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Peltzer C, Bhatt S, Kamel I, Hussini N, Zagvazdin Y, Shoja MM. Epiphora and Hyperlacrimation as Paradoxical Manifestations of Facial Nerve Injury: Mechanistic Insights. Cureus 2024; 16:e59440. [PMID: 38826950 PMCID: PMC11140633 DOI: 10.7759/cureus.59440] [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: 12/09/2023] [Accepted: 04/30/2024] [Indexed: 06/04/2024] Open
Abstract
The incidence of facial nerve paralysis is approximately 30 per 100,000 persons annually. Although it is often idiopathic, as in Bell's palsy, it can also result from infections, trauma, or neoplasms. Facial nerve paralysis may present with partial or total facial paresis, lagophthalmos, denervation of the lacrimal gland, and other ocular abnormalities. While dry eye is a commonly expected outcome of facial nerve injury, some patients may paradoxically experience epiphora and hyperlacrimation. In this review, we examine this phenomenon and its mechanisms in facial nerve injury. Several mechanisms have been proposed for epiphora and hyperlacrimation, including aberrant axonal regeneration, which is known to cause crocodile tears syndrome; ocular irritation due to dry eye, resulting in increased reflex lacrimation due to disruption of the tear film; and impaired drainage of tears caused by paralysis of the orbicularis oculi muscle and malposition of the eyelids. Understanding the pathophysiology of these symptoms is crucial in guiding the management of patients with facial nerve injury. Further experimental and clinical studies focusing on the quantification of tear production and localization of nerve damage will help improve our understanding of the neuroanatomical correlates of this paradoxical manifestation.
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Affiliation(s)
- Cadynce Peltzer
- Department of Medical Education, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Shreya Bhatt
- Department of Medical Education, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Irene Kamel
- Department of Medical Education, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Nourdeen Hussini
- Department of Medical Education, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Yuri Zagvazdin
- Department of Medical Education, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA
| | - Mohammadali M Shoja
- Department of Medical Education, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA
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Kim HJ, Lee SJ, Sa S, Bae JH, Song G, Lee CW, Kim JH, Shim SR, Hong M, Han HW. Safety of COVID-19 Vaccines among Patients with Type 2 Diabetes Mellitus: Real-World Data Analysis. Diabetes Metab J 2023; 47:356-365. [PMID: 36872064 PMCID: PMC10244203 DOI: 10.4093/dmj.2022.0129] [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] [Received: 04/11/2022] [Accepted: 08/04/2022] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Little is known about the adverse events (AEs) associated with coronavirus disease 2019 (COVID-19) vaccination in patients with type 2 diabetes mellitus (T2DM). METHODS This study used vaccine AE reporting system data to investigate severe AEs among vaccinated patients with T2DM. A natural language processing algorithm was applied to identify people with and without diabetes. After 1:3 matching, we collected data for 6,829 patients with T2DM and 20,487 healthy controls. Multiple logistic regression analysis was used to calculate the odds ratio for severe AEs. RESULTS After COVID-19 vaccination, patients with T2DM were more likely to experience eight severe AEs than controls: cerebral venous sinus thrombosis, encephalitis myelitis encephalomyelitis, Bell's palsy, lymphadenopathy, ischemic stroke, deep vein thrombosis (DVT), thrombocytopenia (TP), and pulmonary embolism (PE). Moreover, patients with T2DM vaccinated with BNT162b2 and mRNA-1273 were more vulnerable to DVT and TP than those vaccinated with JNJ-78436735. Among patients with T2DM administered mRNA vaccines, mRNA-1273 was safer than BNT162b2 in terms of the risk of DVT and PE. CONCLUSION Careful monitoring of severe AEs in patients with T2DM may be necessary, especially for those related to thrombotic events and neurological dysfunctions after COVID-19 vaccination.
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Affiliation(s)
- Hye Jun Kim
- Department of Biomedical Informatics, CHA University School of Medicine, Seongnam,
Korea
- Institute of Basic Medical Sciences, CHA University School of Medicine, Seongnam,
Korea
- Institute for Biomedical Informatics, CHA University School of Medicine, Seongnam,
Korea
| | - Sang Jun Lee
- Department of Biomedical Informatics, CHA University School of Medicine, Seongnam,
Korea
- Institute of Basic Medical Sciences, CHA University School of Medicine, Seongnam,
Korea
- Institute for Biomedical Informatics, CHA University School of Medicine, Seongnam,
Korea
| | - Soonok Sa
- Department of Biomedical Informatics, CHA University School of Medicine, Seongnam,
Korea
- Institute of Basic Medical Sciences, CHA University School of Medicine, Seongnam,
Korea
- Institute for Biomedical Informatics, CHA University School of Medicine, Seongnam,
Korea
| | - Jung Ho Bae
- Department of Internal Medicine and Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul,
Korea
| | - Gyuseon Song
- Department of Biomedical Informatics, CHA University School of Medicine, Seongnam,
Korea
- Institute of Basic Medical Sciences, CHA University School of Medicine, Seongnam,
Korea
- Institute for Biomedical Informatics, CHA University School of Medicine, Seongnam,
Korea
| | - Chae Won Lee
- Department of Biomedical Informatics, CHA University School of Medicine, Seongnam,
Korea
- Institute of Basic Medical Sciences, CHA University School of Medicine, Seongnam,
Korea
- Institute for Biomedical Informatics, CHA University School of Medicine, Seongnam,
Korea
| | - Ju Hee Kim
- Department of Biomedical Informatics, CHA University School of Medicine, Seongnam,
Korea
- Institute of Basic Medical Sciences, CHA University School of Medicine, Seongnam,
Korea
- Institute for Biomedical Informatics, CHA University School of Medicine, Seongnam,
Korea
| | - Sung Ryul Shim
- Department of Biomedical Informatics, CHA University School of Medicine, Seongnam,
Korea
- Institute of Basic Medical Sciences, CHA University School of Medicine, Seongnam,
Korea
- Institute for Biomedical Informatics, CHA University School of Medicine, Seongnam,
Korea
- Department of Health and Medical Informatics, Kyungnam University College of Health Sciences, Changwon,
Korea
| | - Myunghee Hong
- Department of Biomedical Informatics, CHA University School of Medicine, Seongnam,
Korea
- Institute of Basic Medical Sciences, CHA University School of Medicine, Seongnam,
Korea
- Institute for Biomedical Informatics, CHA University School of Medicine, Seongnam,
Korea
| | - Hyun Wook Han
- Department of Biomedical Informatics, CHA University School of Medicine, Seongnam,
Korea
- Institute of Basic Medical Sciences, CHA University School of Medicine, Seongnam,
Korea
- Institute for Biomedical Informatics, CHA University School of Medicine, Seongnam,
Korea
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Mohseni Afshar Z, Sharma A, Babazadeh A, Alizadeh-Khatir A, Sio TT, Taghizadeh Moghadam MA, Tavakolli Pirzaman A, Mojadad A, Hosseinzadeh R, Barary M, Ebrahimpour S. A review of the potential neurological adverse events of COVID-19 vaccines. Acta Neurol Belg 2023; 123:9-44. [PMID: 36385246 PMCID: PMC9668235 DOI: 10.1007/s13760-022-02137-2] [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] [Received: 03/17/2022] [Accepted: 10/27/2022] [Indexed: 11/17/2022]
Abstract
Despite the advantages of getting access to the coronavirus disease 2019 (COVID-19) vaccines, their potential ability to induce severe adverse events (AEs) has been a significant concern. Neurological complications are significant among the various adverse events following immunization (AEFI) due to their likely durability and debilitating sequelae. Neurological AEs following COVID-19 vaccination can either exacerbate or induce new-onset neuro-immunologic diseases, such as myasthenia gravis (MG) and Guillain-Barre syndrome (GBS). The more severe spectrum of AEs post-COVID19 vaccines has included seizures, reactivation of the varicella-zoster virus, strokes, GBS, Bell's palsy, transverse myelitis (TM), and acute disseminated encephalomyelitis (ADEM). Here, we discuss each of these neurological adverse effects separately.
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Affiliation(s)
- Zeinab Mohseni Afshar
- grid.412112.50000 0001 2012 5829Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Akanksha Sharma
- grid.417468.80000 0000 8875 6339Department of Neurology, Mayo Clinic, Scottsdale, AZ USA
| | - Arefeh Babazadeh
- grid.411495.c0000 0004 0421 4102Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Ali Alizadeh-Khatir
- grid.411495.c0000 0004 0421 4102Mobility Impairment Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Terence T. Sio
- grid.417468.80000 0000 8875 6339Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ USA
| | | | - Ali Tavakolli Pirzaman
- grid.411495.c0000 0004 0421 4102Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Ahmadreza Mojadad
- grid.411495.c0000 0004 0421 4102Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Rezvan Hosseinzadeh
- grid.411495.c0000 0004 0421 4102Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Mohammad Barary
- Student Research Committee, Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran. .,Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran.
| | - Soheil Ebrahimpour
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
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Paudel S, Shrestha MG, Ramtel R, Bhattarai A, Gupta U. Facial Palsy in COVID-19 Patient: A Case Report. JNMA J Nepal Med Assoc 2022; 60:982-984. [PMID: 36705175 PMCID: PMC9795104 DOI: 10.31729/jnma.7890] [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: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
Facial paralysis is one of the common problems leading to facial deformation. COVID-19 virus rarely has been shown to be associated with facial palsy. Here we present a case of a 60-year-old woman who presented with features of left lower motor facial palsy signs along with common features suggestive of COVID-19 infection. Brain imaging did not reveal any pertinent pathology but her polymerase chain reaction for COVID-19 was positive. This case highlights the fact that acute COVID-19 infection can be considered a cause of motor neuron facial palsy in the ongoing pandemic of COVID-19. Cases with neurological features suggestive of facial palsy therefore should be suspected of acute COVID-19 infection based on other pertinent findings of COVID-19 infection and thus polymerase chain reaction testing should be done. Keywords case reports; COVID-19; facial palsy.
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Affiliation(s)
- Shailes Paudel
- Bhingri Primary Health Care Center, Bhingri, Pyuthan, Nepal,Correspondence: Dr Shailes Paudel, Bhingri Primary Health Care Center, Bhingri, Pyuthan, Nepal. , Phone: +977-9843142185
| | | | | | | | - Umang Gupta
- Maharajgunj Medical Campus, Maharajgunj, Kathmandu, Nepal
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Gupta S, Jawanda MK. Surge of Bell's Palsy in the era of COVID-19; Systematic review. Eur J Neurol 2022; 29:2526-2543. [PMID: 35478425 DOI: 10.1111/ene.15371] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/18/2022] [Accepted: 04/20/2022] [Indexed: 01/08/2023]
Abstract
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.
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Affiliation(s)
- S Gupta
- Dept. of Oral Pathology and Microbiology & Forensic odontology, Rayat and Bahra Dental college and hospital, Mohali, Punjab, India
| | - M K Jawanda
- Dept. of Oral Pathology and Microbiology & Forensic odontology, Laxmi bai institute of dental sciences and hospital, Patiala, Punjab, India
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