Abducens Palsy and Anosmia Associated with COVID-19: A Case Report

Abstract

Aim: To report the case of acute isolated abducens nerve palsy and anosmia in a healthy 69-year-old female following SARS-CoV-2 infection. Method: This is a case report of a previously healthy 69-year-old Caucasian female who presented to the emergency eye centre with a four-day history of binocular, horizontal diplopia eight days after testing positive for SARS-CoV-2 infection. Anosmia was her isolated symptom of COVID-19. Results: The patient was diagnosed with left abducens nerve palsy. Aetiology was presumed to be post-viral as the patient was not diabetic and had no pre-existing microvascular risk factors. Diplopia resolved within 3.5 weeks. Measurements confirmed complete spontaneous recovery of the abducens palsy within 6 weeks. Conclusion: Cranial nerve palsies may constitute part of the neurological spectrum of COVID-19 disease. This case report aims to raise awareness amongst clinicians of coronavirus-induced neurological symptoms. Research suggests SARS-CoV-2 infection can trigger an aberrant immune response in some individuals, causing inflammatory nerve damage leading to anosmia and neuropathy. This case report supports the hypothesis that direct or indirect virally mediated injuries along the routes of the cranial nerves can cause neuropathy and olfactory dysfunction. The longer latency effects of COVID-19 infection are not well understood. The long-term rehabilitation of patients exposed to COVID-19 is a major public health concern requiring multidisciplinary expertise. This case report highlights the value of the Orthoptist in the diagnosis and care of patients experiencing neuropathy following COVID-19 exposure.

Case Report: Unilateral Sixth Cranial Nerve Palsy Associated With COVID-19 in a 2-year-old Child

“…For adults, few cases have already been described showing a delayed manifestation of cranial nerve dysfunction after SARS-CoV-2 infection similar to our case (23). While some children have been described to only show ophthalmoparesis as symptom of SARS-CoV-2-infection (6), adults tend to show additional (preceding) symptoms such as anosmia, respiratory or general complaints (23,24). For the majority of both adult and pediatric cases, rapid recovery within 4 to 6 weeks has been reported (6,20,23).…”

“…However, no IgG antibodies were detected and infection was not confirmed by follow-up serology, so this case may not represent a COVID 19 associated pathology (6). For adults, few cases have already been described showing a delayed manifestation of cranial nerve dysfunction after SARS-CoV-2 infection similar to our case (23). While some children have been described to only show ophthalmoparesis as symptom of SARS-CoV-2-infection (6), adults tend to show additional (preceding) symptoms such as anosmia, respiratory or general complaints (23,24).…”

“…While some children have been described to only show ophthalmoparesis as symptom of SARS-CoV-2-infection (6), adults tend to show additional (preceding) symptoms such as anosmia, respiratory or general complaints (23,24). For the majority of both adult and pediatric cases, rapid recovery within 4 to 6 weeks has been reported (6,20,23).…”

Bilateral Abducens Nerve Palsy and the possible Association with COVID-19: A Case Report

“…[12,13] Specifically, COVID-19 may infect endothelial cells, compromising the integrity of the blood-brain barrier, or infiltrate leukocytes that become subsequent viral reservoirs for dissemination. [14] Macrophages expressing ACE2 receptors may augment systemic inflammation, perpetuating widespread tissue injury. [15] The pathogenesis of ophthalmoplegia is controversial and several mechanisms have been postulated: The first is a direct cytopathic effect from the virus itself on the surrounding neural tissue.…”

Cranial neuropathy in COVID-19: a case series and review of literature

“…After 5 days, the patient improved significantly and at 2 weeks, there was no residual focal neurological deficit. berculosis, fungal sinusitis or other conditions leading to cranial nerve involvement, a total of 11 studies were enlisted (one systematic review and 10 other studies) in Table 1 [3][4][5][6][7][8][9][10][11][12][13]. It is evident from the literature that cranial neuropathy can occur across all age groups (6-year-old child to 62-year-old adult), can involve various cranial nerves (2 nd , 3 rd , 5 th , 6 th , 7 th and even 10 th cranial nerve), often requires no drug treatment resolving with only rehabilitation and conservative management, sometimes require steroids and rarely additional drugs like Intravenous immunoglobulin (IVIG).…”