ABSTRACT
Objective: To report 3 cases of bilateral facial nerve palsy as the only neurological deficit after a recent COVID-19 infection. Background: Neurologic complications of SARS-CoV-2 infection including hyposmia, cerebrovascular disease and seizures have significantly added to the morbidity and mortality during the COVID-19 pandemic. Bilateral facial nerve palsy while rare, can be attributed to a range of etiologies including infectious, metabolic, oncologic and autoimmune processes, but has rarely been reported with COVID-19 infections. Design/Methods: N/A Case 1: A 54-year old woman presented to the neurology clinic reporting an inability to move her lips and difficulty keeping food in her mouth 14 days after testing positive for COVID-19, her MRI was unrevealing. Case 2: A 36-year-old man presented to the emergency department reporting face numbness and a bifacial droop 5 days after testing positive for COVID-19, his MRI showed inflammation of the right 7 nerve. Case 3: A 42-year-old woman presented to the emergency department for a stroke evaluation with worsening bilateral facial weakness 5 days after testing positive for COVID-19, her MRI showed bilateral enhancement of the 7 cranial nerves. All three patients had bilateral facial weakness on exam. Tests for Herpes, Lyme, HIV, tuberculosis, syphilis, sarcoidosis and diabetes were negative for the first two cases and Stroke workup was unrevealing for the third. None were vaccinated, had other neurologic deficits or cardiorespiratory symptoms. Two of the three patients had a viral prodrome preceding their bifacial palsy. All three were treated with acyclovir and prednisone and showed improvement of symptoms on follow-up. Conclusions: Bilateral facial palsy can impede enteral nutrition and can be distressful from a cosmetic standpoint. COVID-19 infections should now be a part of the differential for bilateral facial nerve palsy. Whether this manifestation is akin to autoimmune phenomena such as a limited Guillain-Barré syndrome or an infectious reactivation needs further research.