Unilateral Hypoglossal Nerve Palsy as a COVID-19 Sequel

Abstract

Coronavirus disease 2019, caused by severe acute respiratory syndrome coronavirus 2 is spreading around the world, and the outbreak continues to escalate. Recently, it has been noticed that besides the typical respiratory complications, some severely affected coronavirus disease 2019 patients also experience neurological manifestations. Here, we describe the case of a newly diagnosed unilateral hypoglossal nerve palsy in a severe coronavirus disease 2019 patient. The intubation procedure was uneventful, and magnetic resonance imaging excluded the most reported causes of isolated hypoglossal nerve injury. This case reports a rare condition. Although a reasonable doubt remains, it cannot be excluded that it may be a neurological manifestation of severe acute respiratory syndrome coronavirus 2, the authors believe it to be the cause of the palsy. The main importance of this article is to alert clinicians for neurological sequels that may require a targeted rehabilitation program.

Isolated Unilateral Hypoglossal Nerve Palsy: A Delayed Sequel of Covid-19

“…With the regular causes of hypoglossal nerve palsy being ruled out, Covid-19 was assumed to be the probable aetiology in our patient. There has been a report of probable Covid-19 induced isolated unilateral hypoglossal nerve palsy [7]. However, our patient developed the palsy as a delayed sequel.…”

COVID‐19 and the peripheral nervous system. A 2‐year review from the pandemic to the vaccine era

“…Isolated or multiple cranial neuropathies not associated with polyneuropathy or other neurological disorders have been reported (Table 2). 93,96,111‐134 These included suspected bilateral olfactory neuropathy, 111,112 optic neuropathy, 113,114 oculomotor neuropathy either isolated 96,115,116,135 or associated with multiple cranial neuropathies, 93,128 unilateral 117‐124 or bilateral facial nerve palsy, 125‐127 sensorineural hearing loss, 129‐131 and lower cranial nerve impairment 132‐134 . Facial nerve palsy was the most commonly reported with 20 cases, followed by isolated oculomotor nerve neuropathy.…”

“…93,96, These included suspected bilateral olfactory neuropathy, 111,112 optic neuropathy, 113,114 oculomotor neuropathy either isolated 96,115,116,135 or associated with multiple cranial neuropathies, 93,128 unilateral [117][118][119][120][121][122][123][124] or bilateral facial nerve palsy, [125][126][127] sensorineural hearing loss, [129][130][131] and lower cranial nerve impairment. [132][133][134] Facial nerve palsy was the most commonly reported with 20 cases, followed by isolated oculomotor nerve neuropathy. With few exceptions, 114,135 all cases were painless.…”

“…146 Three case of hypoglossal nerve neuropathy have been reported. [132][133][134] All occurred unilaterally and were temporally related with either endotracheal intubation or prone positioning, suggesting a iatrogenic etiology.…”

Presentation of Neuro-COVID is Broad and Pathogenesis Diverse

“…CNS disorders not included in the review were intracerebral bleeding, 2 cerebral vasculitis, 3 acute cerebral demyelination, 4 headache, 5 myoclonus-ataxia syndrome, 6 limbic encephalitis, 7 cytokine release syndrome, 8 delirium, 9 and psychosis. 10 Peripheral nervous system disorders not included in the review were isolated oculomotor, trochlear, facial, or hypoglossal nerve palsy, 11 myositis/ dermatomyositis, 12 myopathy, 13 and rhabdomyolysis. 14 There was no discussion about the putative delineation between neurological disorders due to direct attack of the virus (primary manifestations), secondary CNS/PNS disorders due to the immune response (secondary manifestations), and those occurring as a side effect of the treatment or involvement of other organs than the CNS (tertiary manifestations).…”