The Immediate Onset of Isolated and Unilateral Abducens Nerve Palsy Associated with COVID-19 Infection: A Case Report and Literature Review

Abstract

Cranial nerve palsy associated with coronavirus disease 2019 (COVID-19) is rare. We herein report the first Asian case of the immediate onset of isolated and unilateral abducens nerve palsy (ANP) accompanied with COVID-19 infection. A 25-year-old man developed diplopia one day after the COVID-19 symptom onset. Neurological examination revealed limitation of left eye abduction without ataxia and hyporeflexia. Negative anti-ganglioside antibody results and mild albuminocytological dissociation were noted. The patient was diagnosed with left ANP accompanied by COVID-19 infection. The ANP spontaneously recovered without treatment. ANP can develop during the early phase of COVID-19 infection and adversely affect patients' quality of life.

Clinical control study of acute idiopathic abducens nerve palsy treated with injections of dexamethasone into the lateral rectus muscle

“…More recently, several authors have reported cases of isolated abducens paralysis in patients with COVID-19 [20][21][22][23][24]. A single case involving abducens paralysis without respiratory symptoms was also described [20].…”

Clinical control study of acute idiopathic abducens nerve palsy treated with injections of dexamethasone into the lateral rectus muscle

“…More recently, several authors have reported cases of isolated abducens paralysis in patients with COVID-19 [21][22][23][24][25]. A single case involving abducens paralysis without respiratory symptoms was also described [21].…”

Efferent neuro-ophthalmic complications of coronavirus disease 2019

“…Anosmia and ageusia accompanied another case, raising the possibility of CNS invasion through the olfactory bulbs [20]. Since then, numerous additional abducens palsies have been described in association with COVID-19 [21][22][23] including one with a right abducens nucleus lesion [24] and another mimicking Wernicke's encephalopathy [25]. In a case accompanied by ipsilateral central retinal artery occlusion, Hollenhorst plaques and posterior ischemic optic neuropathy in a 68-year-old man with atrial fibrillation [26], the abducens palsy was attributed to infarction, with watershed diffusion positivity seen throughout the brain on MRI, although whether the underlying etiology was embolic or vasculitic remains unclear.…”