COVID-19 presenting with ophthalmoparesis from cranial nerve palsy

Dinkin, Marc; Gao, Virginia; Kahan, Joshua; Bobker, Sarah M.; Simonetto, Marialaura; Wechsler, Paul M; Harpe, Jasmin; Greer, Christine; Mints, Gregory; Salama, Gayle; Tsiouris, Apostolos John; Leifer, Dana

doi:10.1212/wnl.0000000000009700

Cited by 302 publications

(307 citation statements)

References 7 publications

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“…The ophthalmological involvement during the coronavirus infection occurs in the 12 days later [ 13 ]. Another paper reported 2 cases of ophthalmoplegia associated with neurological impairment [ 14 ], but improvement in both of these patients was slower than in our case. Our patient presented a painless left ophthalmoplegia with binocular diplopia and without headache or other signs of central nervous system involvement.…”

Section: Discussioncontrasting

confidence: 74%

Third Cranial Nerve Palsy Presenting with Unilateral Diplopia and Strabismus in a 24-Year-Old Woman with COVID-19

et al. 2020

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Patient: Female, 24-year-old Final Diagnosis: Third cranial nerve palsy in a women presenting COVID-19 Symptoms: Ophthalmoplegia Medication:— Clinical Procedure: — Specialty: Ophthalmology Objective: Rare disease Background: Coronavirus disease (COVID 19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and is the causative agent of a serious disease that is of great global public health concern. Palsy of the third cranial nerve is very rare in patients with confirmed 2019 novel coronavirus disease (COVID-19). We describe the case of a patient with an incomplete palsy of the left third cranial nerve sparing the pupils in the context of SARS-CoV-2 virus infection. Case Report: We report the case of a 24-year-old woman with confirmed COVID-19, which presented with acute onset of diplopia and strabismus of the left eye that occurred 3 days after the start of general symptoms. The patient had no significant medical history. Based on detailed ophthalmic and neurological examination, acute painless incomplete palsy of the third cranial nerve was suspected. Oculo-cerebral magnetic resonance angiography was unremarkable. Blood tests revealed mild normocytic regenerative anemia. According to the Moroccan recommendations, chloroquine and azithromycin were started. After what, a quick improvement of exotropia and diplopia was observed, and complete recovery was obtained by the sixth day of treatment. No adverse effects of the treatment were noted. Conclusions: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause neurological complications such as cranial nerve palsy. The pathological mechanism remains unclear. Full recovery of the ocular motricity is possible, and prognosis depends on the severity of the respiratory illness.

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Section: Discussioncontrasting

confidence: 74%

Third Cranial Nerve Palsy Presenting with Unilateral Diplopia and Strabismus in a 24-Year-Old Woman with COVID-19

et al. 2020

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“…Across three recent studies, one patient presented with partial third nerve palsy and accompanying bilateral sixth nerve palsy, one with complete third nerve palsy only, one with bilateral sixth nerve palsy, and two with unilateral sixth nerve palsy. , 7,8,9 Similar to the two aforementioned cases, the precise mechanism in our case remains unknown. In these previously mentioned studies, patients who presented with third nerve palsy with or without additional sixth nerve palsy demonstrated a more severe manifestation of their infection and required more intensive, in-patient treatment.…”

Section: Discussionmentioning

confidence: 57%

Diplopia from abducens nerve paresis as a presenting symptom of COVID-19: a case report and review of literature

Ben-David

Halachmi-Eyal

Shyriaiev

et al. 2020

Preprint

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Neurological manifestations of COVID-19 are not well understood. We report a case of a 44-year-old man who presented with fever, double vision, and headache and was subsequently diagnosed with COVID-19 and transient abducens nerve paresis. He did not present with any respiratory symptoms or additional specific neurological findings. We suggest that as the number of cases rises worldwide, physicians should have a greater index of suspicion for COVID-19 in patients with cranial neuropathies even in mild cases without typical respiratory symptoms.

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“…GBS occurred in 5/1200 (0.4%) patients with COVID-19 in one of the studies [13]. There were six other case report of GBS, one Miller Fisher syndrome, and two polyneuritis cranialis [14,[24][25][26][27][28][29][30]. Interestingly, neurotropism of human coronaviruses has been suggested by in vitro and in vivo studies that showed that certain strains of the viruses could persist in the human CNS by targeting oligodendrocytic and neuroglial cell lines [41].…”

Section: Discussionmentioning

confidence: 99%

“…Thirty-one patients experienced a cerebrovascular complication, with 27 ischemic strokes [11,[19][20][21][22][23], 3 hemorrhagic strokes [11,15,23] and 1 cerebral venous sinus thrombosis [11]. There were 15 patients with GBS [13,14,[24][25][26][27][28][29][30] or its variants, 6 reported as encephalitis [12,18,[31][32][33], one with seizures [34], one with acute hemorrhagic necrotizing encephalopathy [16] one reported as transverse myelitis [35], and one reported as ADEM [36]. Nine of these cases were reported as fatal.…”

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confidence: 99%

Neurological Complications of COVID-19: A Systematic Review of Literature

Sriwastava

Srivastava

Kataria

et al. 2020

Preprint

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Abstract Background: To study the nature and frequency of occurrence of “significant” neurological complications in coronavirus disease-2019 (COVID-19) via a systematic review of the literature.Methods: We screened all articles resulting from a search of PubMed, Cochrane, Google Scholar and Scopus, using the keywords "COVID-19 and CNS", "SARS-CoV-2 and CNS”, “COVID-19 and neurological manifestation”, “SARS2 and neurological manifestation” and “COVID-19 and Brain” looking for reports of significant neurological manifestations that would potentially have an impact on the outcome.Results: Twenty-six articles met the inclusion criteria. The significant neurological diagnoses reported were stroke, Guillain Barre Syndrome (GBS) and its variants, encephalitis, seizures, acute hemorrhagic necrotizing encephalopathy, acute disseminated encephalomyelitis (ADEM) and transverse myelitis. Although stroke, predominantly ischemic, was observed in ~ 6% of COVID-19 patients from Wuhan, China, mortality in this cohort was 38%. Of the 24 pooled patients with reports of etiology, 17 had large vessel occlusions. GBS occurred in 5/1200 (0.4%) of the COVID-19 cohort from Italy. One of the six reported encephalitis cases, the ADEM case and the report of transverse myelitis do not have data for conclusive diagnosis.Conclusion: The most frequent significant neurological association with COVID-19 is stroke, predominantly ischemic. In a cohort from Wuhan, China, this was as frequent as ~ 6%, with a 38% mortality. Most common reported etiology is large vessel occlusion. Other reported significant neurological complications are GBS/variants, encephalitis, seizures and acute hemorrhagic necrotizing encephalopathy. The reports of ADEM and transverse myelitis lacked diagnostically conclusive data.

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COVID-19 presenting with ophthalmoparesis from cranial nerve palsy

Cited by 302 publications

References 7 publications

Third Cranial Nerve Palsy Presenting with Unilateral Diplopia and Strabismus in a 24-Year-Old Woman with COVID-19

Third Cranial Nerve Palsy Presenting with Unilateral Diplopia and Strabismus in a 24-Year-Old Woman with COVID-19

Diplopia from abducens nerve paresis as a presenting symptom of COVID-19: a case report and review of literature

Neurological Complications of COVID-19: A Systematic Review of Literature

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