Coronavirus disease 2019 complicated with Bell’s palsy: a case report

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%

Neuromuscular presentations in patients with COVID-19

et al. 2020

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“…At the time of writing this article, we identified 53 research literature describing neurological complications in SARS-COV-2, out of these, 11 described neuromuscular complications in SARS-COV-2 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). Out of these 11, seven studies described 11 cases of GBS, one described Miller Fisher syndrome and Polyneuritis Cranialis, one described Acute myelitis, one described Oculomotor paralysis and 1 described Bell's Palsy (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). Table 1 describes the demographic data, time to onset of neurological symptoms, diagnostic criteria, intervention and outcomes from 11 reported studies with neuromuscular complications associated with SARS-COV-2 infection.…”

Section: Methods Search Strategy and Selection Criteriamentioning

confidence: 99%

“…Wan et al described the first case of Bell's Palsy in a 65 year old female who presented with left lower motor neuron facial paralysis, 2 days after developing pain in the mastoid region (18). Interestingly, this patient had no other symptoms of viral illness.…”

Section: Bell's Palsymentioning

confidence: 98%

“…Interestingly, this patient had no other symptoms of viral illness. MRI brain showed no abnormality however, computed tomography (CT) chest showed patchy areas of ground-glass shadows in the right lower lung raising suspicion for SARS-COV 2 (18). SARS-COV-2 infection was confirmed by real-time reverse-transcriptase-polymerase-chain-reaction assay utilizing throat swabs (18).…”

Section: Bell's Palsymentioning

confidence: 98%

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Neuromuscular Complications With SARS-COV-2 Infection: A Review

et al. 2020

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cases were first reported in Wuhan, Hubei province of China in December, 2019. SARS-COV-2 primarily affects the cardio-respiratory system. Over the last few months, several studies have described various neurological sequelae of SARS-COV-2 infection. Neurological complications are more frequent in patients with severe respiratory infections. In this review, we have analyzed the current literature on neuromuscular complications associated with SARS-COV-2 and highlighted possible mechanisms of neuromuscular invasion. We reviewed 11 studies describing 11 cases of Guillain Barre syndrome (GBS), and 1 case each of Miller Fisher syndrome, Polyneuritis Cranialis, Acute myelitis, Oculomotor paralysis and Bell's Palsy associated with SARS-COV-2 infection. Mean age of patients with GBS was 61.54 years, with standard deviation (SD) 14.18 years. Majority patients had fever and cough as the first symptom of SARS COV-2 infection. Mean time for onset of neurological symptoms from initial symptoms in 11 patients was 8.18 days, with SD of 2.86 days. Mean time to performing electrodiagnostic study from onset of neurological symptom was 6 days with standard deviation of 3.25. Six patients had demyelinating pattern, three had acute sensory motor axonal neuropathy, and one had acute motor axonal neuropathy on electrodiagnostic studies.

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“… 2 A literature review yielded an online case report of Bell’s palsy in a COVID-19-positive patient, and the authors suggest that neurological symptoms could be the first manifestation in patients with asymptomatic or mild infection. 3 …”

Section: Sirmentioning

confidence: 99%