Protracted COVID-19 during Treatment of Facial Palsy

Nursing and Treatment Experience of COVID-19 with Facial Paralysis

Introduction

Facial paralysis is one of the nervous system manifestations reported about COVID-19. There has been no consensus on the treatment and nursing care of COVID-19 combined with facial paralysis. On May 2022, a COVID-19 case with facial paralysis was reported to make suggestions on nursing care and treatment based on successful experience of curing the case with traditional Chinese medicine and western medicine.

Case Presentation

A 27-year-old male, was hospitalized because of "low fever for 12 days and difficulty in left side facial muscle movement for 2 days." The diagnosis of facial paralysis and COVID-19 infection (mild type）is definite which is based on the patient's medical history and test results afterwards.

Management and Outcomes

Medical staff made a comprehensive plan on COVID-19's basic nursing including nutritional support, vital signs monitoring and psychological evaluation, medication guidance including corticosteroids and traditional Chinese medicine, and specialized nursing procedures of facial paralysis. The symptoms of the patient were significantly improved after treatment with traditional Chinese medicine and low-dose corticosteroids. The COVID-19 nucleic acid test turned negative 12 days after admission, and the facial paralysis recovered 1 month later after discharge.

Discussion

Facial paralysis and COVID-19 can coexist. This study finds that COVID-19 (mild type） patients can be treated with traditional Chinese medicine instead of antiviral drugs. This paper puts forward reasonable suggestions that the nursing plan of patients with COVID-19 complicated with specialized diseases should be formulated together with specialist nurses. The nursing plan needs to be implemented on the "General + Specialized" mode.

Facial palsy as a manifestation of COVID-19: A systematic review of cases

Background and Aims

Facial palsy is a rare complication of the COVID-19 infection. Herein, we conducted a systematic review of all published cases of facial palsy post-COVID-19 infection in an attempt to educate the general population and medical practitioners regarding the likely occurrence of facial palsy in COVID-19 patients, its detection, effective treatment plan, and prognosis of the condition.

Methods

We searched PubMed, Google Scholar, and Directory of Open Access Journals (DOAJ) from December 1, 2019 to September 21, 2021.

Results

We included 49 studies bearing accounts of 75 cases who had facial palsy. The mean age of patients was 42.9 ± 19.59 years, with a male-to-female ratio of 8:7. The majority of the cases were reported from Brazil (n = 14), USA (n = 9), Turkey (n = 9), and Spain (n = 9). Noticeably, 30.14% of COVID-19 patients were diagnosed with Guillain-Barré syndrome. In total, 22.97% of patients complained of bilateral facial paralysis (n = 17), whereas ipsilateral paralysis was observed in 77.03% (n = 57). These were common complaints of Lagophthalmos, otalgia, facial drooping, dysarthria, and compromised forehead wrinkling. The treatment regimen mainly included the use of corticosteroids (n = 51) (69.86%), antivirals (n = 23) (31.51%), IVIG (n = 18) (24.66%), antibiotics (n = 13) (17.81%), antiretroviral (n = 9) (12.33%), and antimalarial (n = 8) (10.96%) medications. In all, 35.62% of patients (n = 26) adhered to a combination of antiviral and corticosteroid-based therapy. Positive treatment outcomes were observed in 83.58% (n = 56) of cases. In contrast, 10 patients (14.93%) showed nonsignificant recovery, out of which 3 (4.48%) died from the disease.

Conclusion

The association of facial palsy with COVID-19 is controversial and therefore requires further investigation and published work to confirm a causal relationship. However, physicians should not overlook the likelihood of facial palsy post-COVID-19 infection and treat it accordingly.

Late peripheral facial paralysis after COVID-19: a rapid systematic review and two case reports

Peripheral facial paralysis (PFP) has been shown to be a neurological manifestation of COVID-19. The current study presents two cases of PFP after COVID-19, along with a rapid review of known cases in the literature. Both case reports were conducted following CARE guidelines. We also performed a systematic review of PFP cases temporally related to COVID-19 using PubMed, Embase, and Cochrane Library databases on August 30, 2021, using a rapid review methodology. The two patients experienced PFP 102 and 110 days after COVID-19 symptom onset. SARS-CoV-2 RNA was detected in nasal samples through reverse-transcription real-time polymerase chain reaction (RT-qPCR) testing. Anosmia was the only other neurological manifestation. PFP was treated with steroids in both cases, with complete subsequent recovery. In the rapid review, we identified 764 articles and included 43 studies. From those, 128 patients with PFP were analyzed, of whom 42.1% (54/128) were male, 39.06% (50/128) female, and in 23 cases the gender was not reported. The age range was 18 to 59 (54.68%). The median time between COVID-19 and PFP was three days (ranging from the first symptom of COVID-19 to 40 days after the acute phase of infection). Late PFP associated with COVID-19 presents mild symptoms and improves with time, with no identified predictors. Late PFP should be added to the spectrum of neurological manifestations associated with the long-term effects of SARS-CoV-2 infection as a post COVID-19 condition.

Surge of Bell's Palsy in the era of COVID-19; Systematic review

BACKGROUND

With the progression of Coronavirus infectious disease-19 (COVID-19), various neurological manifestations have been noticed in these patients and Bell's palsy is one of the peripheral neuropathies among those. Bell's palsy has been associated with various other viral agents. Its evidence in patients with COVID-19 signifies the possibility of association between Bell's Palsy and Severe acute respiratory syndrome coronavirus-2 (SARS-CoV2).

OBJECTIVE

To evaluate the number of published cases of Bell's palsy as the only major neurological manifestation in patients with COVID-19 from March 2020 to December 2021 and to investigate the association of SARS-CoV2 and Bell's palsy.

MATERIALS AND METHODS

A systematic review of the published English literature was performed using an electronic search in PubMed / Medline, Scopus, Research gate, Research square and Google Scholar databases, using keywords like 'COVID-19' OR/AND 'SARS-CoV-2', OR/AND 'Bell's palsy', OR/AND 'Facial nerve palsy', OR/AND 'Neurological', OR/AND 'Manifestation'.

RESULTS

Search strategy revealed 32 relevant publications with a total of 46 patients. Bell's palsy was the initial manifestation in 37% cases and in 63% cases it developed after COVID-19 symptoms. 71.7% cases showed complete recovery and 21.7% showed only partial relief from BP.

CONCLUSIONS

Although the number of documented cases in this research are not much, but evidence of Bell's palsy as the only major neurological manifestation in patients with COVID-19 signifies an important clinical finding and the possibility of another viral aetiology of BP. More evidence is needed to establish the exact co-relation between these two entities.