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

Abstract

Cranial nerve neuropathy could be a part of neurological spectrum of COVID-19 disease. Research suggests SARS-CoV-2 infection can trigger an aberrant immune response in some individuals, causing inflammatory nerve damage leading to anosmia and neuropathy. We report here a 50-year-old female patient who presented to the outpatient clinic in Saint John Eye Hospital with a two months history of binocular, horizontal diplopia five days after recovery from SARS-CoV-2 infection, PCR positive test obtained by a nasopharyngeal swab on April 1st, 2021 with upper respiratory tract symptoms. The patient was diagnosed with bilateral abducens nerve palsy. The main cause was presumed to be post-viral as the patient had controlled diabetes “HBA1C: 7%” and had no pre-existing microvascular risk factors. Diplopia still exists after two months of bilateral abducens nerve palsy. Measurements confirmed bilateral limited abductions in both eyes with right or alternating convergent squint. 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. This case report aims to raise awareness amongst clinicians of coronavirus-induced neurological symptoms