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Bell palsy is caused by impaired functioning of the 7th cranial nerve. A disparity in the stable state of the cytokine regulatory axis and a cytokine storm are observed to occur from the binding of the ACE2 to the COVID, and the subsequent functional alterations in the ACE2/AT2R suggest that COVID-19 may use direct or indirect processes to produce neurological symptoms. Increased cases of Bell palsy were reported during the CoV pandemic, so our study aimed to estimate the incidence rate of Bell palsy among COVID-19 patients in South Bangalore, India. Secondary data of patients with Bell palsy were obtained retrospectively from two multispecialty Hospitals in South Bangalore. COVID positive populations were collected between the period of March 2021 and February 2022, and many Bell palsy cases within 3 months of post-Covid period were included. Confirmatory calls were made for patients with Covid Positive who were not diagnosed to discover the occurrence of Bell palsy. A retrospective analysis of Bell palsy cases found 11 incidences between March 2021 and February 2022, when there were 1577 COVID patients in total. According to descriptive statistical analysis, the prevalence of Bell palsy increased by 0.7% during the COVID-19 pandemic. Bell palsy could be considered one of the neurological complications among COVID-19 patients, and appropriate preventative measures should be taken.Copyright © 2023 International Journal of Nutrition, Pharmacology, Neurological Diseases Published by Wolters Kluwer - Medknow.
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Objective: The objective of this study was to evaluate how the coronavirus disease 2019 pandemic affected the profile of patients admitted to the electromyography (EMG) laboratory and the types of neurophysiologic evaluations. Method(s): We included patients who were admitted to our EMG laboratory in the first 6 months of the pandemic period (Period 1) and the same 6 months of the previous year (Period 2). In view of changes in health-care strategies, lockdown, and disease awareness during the pandemic, each group was divided into 3-month periods (early and late). Demographic and clinical characteristics and electrophysiologic data were evaluated retrospectively and compared between the groups. Result(s): In Period 1, there were 1872 studies of 1829 patients, and in Period 2, there were 625 studies of 607 patients. Electrodiagnoses for cranial neuropathies were more frequent during the pandemic when compared with before the pandemic (P = 0.018). The subgroup analysis revealed that the ratio of segmental anterior horn involvement decreased in the early pandemic period (P = 0.003), myopathies decreased in the late pandemic period (P = 0.001), and cranial neuropathies increased in the late pandemic period (P = 0.005) compared with the same periods in the previous year. Conclusion(s): During the pandemic, there have been changes in clinical practice approaches in the electrophysiology laboratory. More cranial neuropathies seemed to be diagnosed in the EMG laboratory during the pandemic, including new-onset facial neuropathies, which was the most significant finding of our study.Copyright © 2023 AVES. All rights reserved.
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Objectives: Since its first appearance in Wuhan December 2019, SARS-CoV2 virus received great attention due to its severe symptoms and high spread causing COVID-19 disease which spread all over the world like a pandemic. The causative virus is capable of human-to-human transmission via droplet and direct contact suggesting that upper respiratory tract is the main site to virus manifestations. There is a great diversity in its clinical picture, although the severe respiratory and neurological symptoms are commonly present;however, other symptoms are present. Although otological manifestations are reported in many COVID-19 patients even in asymptomatic cases, they did not receive much attention compared with other critical manifestations. In this article, we paid our attention specifically to the otological manifestations of COVID-19 and their relevance either to the virus infection, treatment, or vaccination through literature review. Conclusion(s): COVID-19 disease has a deleterious effect on the inner ear. This effect is not only due to SARS-Cov-2 infection, but it could be also due to the ototoxic drugs used for treatment. The COVID-19 vaccinations are found to be implicated in the otological symptoms in some cases.Copyright © 2022, The Author(s).
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Purpose: The main purpose of this study is to highlight the involvement of the facial nerve as one of the presenting symptoms in patients suspected of coronavirus disease associated mucormycosis (CAM). Methods: This is a retrospective observational study conducted at a tertiary care referral centre which included 300 patients with past history of being treated for coronavirus disease and who presented to our department with symptoms of invasive fungal sinusitis. All the patients were evaluated clinically and radiologically for presence of facial nerve palsy (FNP) in suspected cases of CAM. All the patients were managed with combined modality treatment with antifungal therapy and radical endoscopic debridement of the necrotic tissue and fungal debris. Results: The data were analysed to assess the possible epidemiological factors linked to CAM. Diabetes mellitus was the most common associated factor identified for aggravating of CAM. FNP is also one of the common presentation seen among 53 patients with CAM. Conclusion: FNP is an unusual but significant sign in presentation of mucormycosis. It could be easily misdiagnosed as cerebrovascular accident leading to delay in the treatment. During this era of Covid-19 pandemic where wearing of masks has become mandatory, there is a high probability of this finding to be missed. Thus, our study emphasises for thorough cranial nerve examination in all cases of CAM, for an early and an immediate intervention to prevent the spread of the disease and also to improve the overall general condition of the patient.
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Background: Coronavirus disease-2019 (COVID-19) has caused a pandemic that has recently affected every aspect of life. Fortunately, many vaccines with high safety and efficacy profiles were developed timely to face this pandemic. In a very short time, billions of people were vaccinated. In the meantime, a wide range of neurological syndromes are being reported. Guillain-Barre syndrome (GBS) which is a rare immune-mediated post-infectious peripheral neuropathy was reported after both the COVID-19 infection itself and many types of its vaccines. Method(s): We are reporting a case of post-AstraZeneca vaccine GBS and reviewing the literature of all reported post-COVID-19 vaccines GBS till July 2021. Result(s): 29 adult patients were reported. Of them 58.6% were males. Their mean age is 58.2 years. The median time to clinical onset after vaccine administration was 13.2 days. 86.2% of patients had their symptoms following immunization with the 1st dose of AstraZeneca vector-based covid vaccine. Facial palsy was the most predominant single symptom in 75.8% of patients. Conclusion(s): Guillain-Barre syndrome is a well-recognized but still rare adverse event following vaccination against COVID-19. Although preliminary data incriminates viral vector-based vaccines more than the other types, active post-vaccination surveillance and more powerful statistics are mandatory to reach a solid conclusion regarding the presence of a causal relation.Copyright © 2022
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In December 2019, a novel coronavirus outbreak spread rapidly all over the world. The virus is known to be neuroinvasive, but much is still unknown. In this study, we aimed to pres-ent the main neurologic symptoms in patients who were diagnosed with coronavirus disease 2019 (COVID-19). The study was conducted retrospectively by phoning 156 patients in Turkey diagnosed with COVID-19 through real-time polymerase chain reaction;only 100 patients could be reached. Data about their demographics, initial symptoms, neurological symptoms, and sleeping habits were collected. During the disease process, 66% had at least one neurological symptom, 55% had central nervous system symptoms, 42% had peripheral nervous system symptoms, and 64% had sleep disturbances and myalgia. Impaired consciousness, smell and taste impairments, and sleep disturbances were significantly higher in patients with positive chest computed tomography imaging (p < 0.05). Neurological symptoms were observed in COVID-19, as in other coronaviruses. Headache in particular was the most common symptom in our population. In patients with respiratory system findings, the detec-tion of certain neurological symptoms such as smell-taste impairments, impaired consciousness, and sleep disorders were more common. We concluded that COVID-19 patients should be approached in a more holistic way, taking the nervous system into account.Copyright © 2022, Dr. Mladen Stojanovic University Hospital. All rights reserved.
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Arterial dissection is an uncommon complication of reversible cerebral vasocon-striction syndrome (RCVS). We describe the case of a 35-year-old woman with a migraine history who presented with recurrent thunderclap headache and focal neurological signs, including right hemiataxia. She had been diagnosed with COVID-19 disease two weeks earlier. Neuroimaging revealed multifocal stenosis of the posterior circulation arteries and dissection of the right superior cerebellar artery. She improved significantly throughout her one-week hospitalization and maintained only mild ataxia. The interplay between COVID-19 disease, RCVS, and arterial dissection requires further investigation.Copyright © Author(s) (or their employer(s)) and Sinapse 2022.
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Background & Objectives: This study aimed to compare PD patients with and without COVID-19 and to evaluate the associated factors about prognosis. Methods: The data of 37 hospitalized PD patients associated with COVID-19 pneumonia were evaluated. It was compared with the data of 40 PD patients who did not have COVID-19 in the same period. Clinical findings, prognosis, mortality and other related factors were compared in PD patients with and without COVID-19. Results: Hypertension was higher comorbid disease in PD patients with COVID-19 (p = 0.005). The duration of PD was longer in patients without COVID-19 disease (6.02 ± 2.80 vs 5.08 ± 4.59) (p = 0.028). In PD patients with COVID-19, the most common symptoms were myalgia-arthralgia (73.0%) and fatigue (48.6%). Intensive care was required in 17 (45.9%) patients, and invasive mechanical ventilation (IMV) was required in 9 (24.3%) patients. The in-hospital mortality rate was 29.7% (n = 11). Mortality and IMV requirement were higher in patients whose initial symptom was diarrhea (p = 0.004, p = 0.008, respectively). No correlation was detected between PD stage, treatment options and prognosis (p < 0.05). Conclusion: Mortality rate and IMV requirement are higher in PD patients with COVID-19 pneumonia, particularly in patients with initial symptoms of diarrhea. These patients should be followed more carefully in terms of probable poor prognosis. © 2023, ASEAN Neurological Association. All rights reserved.
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Lower motor neuron facial nerve palsy (FNP) has many causes. Bell's palsy is by far the commonest cause. Among other causes include infective and neoplastic causes. While FNP caused by facial nerve schwannoma (FNS); a benign neoplastic condition of the facial nerve is slowly progressing, infective causes mainly viral origins present with acute FNP. We present a young female who complained of an acute onset of FNP on day five of her COVID-19 infection. She initially presented with symptoms suggestive of ear infection, and subsequent magnetic resonance imaging (MRI) showed evidence of FNS, which she was subjected to surgery later at our center. This rare acute incidence of FNP in schwannoma might be triggered by the COVID-19 infection and demonstrates the role of imaging in finding the cause of FNP.
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The diagnosis of Kawasaki disease (KD) is challenging and often delayed mainly in case of young infants and in presence of an incomplete disease and atypical features. Facial nerve palsy is one of the rare neurologic symptoms of KD, associated with a higher incidence of coronary arteries lesions and may be an indicator of a more severe disease. Here, we describe a case of lower motor neuron facial nerve palsy complicating KD and perform an extensive literature review to better characterize clinical features and treatment of patients with KD-associated facial nerve palsy. The patient was diagnosed at the sixth day of disease and presented extensive coronary artery lesions. A prompt treatment with intravenous immunoglobulins, aspirin and steroids obtained a good clinical and laboratory response, with resolution of facial nerve palsy and improvement of coronary lesions. The incidence of facial nerve palsy is 0.9-1.3%; it is often unilateral, transient, more frequent on the left and seemingly associated with coronary impairment. Our literature review showed coronary artery involvement in the majority of reported cases (27/35, 77%) of KD with facial nerve palsy. Unexplained facial nerve palsy in young children with a prolonged febrile illness should prompt consideration of echocardiography to exclude KD and start the appropriate treatment.
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Facial nerve palsy is a clinical diagnosis differentiating between central upper motor neuron lesions and peripheral lower motor neuron lesions. Rehabilitation is an important issue in peripheral facial nerve palsy management. In this article, we present the case of an adult woman affected by right peripheral facial nerve palsy due to acoustic neuroma surgical excision. She immediately started a rehabilitation plan, but it was stopped due to COVID-19 lockdown and did not resume because of the fear of contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Therefore, we planned to treat her palsy with remote neurocognitive rehabilitation. After 10 months of treatment, the patient underwent a follow-up physiatric assessment, confirming right facial palsy improvement. There was a slight nasolabial groove flattening and slight left oral rime deviation while smiling (House-Brackmann classification improved from Grade IV to III). Telerehabilitation represents a valid strategy for neurocognitive rehabilitation, not only in a pandemic scenario, but also in other conditions that lead to social distancing.
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OBJECTIVE: Several cases of facial nerve paralysis (FNP) post-COVID-19 infection have been reported with varying presentations and management. This study aims to identify FNP clinical characteristics and recovery outcomes among patients acutely infected with COVID-19. We hypothesize that FNP is a potentially unique sequalae associated with COVID-19 infections. METHODS: A systematic review of PubMed-Medline, OVID Embase, and Web of Science databases from inception to November 2021 was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: This search identified 630 studies with 53 meeting inclusion criteria. This resulted in 72 patients, of which 30 (42%) were diagnosed with Guillain-Barré Syndrome (GBS). Non-GBS patients were on average younger (36 vs. 53 years) and more likely to present with unilateral FNP (88%) compared to GBS patients who presented predominantly with bilateral FNP (74%). Among non-GBS patients, majority (70%) of FNP presented a median of 8 [IQR 10] days after the onset of initial COVID-19 symptom(s). Treatment for non-GBS patients consisted of steroids (60%), antivirals (29%), antibiotics (21%), and no treatment (21%). Complete FNP recovery in non-GBS patients was achieved in 67% patients within a median of 11 [IQR 24] days. CONCLUSION: FNP is a possible presentation post COVID-19 infections, associated with both GBS and non-GBS patients. Although no causation can be assumed, the clinical course of isolated FNP associated with COVID-19 raises the possibility of a unique presentation differing from Bell's palsy, seen with higher proportion of patients developing bilateral FNP and a shorter duration to complete recovery. Laryngoscope, 2022.
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An 81-year-old woman developed progressive proximal weakness and myalgias several months following a COVID-19 infection. She was admitted to her local hospital for progressive weakness, peripheral edema, and exertional dyspnea. Neurology evaluation noted proximal arm and leg weakness. She had creatine kinase 740 U/L, white blood cells 21,000/mL (with abnormal differential), and abnormal antibody serologies. Additional diagnostic testing obtained included a thigh MRI and muscle biopsy. During her COVID-19 admission, a mediastinal mass had been detected, which was increased in size on this current admission. Notably, she had a remote history of an incidentally discovered mediastinal mass, which had been incompletely resected 18 years prior. At neuromuscular follow-up one month later, she reported improvement in peripheral edema and dyspnea but ongoing weakness. Strength exam noted symmetric Medical Research Council grade 4 weakness in neck flexion/extension, shoulder abduction, elbow flexion/extension, wrist extension, hip flexion/abduction/extension, and knee flexion. She had no fatiguability and no facial or bulbar weakness. Remainder of her neuromuscular examination was unremarkable. Her white blood cell count differential remained abnormal but had improved from her initial presentation. Her recent muscle biopsy slides were reviewed again. Bone marrow biopsy and mediastinal mass biopsy were obtained. A unifying diagnosis was made, and she was started on therapy with resolution of her weakness, myalgias, and abnormal cell counts.
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Background: There has been lot of speculation around the possible side effects associated with COVID vaccination and incidence of facial palsy is one of them. Bilateral facial palsy is less likely to be idiopathic as compared to unilateral facial nerve palsy and warrants further investigations to find any secondary cause. COVID 19 infection and the vaccinations for the same are also included in the unique list of differentials. Case report: We report an interesting case of bilateral rapidly sequential facial nerve palsy following the administration of COVID vaccination that showed subsequent improvement. We provide literature review to report the current incidence of same, secondary to the vaccination as well the infection itself Case presentation: Following the introduction of COVID 19 vaccine, there have been reports of various cranial nerve involvement including lower motor neuron type facial paresis. Bilateral facial palsy is less likely to be idiopathic as compared to unilateral palsy(23% vs 70%) and requires further work up to determine the etiology before determining to be idiopathic. Unilateral facial palsy(FP) has been reported in the Phase I and II trials for Pfizer and Moderna vaccine, with a total of 7 cases reported in these initial trials. To date, there is no direct evidence that these vaccines have increased the incidence of facial palsy as compared to adverse events reported with other vaccines or compared to COVID 19 infection itself. We report a unique case of bilateral lower motor neuron type facial palsy noted in a young male within hours of receiving the vaccine that later improved with treatment. Reports of simultaneous bilateral facial palsy after vaccine are rare with only few cases reported to date in literature. Conclusion(s): In conclusion from current available literature, we would like to postulate that though there is a risk of facial nerve palsy following the vaccination, it is comparable to the risks associated with any other vaccinations and not been higher than the non-vaccinated population. The overall risk is higher with the actual COVID 19 infection itself as compared to the vaccine.Copyright © 2022
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Facial palsy (FP) is a life changing condition with physical, aesthetic, functional and psychosocial consequences, which requires specialized diagnosis, rehabilitation and (surgical) management to improve facial function and reduce its negative effects. Since patients remain in follow-up during their life and often have to travel far to receive treatment, improvements can be made in the field of telemedicine. Telemedicine is a growing field of study in medical practice and several advances have been made in the field of plastic surgery. Especially during the COVID-19 pandemic, considerable experience was gained in this way of consultation. This review provides an overview of current research available in the field of E-Health and M-Health in plastic surgery and for patients with a peripheral facial palsy.Copyright © 2021 The Author(s)
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SARS-CoV-2 infection has been associated with multiple neurological manifestations. One such manifestation, which has been described since the early stages of the COVID-19 pandemic and is relevant for current neurological practice, is Guillain-Barre syndrome (GBS). The literature describes neurotoxic mechanisms of the virus itself and the possible pathways by which it may affect the peripheral nerves in experimental studies;however, we still lack information on the mechanisms causing the immune response that gives rise to GBS in the context of SARS-CoV-2 infection. Colombia is one of the Latin American countries worst affected by the pandemic, with the third-highest number of cases in the region;thus, it is essential to recognise GBS, as this potential postinfectious complication may severely compromise the patient's functional status in the absence of timely diagnosis and treatment. We present a series of 12 cases of GBS associated with SARS-CoV-2 infection from hospitals in 4 different Colombian cities and describe the clinical presentation, laboratory and electrophysiological study findings, and treatment.Copyright © 2022 Sociedad Espanola de Neurologia
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COVID-19 vaccination is one of the most effective ways to prevent the spread of SARS-CoV2. However,these vaccines are not devoid of adverse effects requiring post-vaccination follow-up. Aim(s): Determine the frequency of adverse events(AEs)of an anti-COVID-19 messenger RNA vaccine (mRNA) collected among health care workers(HCW) at Charles Nicolle Hospital in Tunis. Method(s): Descriptive cross-sectional study carried out in September 2021, involving the HCW of the Charles Nicolle hospital in Tunis who had received the first dose of an mRNA anti-COVID 19 vaccine during a mobile vaccination campaign in the workplace. The data collection was carried out using a pre-established questionnaire containing the adverse vaccine reactions defined by the Tunisian Ministry of Health technical sheets. Result(s): The study population was composed of 139 HCW. Post-vaccine AEs were reported in 78% of cases. A predominance of women was noticed(78%). The age group most affected was between 40 and 45 years old. The most common AEs were injection site pain in 65% of cases, fever in 30% of cases, headache in 15% of cases and myalgia in 14% of cases. In addition, four cases of dizziness, two cases of generalized pruritus and one case of lymphadenopathy and acute peripheral facial paralysis were reported. The time to onset of AEs ranged from the same day to three days. The average duration of these AEs ranged from one to seven days. Five percent of our population took time off work which variated from one to three days. Conclusion(s): The occurrence of AEs following vaccination with an mRNA vaccine should not destabilize the promotion of vaccination in the workplace. However, close post-vaccination surveillance is necessary to ensure good occupational activity in the care setting.
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Background Left Ventricular Non-Compaction Cardiomyopathy (LVNC) is a rare genetic, developmental disorder when the left apical chamber of the heart contains bundles or pieces of muscle that extend into the chamber called trabeculations. These trabeculations are a sponge-like network of muscle fibers that typically become compacted to transform heart muscle to become smooth and solid during a normal development process. Those who have LVNC most commonly are asymptomatic. Those who are symptomatic present with syncope, palpitations, dizziness, dyspnea, fatigue and/or unexplained weight gain or swelling. LVNC has also been suggested as a rare cause of embolic stroke, in our patient's case, "due to sluggish blood flow in deep intertrabecular recesses." Case We present a 29 year old African American female, G2P0011, with a history of cleft palate repair, and recent pregnancy complicated by COVID-19 who reported to ED after having a fall the day before, leg weakness and numbness, unable to walk, headache and a left facial droop on day of admission. No family history of SCD or other cardiac disease was noted. On assessment, was found to have NIHSS of 7 with rate lateral gaze palsy, left facial palsy, and decreased strength and sensation of LUE and LLE. TPA was not given due to being outside the therapeutic window. CT head and MRI brain were consistent with acute right MCA stroke. Secondary stroke workup with TTE revealed reduced LVEF 15-20%, loosely arranged myocardium with suspected LVNC and RV apical thrombus. Cardiac MRI showed increased trabeculations consistent with LVNC. Decision-making Currently, there are no ACC/AHA guidelines on anticoagulation in the setting of LVNC. Cardiology and Neurology had an extensive multidisciplinary discussion on the need for anticoagulation specifically with Warfarin. The patient was educated extensively on the need for medical adherence with anticoagulation and guideline directed medical therapy. Conclusion The patient was started on guideline directed medical therapy for cardiomyopathy and was started on Warfarin after bridging from Lovenox. She continued with physical therapy and was noted to have improvement in residual deficits at her outpatient follow up.Copyright © 2023 American College of Cardiology Foundation
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ChAdOx1 nCoV-19 (AZD1222) is a replication-deficient chimpanzee adenovirus vectored vaccine developed by Oxford and AstraZeneca for a disease we all know as Coronavirus, or COVID-19. Ongoing clinical studies reveal that the ChAdOx1 nCoV-19 vaccine has a tolerable safety profile and is effective against symptomatic COVID-19. This vaccine may prove crucial in boosting herd immunity, averting life threatening illness, and relieving the current pandemic. In this mini review, we performed a thorough literature search through PubMed and Google Scholar and reported various case reports associated with complications of the adenovirus-vectored COVID-19 vaccine. Various adverse effects of the ChAdOx1 nCoV-19 vaccine were reported around the globe, which were often serious but rare and developed into life-threatening pathologies such as GBS, thrombocytopenia, demyelinating neuropathies, progressive dementia, cerebral infarction, IgA vasculitis, hemophagocytic lymphohistiocytosis, herpes zoster, cutaneous reactions, and vein thrombosis. These worldwide reported complications, which are usually rare and severe, will aid clinicians in understanding and managing unforeseen situations. There is a need for more research to find out more about these complications and their etiopathogenesis. However, the benefits of these vaccinations for stopping the spread of the outbreak and lowering the fatality rate outweigh the potential risk of the uncommon complications.Copyright © The Author(s) 2023.