ABSTRACT
Introduction: Viruses belonging to the SARS-COV family are known for their neurotropic properties. During the COVID-19 pandemic increasing data emerged, providing evidence for CNS and PNS engagement due to SARS-COV-2 infection. Cranial nerves as well as peripheral nerves have been described to be affected. According to some recent studies, a significant number of COVID-19 patients develop neurological manifestations. Method(s): We present a case of a 38-year-old woman suffering from left-sided facial pain and hypoesthesia, as well as paraesthesia, hypoesthesia, and pain in her left arm. One to two weeks prior to these symptoms, she presented with signs of upper respiratory tract infection and loss of taste and smell. She underwent a routine neurological examination and prior to her admission to the neurology ward she tested positive with qPCR for SARS-COV-2 in a nasopharynx swab. Subsequently she underwent brain and spinal MRI, analysis of cerebrospinal fluid (CSF) and neurophysiological examinations including nerve conduction studies and blink reflex analysis. Result(s): The brain and spinal MRI, CSF analysis and nerve conduction studies of the left arm (n. medianus, n. ulnaris, and the superficial radial nerve) and the facial nerve (CN VII) showed normal results. Normal blink reflex responses were obtained from both the supraorbital nerve and infraorbital nerve. When examining the mental nerve, normal responses were obtained from the asymptomatic right side but from the symptomatic left side both ipsilateral R2 and contralateral R2 responses were absent. This indicates an afferent non-specific lesion in the left mental nerve. Conclusion(s): When considering the course of her condition and excluding other probable causes, the symptoms were regarded to be related to her SARS-COV-2 infection. Hence, with this case report we can present objective neurophysiological evidence that a specific segment of the trigeminal nerve, in this case the mental nerve, can be affected by neuralgia due to COVID-19. It is notable that the patient did not present with symptoms of typical/classic trigeminal neuralgia. She was treated with carbamazepine and the facial pain was significantly improved. To the best of our knowledge, this is the first report of a pathological blink reflex associated with COVID-19. Copyright © 2022