Bilateral trochlear nerve palsy due to cerebral vasculitis related to COVID-19 infection

COVID-19 is caused by the coronavirus SARS-CoV-2 that has an affinity for neural tissue. There are reports of encephalitis, encephalopathy, cranial neuropathy, Guillain-Barrè syndrome, and myositis/rhabdomyolysis in patients with COVID-19. In this review, we focused on the neuromuscular manifestations of SARS-CoV-2 infection. We analyzed all published reports on SARS-CoV-2-related peripheral nerve, neuromuscular junction, muscle, and cranial nerve disorders. Olfactory and gustatory dysfunction is now accepted as an early manifestation of COVID-19 infection. Inflammation, edema, and axonal damage of olfactory bulb have been shown in autopsy of patients who died of COVID-19. Olfactory pathway is suggested as a portal of entry of SARS-CoV-2 in the brain. Similar to involvement of olfactory bulb, isolated oculomotor, trochlear and facial nerve has been described. Increasing reports Guillain-Barrè syndrome secondary to COVID-19 are being published. Unlike typical GBS, most of COVID-19-related GBS were elderly, had concomitant pneumonia or ARDS, more prevalent demyelinating neuropathy, and relatively poor outcome. Myalgia is described among the common symptoms of COVID-19 after fever, cough, and sore throat. Duration of myalgia may be related to the severity of COVID-19 disease. Few patients had muscle weakness and elevated creatine kinase along with elevated levels of acute-phase reactants. All these patients with myositis/rhabdomyolysis had severe respiratory complications related to COVID-19. A handful of patients with myasthenia gravis showed exacerbation of their disease after acquiring COVID-19 disease. Most of these patients recovered with either intravenous immunoglobulins or steroids.

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“…We also included 5 reports (6 patients) of isolated cranial neuropathy in COVID-19 patients (Table 6) [82][83][84][85][86][87].…”

Section: Search Resultsmentioning

confidence: 99%

“…She showed spontaneous improvement in diplopia. Oliveira RMC et al reported a 69-year-old male with stabbing occipital pain and diplopia secondary to trochlear nerve palsy [83]. He had evidence of vertebrobasilar vasculitis that showed improvement on intravenous methylprednisolone.…”

Section: Cranial Neuropathymentioning

confidence: 98%

Neuromuscular presentations in patients with COVID-19

et al. 2020

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“…The highly sulfated state results in a negative density and binding capacity for a variety of positively charged ligands. A partial but representative summary of individual sites of vasculitis is provided (Table 1) [ [54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69].…”

Section: Vasculitis In Covid-19mentioning

confidence: 99%

COVID-19-associated vasculitis and vasculopathy

Becker

2020

J Thromb Thrombolysis

250

259

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The COVID-19 pandemic now totaling 13,000,000 cases and over 571,000 deaths has continued to teach the medical, scientific and lay communities about viral infectious disease in the modern era. Among the many lessons learned for the medical community is the potential for transmissibility and host infectivity of the SARS-CoV-2 virus. Moreover, it has become clear that the virus can affect any organ including the circulatory system, directly via either tissue tropism or indirectly stemming from inflammatory responses in the form of innate immunity, leukocyte debris such as cell-free DNA and histones and RNA viral particles. The following review considers COVID-19-associated vasculitis and vasculopathy as a defining feature of a virus-induced systemic disease with acute, subacute and potential chronic health implications.

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“…The development of encephalitis and GBS were generally delayed after COVID-19 symptoms onset. MRI-proven central nervous system vasculitis occurred in two patients 11-29 days after COVID-19 symptoms onset and responded to either corticosteroids or tocilizumab (146,147). Using RT-PCR or antibody testing, if available, cerebrospinal fluid SARS-CoV-2 were positive in only some of these cases (144).…”

Section: Neurological Manifestationsmentioning

confidence: 99%

Autoimmune and Rheumatic Manifestations Associated With COVID-19 in Adults: An Updated Systematic Review

2021

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Background: Numerous cases of the coronavirus disease 2019 (COVID-19) with autoimmune and rheumatic manifestations have been reported. Despite the available reviews that summarized its autoimmune/rheumatic manifestations, a systematic approach is still lacking. Therefore, we conducted a comprehensive systematic review in order to give an overview upon these rare but clinically significant manifestations.Methods: We performed a literature search of PubMed and EMBASE as of October 9, 2020. All articles relevant to either systemic or organ-specific autoimmune and rheumatic manifestations potentially associated with COVID-19 were collected. The reviewed literature were limited to adults ≥18 years.Results: Although most of the existing evidence was based on case reports or case series without a long-term follow-up, a variety of autoimmune/rheumatic manifestations were associated with COVID-19. The manifestations that have a consistent association with COVID-19 include autoimmune cytopenia, cutaneous vasculitis, encephalitis, and Guillain-Barre syndrome. Such association is conflicting as regards to antiphospholipid syndrome, hemophagocytic lymphohistiocytosis, and myasthenia gravis.Conclusion: Our systematic review indicated the potential of the COVID-19 virus to trigger a myriad of autoimmune and rheumatic manifestations, which should be considered amid global efforts to combat COVID-19.

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Bilateral trochlear nerve palsy due to cerebral vasculitis related to COVID-19 infection

Cited by 38 publications

References 1 publication

Neuromuscular presentations in patients with COVID-19

Neuromuscular presentations in patients with COVID-19

COVID-19-associated vasculitis and vasculopathy

Autoimmune and Rheumatic Manifestations Associated With COVID-19 in Adults: An Updated Systematic Review

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