Patient with COVID – 19 infection presenting with acute 6th cranial nerve palsy: A case report

Srijon, SM Sanayet Bin Mustafiz; Khanam, Rawshan Arra; Mimi, Al Fateha Rahman

doi:10.3329/bccj.v8i2.50036

Cited by 4 publications

(9 citation statements)

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“…Hyperlactatemia further suppresses the oxygen-carrying capacity of red blood corpuscles, which further intensifies hypoxic conditions in the muscle tissues [87]. In addition, SARS-CoV-2 can directly infect the musculoskeletal system expressing endothelial cells of the skeletal muscle and spinal cord through ACE2, which have been also regarded as the mechanism of musculoskeletal manifestation in COVID-19 patients [157]. Analgesics may not be therapeutically effective in attenuating such pain; however, viral exclusion has been proposed to be a potential therapeutic strategy [87].…”

Section: Skeletal Muscle Manifestationsmentioning

confidence: 99%

Emerging COVID-19 Neurological Manifestations: Present Outlook and Potential Neurological Challenges in COVID-19 Pandemic

et al. 2021

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The unremitting coronavirus disease 2019 (COVID-19) pandemic caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) marked a year-long phase of public health adversaries and has severely compromised healthcare globally. Early evidence of COVID-19 noted its impact on the pulmonary and cardiovascular functions, while multiple studies in recent time shed light on its substantial neurological complications, though a comprehensive understanding of the cause(s), the mechanism(s), and their neuropathological outcomes is scarce. In the present review, we conferred evidence of neurological complications in COVID-19 patients and shed light on the SARS-CoV-2 infection routes including the hematogenous, direct/neuronal, lymphatic tissue or cerebrospinal fluid, or infiltration through infected immune cells, while the underlying mechanism of SARS-CoV-2 invasion to the central nervous system (CNS) was also discussed. In an up-to-date manner, we further reviewed the impact of COVID-19 in developing diverse neurologic manifestations associated with CNS, peripheral nervous system (PNS), skeletal muscle, and also pre-existing neurological diseases, including Alzheimer's disease, Parkinson's disease, multiple sclerosis, epilepsy, and myasthenia gravis. Furthermore, we discussed the involvement of key factors including age, sex, comorbidity, and disease severity in exacerbating the neurologic manifestations in COVID-19 patients. An outlook of present therapeutic strategies and state of existing challenges in COVID-19 management was also accessed. Conclusively, the present report provides a comprehensive review of COVID-19-related neurological complications and emphasizes the need for their early clinical management in the ongoing COVID-19 pandemic. Keywords COVID-19 • SARS-CoV-2 • CNS • PNS • Neuroinvasion • COVID-19 pandemic • Neurological complications Highlights• Coronavirus disease 2019 (COVID-19)-associated complications involve substantial neurological manifestations.• SARS-CoV-2 infection routes include the hematogenous, neuronal, lymphatic tissue/cerebrospinal fluid, or infiltration through infected immune cells.• COVID-19 promotes neurologic manifestations associated with the central and peripheral nervous system and exacerbates the pre-existing neurological and neurodegenerative conditions. • Patient's age, sex, comorbidity, and severity of the infection are key factors that determine the extent of neurologic manifestations in COVID-19 patients.

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Section: Skeletal Muscle Manifestationsmentioning

confidence: 99%

Emerging COVID-19 Neurological Manifestations: Present Outlook and Potential Neurological Challenges in COVID-19 Pandemic

et al. 2021

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“…[23] The affection of the third cranial nerve (oculomotor nerve palsy) was reported in 8 patients, [3,7,8,12,[24][25][26] while affection of the fourth cranial nerve (trochlear nerve palsy) was reported in four patients. Finally, palsy of the sixth cranial nerve (Abducent) was reported in seventeen cases [4,7,8,12,[18][19][20][21]25,27,28] Abducent nerve affection has the largest number of reported cases. Whether there is a predilection for SARS-CoV-2 infection of the Abducent nerve compared to other oculomotor nerves remains a question to be answered.…”

Section: Discussionmentioning

confidence: 99%

“…[ 4 , 8 , 12 , 18 , 24 , 26 ] Corticosteroids were used in the management of other cases. [ 2 , 20 , 30 , 31 ]…”

Section: Discussionmentioning

confidence: 99%

An overview of third, fourth and sixth cranial nerve palsies in the setting of COVID-19: A case report and systematic review

et al. 2022

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Background: Covid-19 has serious sequelae that may be poorly understood, underreported, and, as a result, not diagnosed promptly, such as variations in clinical manifestations of hyperinflammation among people infected with SARS-CoV-2. ophthalmoplegia can be one of these manifestations.Methods: We are reporting a 55-year-old male patient with unilateral diplopia considering it as a case of multisystem inflammatory syndrome in adults. We also reviewed the literature systematically for the previously reported studies/cases with third, fourth and sixth cranial nerve palsies due to or after Covid-19.Results: The literature search yielded 17 studies reporting 29 patients. 71.4% of the patients were males with a mean age of 42.23 years. Ophthalmological symptoms took 9.7 days to appear after the respiratory involvement. All patients had diplopia as part of their visual symptoms. 41.4% of the patients had unilateral sixth nerve palsy, 24% had bilateral sixth nerve involvement, 17% had fourth nerve involvement, and 27.6% had third nerve involvement. Conclusion:Ophthalmoplegia is considered presenting symptom of Covid-19. Further research is needed to detect all neuroophthalmological manifestations of Covid-19.

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“…The most frequently affected cranial nerves among COVID-19 patients were the facial nerve (26%) and the abducens nerve (12%). [ 15 - 18 , 22 , 23 , 25 , 26 , 28 , 29 , 34 - 36 ]. The mean time from respiratory symptoms to the onset of neurological signs was 9.6 ± 7.4 days, and the mean recovery time was 16.3 ± 15.3 days.…”

Section: Reviewmentioning

confidence: 99%

“…The most frequent neurological manifestations in facial nerve paralysis were the inability to close one eye, drooping on one side of the mouth, loss of forehead wrinkling on the affected side, and deviation of angle of the mouth towards the opposite side along with drooling of saliva on the right side [ 19 , 23 ]. Regarding sixth-nerve palsy, diplopia was the most common sign [ 25 , 26 , 28 , 29 , 34 ].…”

Section: Reviewmentioning

confidence: 99%

Cranial Nerve Impairment Associated With COVID-19 Infections: A Systematic Review

Tonkal¹,

Alamri²,

AlMaghrabi³

et al. 2022

Cureus

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The COVID-19 pandemic has created huge economic and healthcare burdens. In most cases, the virus affects the lungs and causes respiratory symptoms. Additionally, its impact on the cranial nerves remains unclear. We thus aimed to investigate cranial nerve dysfunction in patients with COVID-19 infection.We conducted a systematic literature search of relevant and eligible literature in five databases: PubMed, Web of Science, Medline, EBSCO, and Google Scholar.Our sample included 21 case reports, one case series with 29 patients, and one analytical study with 135 cases. Participant ages ranged from 23 months to 72 years (mean age of 47.5 ± 19.02). The mean time from respiratory symptoms to the onset of neurological signs was (9.6 ± 7.4) days, and the mean recovery time was (16.3 ± 15.3) days.Cranial nerve impairment associated with COVID-19 infection has affected a large population, from infants to the elderly. Facial and abducent nerves were the most commonly affected cranial nerves with reported good prognosis or complete recovery within a few days to weeks. Olfactory dysfunctions were widely detected among COVID-19 patients.

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Patient with COVID – 19 infection presenting with acute 6th cranial nerve palsy: A case report

Cited by 4 publications

References 0 publications

Emerging COVID-19 Neurological Manifestations: Present Outlook and Potential Neurological Challenges in COVID-19 Pandemic

Emerging COVID-19 Neurological Manifestations: Present Outlook and Potential Neurological Challenges in COVID-19 Pandemic

An overview of third, fourth and sixth cranial nerve palsies in the setting of COVID-19: A case report and systematic review

Cranial Nerve Impairment Associated With COVID-19 Infections: A Systematic Review

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