Bilateral Facial Nerve Palsy After Sars Cov-2 Infection in Pediatric Patient

Abstract

COVID-19 infection has been associated with several neurologic manifestations including anosmia, acute ischemic stroke, Guillain-Barré syndrome, encephalopathy and cranial nerve involvement. Though multiple cases of unilateral facial nerve palsy have been reported but bilateral facial palsy is very rare. Our case was 12 years old female patient who presented with difficulty in closing mouth, drooling of saliva and change in voice. On examination, there was loss of bilateral nasolabial folds, nasal twang of speech and incomplete eye closure bilaterally. Laboratory reports suggested raised CRP and amylase along with positive Immunoglobulin IgG covid-19 antibodies. Magnetic Resonance Imaging of brain and neck showed no abnormality. The child was managed conservatively with supportive care, subsequent to which she gradually improved over next 4-6 weeks. To the best of our knowledge, this is the first pediatric case where SARS-COV2 infection was found to be associated with bilateral facial nerve palsy as a post covid complication. Therefore, bilateral facial palsy should be considered as one of the associations of COVID especially in the present era. A detailed history and examination should be done as it often gets missed due to bilateral involvement. All differential diagnosis should be ruled out by relevant laboratory & radiological tests. Most children are likely to recover well with supportive treatment.