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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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Samimiardestani S, Irani S, Hasibi M, Seyedahadi M, Bastaninejad S, Firouzifar M, Mohammadi Ardehali M, Berijani S, Erfanian R, Kazemi MA, Etemadi-Aleagha A, Rahimi A, Karimi Yarandi K, Ahadi S. Distinguishing Characteristics of COVID-19-Associated Mucormycosis; a Case Series. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2022; 10:e66. [PMID: 36381973 PMCID: PMC9637258 DOI: 10.22037/aaem.v10i1.1644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Since the emergence of COVID-19 pandemic, several articles have reported the co-existence of mucormycosis and COVID-19. This study aimed to distinguish the characteristics of COVID-19-associated rhinocerebral mucormycosis. METHODS In this case series, 18 patients with COVID-19-associated rhinocerebral mucormycosis and unique clinical manifestations and outcomes, who were referred to Amiralam Hospital, a tertiary otorhinolaryngology center, Tehran, Iran, during the COVID-19 era, were reported. RESULTS Eighteen patients with the mean age of 62.0 ± 11.6 (range: 42 - 83) years were studied (50% males). The mean time interval between diagnosis of COVID-19 and first manifestation of mucormycosis was 15.5 ± 9.7 days. The most common presenting symptom was facial paresthesia (72.2%). Fifty percent of patients developed frozen eye. Palatal necrosis was seen in 7 cases (38.8%). Remarkably, facial paralysis was observed in 5 (27.7%) patients. Another notable clinical picture was cavernous sinus thrombosis, seen in 7 patients. We also had two cases of carotid artery occlusion. Three patients, unfortunately, passed away. CONCLUSION Rhinocerebral mucormycosis is one of the most important complications of COVID-19 patients, especially those with underlying diseases. It seems that the key to proper management of mucormycosis is early diagnosis and timely intervention, which could give a patient a chance to live more.
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Affiliation(s)
- Seyedhadi Samimiardestani
- Otorhinolaryngology Research Center, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shirin Irani
- Otorhinolaryngology Research Center, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran. ,Corresponding Author: Shirin Irani; Amiralam Hospital, North Sa’di Street, Enghelab Street, Tehran, Iran. Fax Number: +98 2166343177, , Cell phone: +98 912 4182775
| | - Mehrdad Hasibi
- Infectious Disease Department, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maral Seyedahadi
- Neurology Department, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahin Bastaninejad
- Otorhinolaryngology Research Center, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Firouzifar
- Otorhinolaryngology Research Center, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Sina Berijani
- Otorhinolaryngology Research Center, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Erfanian
- Otorhinolaryngology Research Center, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Kazemi
- Department of Radiology, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Afshar Etemadi-Aleagha
- Department of Anesthesiology, Amir-Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Abolfazl Rahimi
- Department of Ophthalmology, Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | | | - Samira Ahadi
- Otorhinolaryngology Research Center, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Shakrawal J, Bhatnagar KR, Srivastava K. COVID-19 - associated third nerve palsy. Indian J Ophthalmol 2021; 69:2913-2915. [PMID: 34571694 PMCID: PMC8597522 DOI: 10.4103/ijo.ijo_1619_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Jyoti Shakrawal
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Kavita R Bhatnagar
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Krati Srivastava
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
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Deshpande G, Giri P. Acute monocular vision loss as presenting symptom of delayed stroke from internal carotid occlusion in COVID-19. Indian J Ophthalmol 2021; 69:1325-1327. [PMID: 33913892 PMCID: PMC8186595 DOI: 10.4103/ijo.ijo_439_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/08/2021] [Accepted: 03/15/2021] [Indexed: 12/01/2022] Open
Abstract
Covid-19 infection has been declared a pandemic by the World Health Organization. We present a unique case of a middle-aged gentleman, who recovered from asymptomatic Covid-19 infection and presented again with delayed stroke. He had vision loss secondary to internal carotid artery occlusion in the absence of neurological symptoms. To the best of our knowledge, this is the first case that describes cerebrovascular stroke due to delayed large vessel occlusion secondary to Covid-19 infection presenting as monocular vision loss.
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Affiliation(s)
| | - Pramod Giri
- Department of Neurosurgery Neuron Hospital, Nagpur, Maharashtra, India
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