nerve palsy (ANP) accompanied with COVID-19 infection. A 25-year-old man developed diplopia one day after the COVID-19 symptom onset. Neurological examination revealed limitation of left eye abduction without ataxia and hyporeflexia. Negative anti-ganglioside antibody results and mild albuminocytological dissociation were noted. The patient was diagnosed with left ANP accompanied by COVID-19 infection. The ANP spontaneously recovered without treatment. ANP can develop during the early phase of COVID-19 infection and adversely affect patients' quality of life.
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Affiliation(s)
- Takafumi Kubota
- Department of Neurology, Tohoku University Graduate School of Medicine, Japan
| | - Naoto Sugeno
- Department of Neurology, Tohoku University Graduate School of Medicine, Japan
| | - Hirohito Sano
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Koji Murakami
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Kensuke Ikeda
- Department of Neurology, Tohoku University Graduate School of Medicine, Japan
| | - Tatsuro Misu
- Department of Neurology, Tohoku University Graduate School of Medicine, Japan
| | - Masashi Aoki
- Department of Neurology, Tohoku University Graduate School of Medicine, Japan
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32
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Soltani S, Zandi M, Ahmadi SE, Zarandi B, Hosseini Z, Akhavan Rezayat S, Abyadeh M, Pakzad I, Malekifar P, Pakzad R, Mozhgani SH. Pooled Prevalence Estimate of Ocular Manifestations in COVID-19 Patients: A Systematic Review and Meta-Analysis. IRANIAN JOURNAL OF MEDICAL SCIENCES 2022; 47:2-14. [PMID: 35017772 PMCID: PMC8743370 DOI: 10.30476/ijms.2021.89475.2026] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 04/22/2021] [Accepted: 06/05/2021] [Indexed: 01/08/2023]
Abstract
Background There are reports of ocular tropism due to respiratory viruses such as severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Various studies have shown ocular manifestation in coronavirus disease-2019 (COVID-19) patients. We aimed to identify ophthalmic manifestations in COVID-19 patients and establish an association between ocular symptoms and SARS-CoV-2 infection. Methods A systematic search of Medline, Scopus, Web of Science, Embase, and Cochrane Library was conducted for publications from December 2019 to April 2021. The search included MeSH terms such as SARS-CoV-2 and ocular manifestations. The pooled prevalence estimate (PPE) with 95% confidence interval (CI) was calculated using binomial distribution and random effects. The meta-regression method was used to examine factors affecting heterogeneity between studies. Results Of the 412 retrieved articles, 23 studies with a total of 3,650 COVID-19 patients were analyzed. The PPE for any ocular manifestations was 23.77% (95% CI: 15.73-31.81). The most prevalent symptom was dry eyes with a PPE of 13.66% (95% CI: 5.01-25.51). The PPE with 95% CI for conjunctival hyperemia, conjunctival congestion/conjunctivitis, and ocular pain was 13.41% (4.65-25.51), 9.14% (6.13-12.15), and 10.34% (4.90-15.78), respectively. Only two studies reported ocular discomfort and diplopia. The results of meta-regression analysis showed that age and sample size had no significant effect on the prevalence of any ocular manifestations. There was no significant publication bias in our meta-analysis. Conclusion There is a high prevalence of ocular manifestations in COVID-19 patients. The most common symptoms are dry eyes, conjunctival hyperemia, conjunctival congestion/conjunctivitis, ocular pain, irritation/itching/burning sensation, and foreign body sensation.
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Affiliation(s)
- Saber Soltani
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,Research Center for Clinical Virology, Department of Virology, Tehran University of Medical Sciences, Tehran, Iran
| | - Milad Zandi
- Department of Hematology and Blood Banking, School of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran.,Hepatitis Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Seyed-Esmaeil Ahmadi
- Department of Hematology and Blood Banking, School of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Bahman Zarandi
- Department of Hematology and Blood Banking, School of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Zeinab Hosseini
- Hepatitis Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Sara Akhavan Rezayat
- Department of Health Economics and Management, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Morteza Abyadeh
- Cell Science Research Center, Department of Molecular Systems Biology, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Iraj Pakzad
- Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran.,Department of Microbiology, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Pooneh Malekifar
- Department of Epidemiology, School of Public Health, Tehran University Medical Sciences, Tehran, Iran
| | - Reza Pakzad
- 0Department of Epidemiology, Faculty of Health, Ilam University Medical Sciences, Ilam, Iran.,1Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Sayed-Hamidreza Mozhgani
- 2Department of Microbiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran.,3Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
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Dean A, Said A, Marri K, Chelius D. Stridor Due to Cranial Nerve X Palsy Progressing to Polyneuropathy in a Teenager With COVID-19. Pediatrics 2021; 148:183397. [PMID: 34851417 DOI: 10.1542/peds.2021-051534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 11/24/2022] Open
Abstract
The neurologic manifestations of coronavirus disease 2019 (COVID-19) are wide-ranging, including various cranial neuropathies, beyond anosmia and dysgeusia, the exact neuropathological mechanism of which are yet unknown. Acute cranial nerve (CN) X neuritis with vocal cord paralysis has not been reported in COVID-19 and is a rare presentation of neuropathy in general. A girl aged 14 years was admitted with stridor. She was diagnosed with symptomatic COVID-19 8 days before. By presentation, fever had resolved, but she had developed stridor; sore throat with dysphagia; chest, shoulder, and back pain; and generalized weakness. Neurologic examination and laryngoscopy were consistent with isolated left CN X palsy. Steroids were started, but neurologic disease progressed with subjective pain, right lower face numbness, and eye fatigability. Respiratory distress increased, and she was intubated for airway protection. MRI revealed abnormal enhancement of CNs III, V, XII, and X. Cerebrospinal fluid studies were normal. Nasopharyngeal severe acute respiratory syndrome coronavirus 2 polymerase chain reaction test result was positive. She was treated with intravenous immunoglobulin, a total of 2 g/kg, and steroids were continued. She made a full neurologic recovery and was discharged after 9 days of hospitalization. This is a case of a teenager who presented with an acute, life-threatening CN X palsy and development of a progressive polyneuropathy in the setting of COVID-19. Although there was concern for Guillain-Barre syndrome, a definitive diagnosis could not be made, and the unusual features of this case, including presentation with stridor and predominate CN involvement seem to indicate a separate symptomatic COVID-19-associated polyneuritis.
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Affiliation(s)
| | | | | | - Daniel Chelius
- Otolaryngology, Baylor College of Medicine, Houston, Texas
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Marsiglia M, Chwalisz BK, Maher M. Neuroradiologic Imaging of Neurologic and Neuro-Ophthalmic Complications of Coronavirus-19 Infection. J Neuroophthalmol 2021; 41:452-460. [PMID: 34788237 PMCID: PMC8582975 DOI: 10.1097/wno.0000000000001454] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND To review the literature and provide a summary of COVID-19-related neurologic and neuro-ophthalmic complications. METHODS The currently available literature was reviewed on PubMed and Google Scholar using the following keywords for searches: CNS, Neuro-Ophthalmology, COVID-19, SARS-CoV-2, coronavirus, optic neuritis, pseudotumor cerebri, Acute Disseminated Encephalomyelitis, posterior reversible encephalopathy syndrome (PRES), meningitis, encephalitis, acute necrotizing hemorrhagic encephalopathy, and Guillain-Barré and Miller Fisher syndromes. RESULTS Neuroradiologic findings of neurologic and neuro-ophthalmologic complications in relationship to COVID-19 infection were reviewed. Afferent visual pathway-related disorders with relevant imaging manifestations included fundus nodules on MRI, papilledema and pseudotumor cerebri syndrome, optic neuritis, Acute Disseminated Encephalomyelitis, vascular injury with thromboembolism and infarct, leukoencephalopathy, gray matter hypoxic injury, hemorrhage, infectious meningitis/encephalitis, acute necrotizing hemorrhagic encephalopathy, and PRES. Efferent visual pathway-related complications with relevant imaging manifestations were also reviewed, including orbital abnormalities, cranial neuropathy, Guillain-Barré and Miller Fisher syndromes, and nystagmus and other eye movement abnormalities related to rhombencephalitis. CONCLUSION COVID-19 can cause central and peripheral nervous system disease, including along both the afferent and efferent components of visual axis. Manifestations of disease and long-term sequela continue to be studied and described. Familiarity with the wide variety of neurologic, ophthalmic, and neuroradiologic presentations can promote prompt and appropriate treatment and continue building a framework to understand the underlying mechanism of disease.
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Pawar N, Ravindran M, Padmavathy S, Chakrabarty S. Acute abducens nerve palsy after COVID-19 vaccination in a young adult. Indian J Ophthalmol 2021; 69:3764-3766. [PMID: 34827043 PMCID: PMC8837376 DOI: 10.4103/ijo.ijo_1968_21] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We present the case of a 23-year-old young man with left-eye abducens nerve palsy following the COVID-19 vaccination. Given the temporal relationship between vaccination and the onset of symptoms, the lack of systemic history, and unremarkable magnetic resonance imaging, the patient’s abducens nerve palsy was related to his vaccination. The ophthalmologist should be aware of this neurotropic sequela of COVID-19 vaccination in young adults.
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Affiliation(s)
- Neelam Pawar
- Department of Paediatric Opthalmology and Strabismus, Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India
| | - Meenakshi Ravindran
- Department of Paediatric Opthalmology and Strabismus, Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India
| | - S Padmavathy
- Department of Neurophthalmology, Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India
| | - Sabyasachi Chakrabarty
- Department of Paediatric Opthalmology and Strabismus, Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India
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Lin TP, Ko CN, Zheng K, Lai KH, Wong RL, Lee A, Zhang S, Huang SS, Wan KH, Lam DS. COVID-19: Update on Its Ocular Involvements, and Complications From Its Treatments and Vaccinations. Asia Pac J Ophthalmol (Phila) 2021; 10:521-529. [PMID: 34839344 PMCID: PMC8673850 DOI: 10.1097/apo.0000000000000453] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/10/2021] [Indexed: 01/08/2023] Open
Abstract
ABSTRACT The coronavirus disease 2019 (COVID-19) came under the attention of the international medical community when China first notified the World Health Organization of a pneumonia outbreak of then-unknown etiology in Wuhan in December 2019. Since then, COVID-19 caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has appalled the world by spreading at a pandemic speed. Although ophthalmologists do not directly engage in the clinical care of COVID-19 patients, the ophthalmology community has become aware of the close ties between its practice and the pandemic. Not only are ophthalmologists at heightened risk of SARS-CoV-2 exposure due to their physical proximity with patients in routine ophthalmic examinations, but SARS-CoV-2 possesses ocular tropism resulting in ocular complications beyond the respiratory tract after viral exposure. Furthermore, patients could potentially suffer from adverse ocular effects in the therapeutic process. This review summarized the latest literature to cover the ophthalmic manifestations, effects of treatments, and vaccinations on the eye to aid the frontline clinicians in providing effective ophthalmic care to COVID-19 patients as the pandemic continues to evolve.
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Affiliation(s)
- Timothy P.H. Lin
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | | | - Ke Zheng
- C-MER (Beijing) Dennis Lam Eye Hospital, Beijing, China
| | - Kenny H.W. Lai
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
- C-MER International Eye Care Group, Hong Kong
| | - Raymond L.M. Wong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
- C-MER International Eye Care Group, Hong Kong
| | - Allie Lee
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | | | - Suber S. Huang
- Retina Center of Ohio, Cleveland, OH, US
- Bascom Palmer Eye Institute, Miami, FL, US
| | - Kelvin H. Wan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Dennis S.C. Lam
- C-MER International Eye Research Center of The Chinese University of Hong Kong (Shenzhen), China
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37
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Adverse Ocular Events following COVID-19 Vaccination. Inflamm Res 2021; 70:1005-1009. [PMID: 34561753 PMCID: PMC8475832 DOI: 10.1007/s00011-021-01506-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 08/28/2021] [Accepted: 09/13/2021] [Indexed: 12/15/2022] Open
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38
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Early reversible leukoencephalopathy and unilateral sixth cranial nerve palsy in mild COVID-19 infection. Neurol Sci 2021; 42:4899-4902. [PMID: 34482471 PMCID: PMC8418453 DOI: 10.1007/s10072-021-05545-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/31/2021] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To provide new insights into neurological manifestations of COVID-19. We describe a patient with mild COVID-19 associated with diplopia from right sixth cranial nerve palsy and early diffuse leukoencephalopathy, successfully treated with intravenous methylprednisolone. METHODS The patient was evaluated for diplopia that occurred 1 day after the onset of fever, myalgia, and headache. A complete neurological workup, including neurological examination, cerebrospinal fluid (CSF) analysis with viral polymerase chain reaction (PCR), serum autoimmune encephalitis, and anti-nerve antibodies and brain magnetic resonance imaging (MRI), was performed. RESULTS Clinical examination revealed incomplete right sixth cranial nerve palsy. Brain MRI showed diffuse confluent fluid-attenuated inversion recovery (FLAIR) hyperintense white matter abnormalities, while CSF analysis showed mild hyperproteinorrachia (61 mg/dL) without pleocytosis. The patients were treated with high-dose intravenous methylprednisolone with rapid improvement of neurological symptoms and resolution of CSF and MRI abnormalities. DISCUSSION Our report shows that COVID-19 may predominantly present with neurological symptoms; furthermore, it argues the notion of leukoencephalopathy as a typical feature of a severe case of the disease. Mechanisms underpinning neurological symptoms in COVID-19 still need to be elucidated; nonetheless, early recognition and prompt management may ensure their improvement or even complete recovery and are therefore recommended.
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Doblan A, Kaplama ME, Ak S, Basmacı N, Tarini EZ, Göktaş ŞE, Güler S, Müderris T. Cranial nerve involvement in COVID-19. Am J Otolaryngol 2021; 42:102999. [PMID: 33838359 PMCID: PMC7997027 DOI: 10.1016/j.amjoto.2021.102999] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 03/15/2021] [Indexed: 12/21/2022]
Abstract
Introduction The COVID-19 disease emerged in Wuhan province of China in November 2019 and spread across the world in a short time, resulting in a pandemic. The first case in Turkey was detected on March 11, 2020. The aim of the current study was to reveal the effects of COVID-19 on cranial nerves by monitoring people infected with the disease based on repeated examinations and surveys. Material and method The data of 356 patients with a positive COVID-19 polymerase chain reaction (PCR) test who received treatment between June 2020 and August 2020 in our hospital were prospectively evaluated after the study was approved by the relevant ethics committee. Results Of the 356 patients included in the study, 47 under the age of 18 years were excluded due to their unreliable examination and anamnesis findings. In addition, seven patients that died while in hospital were excluded from the study due to the lack of examination and survey records during their hospitalization. The data of the remaining 302 patients were statistically analyzed. Symptoms of cranial nerve involvement were observed in 135 patients. Conclusion The COVID-19 disease caused by the SARS-CoV2 virus commonly results in cranial nerve symptoms. The fact that these findings are more common and severe in COVID-19 than previous SARS and MERS outbreaks suggests that it has a more neurotrophic and more aggressive neuroinvasion. While the negative effects of the virus on sensory functions resulting from cranial nerve involvement are evident, motor functions are rarely affected.
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40
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Association Between Novel Coronavirus Disease 2019 (COVID-19) and Idiopathic Intracranial Hypertension. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2021. [DOI: 10.5812/pedinfect.115171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Idiopathic intracranial hypertension (IIH), also known as pseudotumor cerebri, is a rare neurological manifestation of coronavirus disease 2019 (COVID-19) infection. Case Presentation: In this case study, we present a 10-year-old girl with headache, diplopia, bilateral sixth nerve palsy, and papilledema following a history of seven days of fever about two weeks ago. In lumbar puncture, the opening pressure was 56 cmH2O. Cerebrospinal fluid analysis was normal. Brain magnetic resonance imaging (MRI) was suggestive of IIH. Nasopharyngeal reverse transcription-polymerase chain reaction (RT-PCR) was positive for COVID-19. Oral acetazolamide was prescribed, and the patient improved completely after three weeks of continuous medical treatment. Conclusions: Since IIH is a rare neurological complication of COVID-19, we have to suspect COVID-19 infection in any patient with IIH.
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41
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Betsch D, Freund PR. Neuro-Ophthalmologic Manifestations of Novel Coronavirus. ADVANCES IN OPHTHALMOLOGY AND OPTOMETRY 2021; 6:275-288. [PMID: 33937586 PMCID: PMC8080156 DOI: 10.1016/j.yaoo.2021.04.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Devin Betsch
- Department of Ophthalmology & Visual Sciences, Dalhousie University, QEII Health Sciences Centre, 2035-2 West Victoria Building, 1276 South Park Street, Halifax, Nova Scotia B3H 2Y9, Canada
| | - Paul R Freund
- Department of Ophthalmology & Visual Sciences, Dalhousie University, QEII Health Sciences Centre, 2035-2 West Victoria Building, 1276 South Park Street, Halifax, Nova Scotia B3H 2Y9, Canada
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42
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Mechel E, Trinh M, Kodsi S, Hymowitz M, Kainth MK, Lee AM. Ophthalmia neonatorum as the presenting sign of SARS-CoV-2. J AAPOS 2021; 25:230-231. [PMID: 33774164 PMCID: PMC7989099 DOI: 10.1016/j.jaapos.2021.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/09/2021] [Accepted: 03/14/2021] [Indexed: 11/28/2022]
Abstract
The most common ocular manifestation of SARS-CoV-2 in adults and children is acute conjunctivitis. We report the case of a 4-day-old infant who presented with acute-onset mucopurulent discharge of the left eye as well as subconjunctival hemorrhage and palpebral injection, without corneal findings. A diagnosis of ophthalmia neonatorum was established, for which ocular cultures and Gram staining were performed. No bacterial growth was noted, and polymerase chain reaction (PCR) testing for Chlamydia trachomatis, Neisseria gonorrhea, and herpes simplex were negative. Nasopharyngeal and conjunctival SARS-CoV-2 PCR were positive. Given the identification of SARS-CoV-2 illness, lack of other underlying bacterial or viral etiology on testing, and the well-documented ability for SARS-CoV-2 to cause conjunctivitis, the clinical picture was supportive of ophthalmia neonatorum secondary to SARS-CoV-2. The infant was treated with ceftriaxone and azithromycin prior to culture results. During admission, no systemic findings of Covid-19 illness were observed.
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Affiliation(s)
- Elzbieta Mechel
- Department of Ophthalmology, Northwell Health, Great Neck, New York
| | - Minh Trinh
- Department of Ophthalmology, Northwell Health, Great Neck, New York
| | - Sylvia Kodsi
- Department of Ophthalmology, Northwell Health, Great Neck, New York; Department of Pediatrics, Cohen Children's Medical Center, Northwell Health, Queens, New York; Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, Hempstead, New York.
| | - Maggie Hymowitz
- Department of Ophthalmology, Northwell Health, Great Neck, New York; Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, Hempstead, New York
| | - Mundeep K Kainth
- Department of Pediatrics, Cohen Children's Medical Center, Northwell Health, Queens, New York; Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, Hempstead, New York; Institute of Molecular Medicine, Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York
| | - Alice M Lee
- Department of Pediatrics, Cohen Children's Medical Center, Northwell Health, Queens, New York; Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, Hempstead, New York
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Phlyctenular Keratoconjunctivitis in a Patient With COVID-19 Infection. Cornea 2021; 40:1502-1504. [PMID: 34320598 DOI: 10.1097/ico.0000000000002789] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 04/26/2021] [Indexed: 01/08/2023]
Abstract
ABSTRACT The coronavirus disease 2019 global pandemic is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Several ophthalmic manifestations have been reported to be associated with SARS-CoV-2 infection, including conjunctivitis, acute sixth nerve palsy, and multiple cranial neuropathies. We present a unique case of unilateral phlyctenular keratoconjunctivitis in a 5-year-old boy in the setting of SARS-CoV-2 infection.
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Korkmaz MÖ, Güven M. Unilateral Vocal Cord Paralysis Case Related to COVID-19. ACTA ACUST UNITED AC 2021; 3:2319-2321. [PMID: 34337326 PMCID: PMC8300071 DOI: 10.1007/s42399-021-01024-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2021] [Indexed: 01/06/2023]
Abstract
Although the most common neuro-otolaryngological findings associated with COVID-19 infection are chemosensory changes, it should be known that these patients may present with different clinical findings. We present a 57-year-old woman who developed progressive hoarseness while suffering from COVID-19 infection without a history of chronic disease or any other etiological cause. Laryngeal fiberscopy revealed left vocal cord fixed at the cadaveric position and there was a 5-6-mm intraglottic gap during phonation. No other etiological causes were found in the examinations performed with detailed ear-nose-throat examination, neurological evaluations, and imaging methods. Injection laryngoplasty was applied to the patient, and voice therapy was initiated, resulting in significant improvement in voice quality. The mechanism of the idiopathic vocal cord paralysis remains unclear; it is suspected to be related to COVID-19 neuropathy, because the patient had no pre-existing vascular risk factors or evidence of other neurologic diseases on neuroimaging. Laryngeal nerve palsies may represent part of the neurologic spectrum of COVID-19. When voice changes occur in patients during COVID 19 infection, the possibility of vocal cord paralysis due to peripheral nerve damage caused by the SARS-CoV-2 should be considered.
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Affiliation(s)
- Müge Özçelik Korkmaz
- Otorhinolaryngology Department, Medical Faculty, Training and Research Hospital, Sakarya University, Sakarya, Turkey
| | - Mehmet Güven
- Otorhinolaryngology Department, Medical Faculty, Training and Research Hospital, Sakarya University, Sakarya, Turkey
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Sutandi N, Lee F. Vitreoretinal abnormalities in corona virus disease 2019 patients: What we know so far. Taiwan J Ophthalmol 2021; 11:232-243. [PMID: 34703738 PMCID: PMC8493986 DOI: 10.4103/tjo.tjo_30_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 07/10/2021] [Indexed: 12/14/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) has become a global pandemic since December 2019. Although COVID-19 primarily affects the respiratory systems, it has become abundantly clear that it involves multiple organs including the heart, kidney, skin, and brain. Neuro-ophthalmic signs and anterior segment inflammation of the eyes were documented in COVID-19 patients recently. Small but growing number of literatures has also reported the cases of new onset vitreoretinal disorders related to COVID-19 infection. A comprehensive search from four online databases was done. Findings show vitreoretinal involvement in COVID-19 patients including the central retinal vein occlusion, central retinal artery occlusion, reactivation of previous uveitis, chorioretinitis, macular hemorrhage, acute macular neuroretinopathy, paracentral acute middle maculopathy, vitritis with outer retinal abnormalities, varicella zoster virus-related acute retinal necrosis in immunocompromised patient, and other posterior segment pathological changes. The hypotheses for potential pathogenesis of these manifestations are direct viral ocular infection and thromboembolic complications secondary to the hyperinflammatory response. This is the first review article, which provides an overview of current evidence regarding the vitreoretinal manifestations in COVID-19 patients.
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Affiliation(s)
- Nathania Sutandi
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia
| | - Felix Lee
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia
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Jafari Khaljiri H, Jamalkhah M, Amini Harandi A, Pakdaman H, Moradi M, Mowla A. Comprehensive Review on Neuro-COVID-19 Pathophysiology and Clinical Consequences. Neurotox Res 2021; 39:1613-1629. [PMID: 34169404 PMCID: PMC8225460 DOI: 10.1007/s12640-021-00389-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/14/2021] [Accepted: 06/16/2021] [Indexed: 01/08/2023]
Abstract
Aside from the respiratory distress as the predominant clinical presentation of SARS-CoV-2 infection, various neurological complications have been reported with the infection during the ongoing pandemic, some of which cause serious morbidity and mortality. Herein, we gather the latest anatomical evidence of the virus's presence within the central nervous system. We then delve into the possible SARS-CoV-2 entry routes into the neurological tissues, with the hematogenous and the neuronal routes as the two utmost passage routes into the nervous system. We then give a comprehensive review of the neurological manifestations of the SARS-CoV-2 invasion in both the central and peripheral nervous system and its underlying pathophysiology via investigating large studies in the field and case reports in cases of study scarcity.
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Affiliation(s)
- Helia Jafari Khaljiri
- Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Monire Jamalkhah
- Department of Biotechnology, College of Science, University of Tehran, Tehran, Iran
| | - Ali Amini Harandi
- Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Hossein Pakdaman
- Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Milad Moradi
- Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ashkan Mowla
- Division of Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, USA
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Guerrero JI, Barragán LA, Martínez JD, Montoya JP, Peña A, Sobrino FE, Tovar-Spinoza Z, Ghotme KA. Central and peripheral nervous system involvement by COVID-19: a systematic review of the pathophysiology, clinical manifestations, neuropathology, neuroimaging, electrophysiology, and cerebrospinal fluid findings. BMC Infect Dis 2021; 21:515. [PMID: 34078305 PMCID: PMC8170436 DOI: 10.1186/s12879-021-06185-6] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 05/14/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND SARS-CoV-2 can affect the human brain and other neurological structures. An increasing number of publications report neurological manifestations in patients with COVID-19. However, no studies have comprehensively reviewed the clinical and paraclinical characteristics of the central and peripheral nervous system's involvement in these patients. This study aimed to describe the features of the central and peripheral nervous system involvement by COVID-19 in terms of pathophysiology, clinical manifestations, neuropathology, neuroimaging, electrophysiology, and cerebrospinal fluid findings. METHODS We conducted a comprehensive systematic review of all the original studies reporting patients with neurological involvement by COVID-19, from December 2019 to June 2020, without language restriction. We excluded studies with animal subjects, studies not related to the nervous system, and opinion articles. Data analysis combined descriptive measures, frequency measures, central tendency measures, and dispersion measures for all studies reporting neurological conditions and abnormal ancillary tests in patients with confirmed COVID-19. RESULTS A total of 143 observational and descriptive studies reported central and peripheral nervous system involvement by COVID-19 in 10,723 patients. Fifty-one studies described pathophysiologic mechanisms of neurological involvement by COVID-19, 119 focused on clinical manifestations, 4 described neuropathology findings, 62 described neuroimaging findings, 28 electrophysiology findings, and 60 studies reported cerebrospinal fluid results. The reviewed studies reflect a significant prevalence of the nervous system's involvement in patients with COVID-19, ranging from 22.5 to 36.4% among different studies, without mortality rates explicitly associated with neurological involvement by SARS-CoV-2. We thoroughly describe the clinical and paraclinical characteristics of neurological involvement in these patients. CONCLUSIONS Our evidence synthesis led to a categorical analysis of the central and peripheral neurological involvement by COVID-19 and provided a comprehensive explanation of the reported pathophysiological mechanisms by which SARS-CoV-2 infection may cause neurological impairment. International collaborative efforts and exhaustive neurological registries will enhance the translational knowledge of COVID-19's central and peripheral neurological involvement and generate therapeutic decision-making strategies. REGISTRATION This review was registered in PROSPERO 2020 CRD42020193140 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020193140.
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Affiliation(s)
- Juan I. Guerrero
- Translational Neuroscience Research Lab, Faculty of Medicine, Universidad de La Sabana, Autopista Norte, KM 7, Chía, 250001 Colombia
| | - Luis A. Barragán
- Translational Neuroscience Research Lab, Faculty of Medicine, Universidad de La Sabana, Autopista Norte, KM 7, Chía, 250001 Colombia
| | - Juan D. Martínez
- Translational Neuroscience Research Lab, Faculty of Medicine, Universidad de La Sabana, Autopista Norte, KM 7, Chía, 250001 Colombia
| | - Juan P. Montoya
- Translational Neuroscience Research Lab, Faculty of Medicine, Universidad de La Sabana, Autopista Norte, KM 7, Chía, 250001 Colombia
| | - Alejandra Peña
- Translational Neuroscience Research Lab, Faculty of Medicine, Universidad de La Sabana, Autopista Norte, KM 7, Chía, 250001 Colombia
| | - Fidel E. Sobrino
- Translational Neuroscience Research Lab, Clinical Neurology Program, Universidad de La Sabana, Autopista Norte, KM 7, Chía, 250001 Colombia
- Neurology Unit, Hospital Occidente de Kennedy, Bogota, Colombia
| | - Zulma Tovar-Spinoza
- Pediatric Neurosurgery, Pediatric Epilepsy Surgery, Neurosurgical Laser Ablation Program, Upstate University Hospital, 750 East Adams Street, Syracuse, NY 13210 USA
| | - Kemel A. Ghotme
- Translational Neuroscience Research Lab, Faculty of Medicine, Universidad de La Sabana, Autopista Norte, KM 7, Chía, 250001 Colombia
- Pediatric Neurosurgery, Department of Neurosurgery, Fundacion Santa Fe de Bogota, Bogota, Colombia
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Mohan N, Fayyaz MA, del Rio C, Khurana NKRS, Vaidya SS, Salazar E, Joyce J, Ali AA. Neurological manifestations and neuroimaging findings in patients with SARS-CoV2-a systematic review. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021; 57:68. [PMID: 34093004 PMCID: PMC8170868 DOI: 10.1186/s41983-021-00322-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/17/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has drastically affected everyone in a hit or miss manner. Since it began, evidence of the neuro-invasive potential of the virus has been intensifying significantly. Several pathways have been hypothesized to elucidate the neurotropic nature of SARS-CoV2. It is the need of the hour to collect vital information. OBJECTIVE To evaluate and correlate the neuro-radiological and neurological manifestations in patients diagnosed with SARS-CoV2.To identify neuro-invasive pathways of COVID infection. METHODS Relevant studies were identified through four databases-the Cochrane Library, PubMed, Science Direct, and Web of Science. These were searched using relevant keywords-"COVID-19," "SARS-CoV2," "neurological manifestations," "neuroimaging," "CT," and "MRI." Relevant articles were screened according to a pre-defined inclusion and exclusion criteria from December 2019 to August 2020. RESULTS Our review included a total of 63 full text publications with 584 patients, composed mainly of observational studies, case reports, and case series. The most common neurological manifestations associated with COVID-19 were altered mental status, stroke, and paralysis. About 17.85% patients who underwent neuroimaging were found to be having ischemic changes suggestive of a stroke. This was followed by hemorrhagic changes as the second most common finding. The most commonly involved vessel was the Middle Cerebral Artery. Besides stroke, we found that SARS-CoV2 could be the cause for new-onset seizures, Guillain-Barre Syndrome, encephalitis, and many other severe neurological diseases. CONCLUSION The information that we have obtained so far will prove dynamic to healthcare providers working against the COVID-19 pandemic. It is necessary to be aware of these atypical neurological findings for the early diagnosis and treatment of COVID-19 infected patients. However, to completely understand the connection between SARS-CoV2 and the nervous system, further research is necessary.
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Affiliation(s)
- Nikita Mohan
- Jawaharlal Nehru Medical College, Belagavi, Karnataka India
| | | | - Christopher del Rio
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey Nuevo Leon, Mexico
| | | | | | - Esteban Salazar
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey Nuevo Leon, Mexico
| | - John Joyce
- M.S Ramaiah Medical College, Bangalore, Karnataka India
| | - Amrat Ayaz Ali
- Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
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49
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Tisdale AK, Dinkin M, Chwalisz BK. Afferent and Efferent Neuro-Ophthalmic Complications of Coronavirus Disease 19. J Neuroophthalmol 2021; 41:154-165. [PMID: 33935220 DOI: 10.1097/wno.0000000000001276] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE To provide a summary of the neuro-ophthalmic manifestations of coronavirus disease 19 (COVID-19) documented in the literature thus far. METHODS The PubMed and Google Scholar databases were searched using the keywords: Neuro-Ophthalmology, COVID-19, SARS-CoV-2, and coronavirus. A manual search through reference lists of relevant articles was also performed. RESULTS/CONCLUSIONS The literature on COVID-associated neuro-ophthalmic disease continues to grow. Afferent neuro-ophthalmic complications associated with COVID-19 include optic neuritis, papillophlebitis, papilledema, visual disturbance associated with posterior reversible encephalopathy syndrome, and vision loss caused by stroke. Efferent neuro-ophthalmic complications associated with COVID-19 include cranial neuropathies, Miller Fisher syndrome, Adie's pupils, ocular myasthenia gravis, nystagmus and eye movement disorders. Proposed mechanisms of neurologic disease include immunologic upregulation, vasodilation and vascular permeability, endothelial dysfunction, coagulopathy, and direct viral neurotropism. When patients present to medical centers with new onset neuro-ophthalmic conditions during the pandemic, COVID-19 infection should be kept on the differential.
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Affiliation(s)
- Alanna K Tisdale
- Department of Ophthalmology and Visual Sciences (AKT), University of Iowa Hospital and Clinics, University of Iowa Carver College of Medicine, Iowa City, Iowa; Departments of Ophthalmology and Neurology (MD), New York- Presbyterian Hospital, Weill Cornell Medical College, New York City, New York; Department of Ophthalmology (BKC), Massachusetts Eye & Ear; and Department of Neurology (BKC), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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50
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Jungbauer F, Hülse R, Lu F, Ludwig S, Held V, Rotter N, Schell A. Case Report: Bilateral Palsy of the Vocal Cords After COVID-19 Infection. Front Neurol 2021; 12:619545. [PMID: 34093389 PMCID: PMC8172591 DOI: 10.3389/fneur.2021.619545] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 04/20/2021] [Indexed: 01/08/2023] Open
Abstract
During the COVID-19 pandemic, adverse neurological effects have been described. In addition to unspecific neurological symptoms, cranial nerve deficits have appeared as part of SARS-CoV-2 infection. In this case report, we describe a 74-year-old patient who developed bilateral paralysis of the vocal cords some weeks following his dismissal in stable condition after COVID-19 pneumonia. After ruling out central lesions, peripheral tumors, and other possible causes, therapy was initiated with methylprednisolone, inhalations, and oxygen. The patient showed no improvement, so laterofixation after Lichtenberger was performed. The dyspnea worsened after several weeks, so a laser posterior cordectomy was performed with satisfactory outcome.
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Affiliation(s)
- Frederic Jungbauer
- Department for Otorhinolaryngology, Head- and Neck-Surgery, University Medical Centre Mannheim, Mannheim, Germany
| | - Roland Hülse
- Department for Otorhinolaryngology, Head- and Neck-Surgery, University Medical Centre Mannheim, Mannheim, Germany
| | - Fei Lu
- Department for Otorhinolaryngology, Head- and Neck-Surgery, University Medical Centre Mannheim, Mannheim, Germany
| | - Sonja Ludwig
- Department for Otorhinolaryngology, Head- and Neck-Surgery, University Medical Centre Mannheim, Mannheim, Germany
| | - Valentin Held
- Department for Neurology, University Medical Centre Mannheim, Mannheim, Germany
| | - Nicole Rotter
- Department for Otorhinolaryngology, Head- and Neck-Surgery, University Medical Centre Mannheim, Mannheim, Germany
| | - Angela Schell
- Department for Otorhinolaryngology, Head- and Neck-Surgery, University Medical Centre Mannheim, Mannheim, Germany
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