A unique association of bifacial weakness, paresthesia and vestibulocochlear neuritis as post COVID 19 manifestation in pregnant women

Abstract

SARS-CoV-2 is an infection due to a novel virus belonging to the coronavirus family. Since December 2019, first human cases of COVID-19 have been identified in Wuhan (China) and rapidly has been progressed to a global pandemic declared by the world health organization (WHO) on March 11 th 2020. The major complication of COVID-19, is pneumonia, but other presentations like cardiovascular and neurological complications have been reported. Herein, we report a first case of pregnant women presented with bifacial weakness and paraesthesia (BFP) associated to a vestibulocochlear neuritis as post-COVID-19 manifestation. This is a 36-year-old Moroccan female patient with a history of SARS-CoV-2 positive 6 weeks before admission. She presented to the emergency department with rapid bifacial paralysis, bilateral lower extremity paresthesia, vertigo, nausea, vomiting and right auricular pain. An acute stroke was ruled out after neurological examination and brain MRI. Clinical presentation, neurophysiological, audiometry and videonystagmography workup additionally to CSF findings were suggestive of a variant of Guillain Barré Syndrome (GBS), which is BFP associated to right vestibulocochlear neuritis. The patient was treated with Intravenous immunoglobulins (IVIG) therapy associated with intravenous steroids. The patient made a complete recovery of the right facial palsy and the sensorineural hearing loss but still have tingling in lower limbs and left facial palsy at 2 weeks´ follow-up. BFP can be induced by COVID-19 as a postinfectious immune-mediated complication. Regarding the pathophysiology of vestibular neuritis, is probably similar to other viral infection causing nerve damage. Clinicians should consider the association of vestibulocochlear neuritis and BFP as a post SARS-CoV-2 manifestation.

SARS-CoV-2 (COVID-19) and audio-vestibular disorders

“…The documented time-interval, between the SARS-CoV-2 infection and the onset of audio-vestibular symptoms, was maximally a 6-week period. 17 Major findings such as: first author, country of the study, patient's characteristics, type of audiovestibular manifestations, investigations, treatments and outcomes are summarized in Table 1.…”

“…The database search identified 15 case reports or case series (level of evidence 4) for a total of 20 patients with established SARS-CoV-2 infection. 5 – 19 All patients reported a new-onset of audio-vestibular symptoms. The mean patient age was 42.4 ± 35.1 years, while the male to female ratio was 7:13.…”

“…The documented time-interval, between the SARS-CoV-2 infection and the onset of audio-vestibular symptoms, was maximally a 6-week period. 17 …”

COVID-19 infection presented as Guillain-Barre Syndrome: Report of two new cases and review of 116 reported cases and case series

“…After thorough literature review, we found a substantial number of reported cases and case series of Covid-19 infection presented with GBS. Table 1 summarizes demographic, type of relationship with Covid-19, clinical and GBS sub-types, response to specific GBS treatment, and outcome of different GBS cases who presented in concurrent with Covid 19 infection [[ [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] ],[ [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] ...…”

“…Common neurological symptoms of COVID-19 are headache, dizziness, dysgeusia/ageusia, hyposmia/anosmia, seizure, stroke, and encephalopathy [ 2 ]. There have been reported cases of Guillain-Barré Syndrome (GBS) associated with COVID-19 from different parts of the world [[ [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] ],[ [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] ,…”