MR imaging features of COVID-19-related cranial nerves lesions

Objective: To describe six COVID-19-related cranial nerves lesions Background: NA Design/Methods: All participants presented with at least one cranial nerve lesion few days after initial respiratory symptoms of COVID-19, which diagnosis was confirmed based on reverse transcription-polymerase chain reaction (RT-PCR) from nasopharyngeal swab. MRI were performed in 1.5 or 3 Tesla clinical scanners. Case 1: A 41-year-old woman with anosmia and ageusia in the second week that did not resolve after two months. MRI: bilateral hyperintense signal on FLAIR in the olfactory bulb. Case 2: A 27-year-old woman with blurred vision and pain in the left eye in the second week. MRI: hyperintense signal on STIR, with gadolinium enhancement, suggestive of the left optic neuritis. Case 3: A 25-year-old woman with vertigo, right XII nerve palsy, right XI nerve palsy in the second week. MRI: hyperintense focus on T2-weighted-imaging with restricted diffusion in the caudal portion of the pons, medial to the sulcus limitans, in the right XI nerve nucleus, as well as gadolinium enhancement in the mastoid portion of the right XII nerve. Case 4: A 30-year-old woman with right XII nerve palsy on the tenth day. MRI: gadolinium enhancement in the canalicular portion of the right facial nerve. Case 5: A 65-year-old man presenting headache and bilateral facial nerve palsy (L>R) with lower limbs areflexia on the second week. MRI: bilateral contrast enhancement in the canalicular and labyrinthine portions of the facial nerves. Lumbar spine imaging showed gadolinium enhancement in the cauda equina nerve roots. Electroneuromyography and lumbar puncture were suggestive of Guillain-Barré syndrome. Case 6: A 33-year-old man with bilateral facial nerve palsy on the second week. MRI: gadolinium enhancement in the canalicular and labyrinthine portions of the facial nerves Conclusions: Many neurological manifestations have been reported in association with COVID- 19 infection and cranial nerve commitment may be one of them.

COVID-19 and herpes zoster co-infection presenting with trigeminal neuropathy.

BACKGROUND: Varicella-zoster virus (VZV) is a human neurotropic virus that remains in a latent state within ganglionic neurons throughout the entire neuroaxis after the primary infection. When herpes zoster (HZ) leads to trigeminal involvement, the ophthalmic division is the most implicated. COVID-19 has emerged as a viral cause of severe acute respiratory syndrome that has spread all over the world in the last months. Co-infection with COVID-19 and other viruses has been reported, but sparsely, and involving the respiratory viruses. METHODS: The case of a co-infection of COVID-19 with VZV is reported, and the literature reviewed. RESULTS: A 39-year-old immunocompetent man presented with oligosymptomatic infection with COVID-19, which evolved to left facial HZ, affecting the three divisions of the trigeminal nerve. The co-infection was remotely registered, being the respiratory viruses, especially influenza, the most commonly cited association. However, the present case illustrates the emergence of a latent virus infection, which might be favored by the inflammatory response to the former agent (COVID-19). This reaction ascended from the nasal cavity, where trigeminal branches are also placed. CONCLUSIONS: The emergence of latent VZV infection in this rare presentation might illustrate an effect, at least locally, of COVID-19. This virus possibly induced a retrograde reactivation of VZV in a young immunocompetent patient.