Facial Palsy Induced by Covaxin in Adolescent Female - A Rare Case Report.

BACKGROUND: The world has seen nearly 2 years of a pandemic caused by the SARS-CoV-2 virus, notoriously known as COVID-19. Several vaccines have been approved under Emergency Use Authorization (EUA) to combat the disease, one of which is Covaxin, an inactivated adjuvant SARSCoV- 2 vaccine that is generally well tolerated and has fewer side effects. However, we recently have seen a rare case of facial palsy (paralysis) following Covaxin vaccination in an adolescent girl. CASE PRESENTATION: A 16 years old adolescent girl presented with chief complaints of left side deviation of mouth with difficulty in closing right eye after 29 days of receiving the first dose of Covaxin, which was finally diagnosed as a "Covaxin induced facial palsy". Her symptoms were alleviated with some supportive measures, steroid and antiviral treatment, with full recovery. CONCLUSION: The case depicts facial nerve paralysis following Covaxin use, possibly the first of its kind. This case illustrates plausible explanation to Covaxin use and occurrence of facial palsy, however, further studies required to establish causal relationship.

Vaccines and Bell's palsy: A narrative review.

The association between vaccines and peripheral facial palsy (PFP), an issue that has been the subject of debate for many years, has been raised again following results of clinical trials assessing mRNA based COVID-19 vaccines. To review the available literature on this topic, PubMed was searched from inception until February 25, 2022. Inclusion criteria were case reports with documented rechallenge and comparative epidemiological studies. Cases of COVID-19 vaccine-induced PFP with available data on vaccine rechallenge were also identified from Vigibase until December 31, 2021. Of the 347 articles retrieved, 32 comparative epidemiological studies, 1 meta-analysis and 4 case reports met our criteria, of which 13 involved COVID-19 vaccines. Eight studies found an association between at least one vaccine and the occurrence of PFP, whereas 24 did not. Positive studies involved seasonal or pandemic H1N1 influenza vaccines administered parenterally (4 studies) or intranasally (1 study with a toxin-adjuvanted vaccine), BNT162b2, a mRNA COVID-19 vaccine (1 disproportionality analysis and 1 observed-to-expected analysis) and an inactivated virus COVID-19 vaccine (CoronaVac®) (1 study combining a case-control and an observed-to-expected approach). Strong evidence was found only for the intranasal influenza vaccine while other positive studies detected only a marginal association between PFP and vaccination. Of the four case reports with documented rechallenge, only two were positive and involved an influenza vaccine and tozinameran in one case each. In Vigibase, rechallenge was documented in 49 reports with 29 (59.2%) cases being negative and 20 (40.8%) positive. The available data did not confirm an excess risk of PFP after vaccination in most studies. Moreover, of the eight epidemiological studies suggesting a possible excess risk of PFP after any vaccine, three were disproportionality analyses and two observed-to excepted analyses, suggesting great caution should be taken when interpreting these results.

Bilateral peripheric facial nerve palsy following SARS-CoV-2 infection: A case report and review of literature.

Neurologic complications of SARS-CoV-2 infection have been reported commonly. Peripheric facial nerve palsy is one of the most reported neurologic problems. However, idiopathic bilateral facial palsy is a very rare complication of SARS-CoV-2 infection. Herein, we present a case of a COVID-19 35-year-old man, which developed bilateral facial palsy.

Effectiveness of facial palsy protocol among patient with mucormycosis following COVID-19: A case study.

A 41-year-old male with a history of diabetes mellitus presented with right facial palsy post COVID-19 Associated Mucormycosis. A 4-week physiotherapeutic intervention; ice therapy, Mime therapy, Facial Soft Tissue Manipulation, and Facial Proprioceptive Neuromuscular Stimulation, showed improvement in the symptoms of patient and scores of House- Brackman Facial Grading Scale.

Guillain-Barre Syndrome Following SARS-CoV-2 Vaccination: A Case Report.

After more than a year of Coronavirus disease 2019 pandemic, in 2021 Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) vaccination have been made possible and vaccine was distributed globally. Since then, there have been reports of symptoms following SARS-CoV-2 vaccination, including neurological symptoms of ascending paralysis known as Guillain-Barre syndrome. In this report, we describe the first case of Guillain-Barre syndrome following vaccination in Indonesia. Symptoms of ascending paralysis were of late onset after the first dose, however, were full blown after receiving the second dose followed by left-sided facial paralysis.

COVID-19 and Bell's Palsy

Definition: There are various neurological manifestations of coronavirus disease 2019 (COVID-19). Recent data suggest a connection between hemifacial paralysis, or Bell's palsy, and COVID-19. Although the etiology of Bell's palsy is unknown, the leading proposed etiology is viral in nature. Since the onset of the pandemic, numerous studies have investigated the relationship between Bell's palsy, COVID-19 infection, and COVID-19 vaccination. The researchers studied the current literature on the topic of COVID-19 as it relates to Bell's palsy. [ FROM AUTHOR]

Late peripheral facial paralysis after COVID-19: a rapid systematic review and two case reports.

Peripheral facial paralysis (PFP) has been shown to be a neurological manifestation of COVID-19. The current study presents two cases of PFP after COVID-19, along with a rapid review of known cases in the literature. Both case reports were conducted following CARE guidelines. We also performed a systematic review of PFP cases temporally related to COVID-19 using PubMed, Embase, and Cochrane Library databases on August 30, 2021, using a rapid review methodology. The two patients experienced PFP 102 and 110 days after COVID-19 symptom onset. SARS-CoV-2 RNA was detected in nasal samples through reverse-transcription real-time polymerase chain reaction (RT-qPCR) testing. Anosmia was the only other neurological manifestation. PFP was treated with steroids in both cases, with complete subsequent recovery. In the rapid review, we identified 764 articles and included 43 studies. From those, 128 patients with PFP were analyzed, of whom 42.1% (54/128) were male, 39.06% (50/128) female, and in 23 cases the gender was not reported. The age range was 18 to 59 (54.68%). The median time between COVID-19 and PFP was three days (ranging from the first symptom of COVID-19 to 40 days after the acute phase of infection). Late PFP associated with COVID-19 presents mild symptoms and improves with time, with no identified predictors. Late PFP should be added to the spectrum of neurological manifestations associated with the long-term effects of SARS-CoV-2 infection as a post COVID-19 condition.

A privacy preserving diagnostic collaboration framework for facial paralysis using federated learning

Most of the machine learning and artificial intelligence applications are data driven. When it comes to sensitive data, maintaining the data privacy principles is a big challenge. Building a machine learning model for classifying sensitive data is discussed in this paper. Focus is given for medical field where the patient data comes under sensitive or private information category. There are restrictions to share patient data for research purposes or collaboration among doctors in different hospitals due to the privacy concerns. In this work, we take facial paralysis as an example and discuss how to build a model for facial paralysis detection. Here, the data used for training the model is face images which implicitly reveals identity of the patient. We analyse how the facial paralysis images from multiple hospitals can be combined together for building an efficient facial paralysis detection system without compromising privacy of patients. Support Vector Machine based federated learning is applied for the purpose. Hospitals are considered as clients which are the data sources where the local training happens and there is a server performing federated averaging. Unlike in traditional federated learning, soft clustering approach is considered at server side and the update to each client is different. The federated averaging algorithm at server takes care of the distribution of data each client holds and customises the update sent to each client. This approach improves the local test accuracy and the convergence speed. To validate the findings, experiments are conducted with MNIST and covid pneumonia datasets as well.

Bell's Palsy and COVID-19 Infection: A Comparative Analysis with the Pre-pandemic Period

Aim: Bell's palsy is an acute peripheral facial nerve paralysis affecting one side of the face and can be associated with various causes, such as infectious and autoimmune conditions. In line with this, an increase has been observed in the incidence of peripheral facial paralysis during the coronavirus disease-2019 (COVID-19) infection pandemic. We aimed to investigate whether the incidence of Bell's palsy increased before and after the COVID-19 in the pre-vaccine period. Method(s): All cases diagnosed with Bell's palsy in a tertiary hospital aged 18 and up in 2020 were analyzed, and to compare these numbers to pre-pandemic numbers, patients' data from 2019 was accessed. Excluding those who had recurrent facial palsy, those whose conditions were due to central causes, and those who were misdiagnosed, the frequency of the disease was calculated by proportioning it to the total number of patients presenting to Neurology, and Ear, Nose, and Throat Diseases Outpatient Clinics and the Green Zone of the Emergency Department at that time;and the Bell's palsy distribution within three-month periods and whether this distribution is correlated with the distribution of COVID-19 infection were examined. Result(s): Three hundred twenty five cases from 2019 and 291 cases from 2020 were included in the study. No significant difference was detected between those years in terms of age and sex. The frequency of Bell's palsy in 2019 was 0.059% while it was 0.071% in 2020, which suggested a significant difference between the years. The significant difference could be clearly observed in the second and fourth quarters when the cases of COVID-19 infection were at their peak. Conclusion(s): This study suggests that patients with complaints of peripheral facial paralysis should also be examined for COVID-19 infection. Copyright © 2022, Galenos Publishing House. All rights reserved.

Incidence rate, risk factors, and management of Bell's palsy in the Qurayyat region of Saudi Arabia.

Background: Bell's palsy is an idiopathic facial nerve dysfunction causing temporary paralysis of muscles of facial expression. This study aimed to determine the incidence rate, common risk factors, and preferred treatment by the Saudi patients with Bell's palsy. Method: This cross-sectional study was carried out in the Qurayyat region of Saudi Arabia. The retrospective medical records were searched from 2015-2020 of patients diagnosed with Bell's palsy at Qurayyat General Hospital and King Fahad hospital. A 28-item questionnaire was developed by a team of experts and pre-tested among patients with Bell's palsy before being sent to the eligible participants. The data were analyzed using summary statistics, Chi-square test, Fisher exact test and Likelihood ratio test. Results: We identified 279 cases of Bell's palsy from the medical records of the hospitals from the years 2015 to 2020, accounting for 46.5 cases per year and an incidence rate of 25.7 per 100,000 per year. Out of 279 patients with Bell's palsy, only 171 returned the questionnaire accounting for a response rate of 61.2%. Out of 171 patients with Bell's palsy, females (n = 147, 86.0%) accounted for the majority of cases. The most affected age group among participants with Bell's palsy was 21-30 years (n = 76, 44.4%). There were 153 (89.5%) cases who reported Bell's palsy for the first time. The majority of the participants experienced right-sided facial paralysis (n = 96, 56.1%). Likelihood ratio test revealed significant relationship between exposure to cold air and common cold with age groups (χ 2(6, N = 171) = 14.92, p = 0.021), χ 2(6, N = 171) = 16.35, pp = 0.012 respectively. The post hoc analyses revealed that participants in the age group of 20-31-years were mostly affected due to exposure to cold air and common cold than the other age groups. The main therapeutic approach preferred was physiotherapy (n = 149, 87.1%), followed by corticosteroids and antivirals medications (n = 61, 35.7%), acupressure (n = 35, 20.5%), traditional Saudi herb medicine (n = 32, 18.7%), cauterization by hot iron rod (n = 23, 13.5%), supplementary therapy (n = 2, 1.2%), facial cosmetic surgery (n = 1, 0.6%) and no treatment (n = 1, 0.6%). The most preferred combined therapy was physiotherapy (87.6%) with corticosteroid and antiviral drugs (35.9%), and acupressure (17.6%). Conclusion: The rate of Bell's palsy was approximately 25.7 per 100,000 per year in the Qurayyat region of Saudi Arabia. Exposure to cold air and common cold were the significant risk factors associated with Bell's palsy. Females were predominantly affected by Bell's palsy in the Qurayyat region of Saudi Arabia. Bell's palsy most commonly occurred in the age group 21-30 years. The most favored treatment was physiotherapy following Bell's palsy.

Bilateral Facial Weakness with Distal Paresthesia Following COVID-19 Vaccination: A Scoping Review for an Atypical Variant of Guillain-Barré Syndrome.

Background and Purpose: Recent population-based studies from the US and UK have identified an increase in the occurrence of Guillain-Barré syndrome (GBS) following coronavirus disease 2019 (COVID-19) vaccination. However, the localized variant of GBS might be underestimated due to its rarity and atypical features. We aimed to identify and characterize bilateral facial weakness with distal paresthesia (BFWdp) as a GBS variant following COVID-19 vaccination. Materials and Methods: Relevant studies published during the COVID-19 pandemic were searched and identified in the MEDLINE, Embase, and other databases. Results: This review found that 18 BFWdp cases presented characteristics similar to previous BFWdp cases as defined in the literature: male dominance, frequent albuminocytological dissociation, and acute inflammatory demyelinating neuropathy pattern. In contrast, facial nerve enhancement on brain MRI and antiganglioside antibody positivity were often observed in BFWdp following COVID-19 vaccination. Conclusions: The mechanism of BFWdp following COVID-19 vaccination appears to be somewhat different from that of sporadic BFWdp. Neurological syndromes with rare incidence and difficulty in diagnosis should be considered adverse events of COVID-19 vaccination.

Patients with post-COVID-19 vaccination facial palsy: To boost or not to boost?

A possible association between Bell's palsy and COVID-19 vaccination has been suggested. While it is likely that COVID-19 vaccine recipients from the general population do have a slightly increased risk of developing Bell's palsy, there are little data regarding this risk in individuals with a history of disease. Gaining a better understanding of this association is particularly important for informing evidence-based recommendations regarding future booster shots in subjects who developed Bell's palsy as a side effect of vaccination, or as a result of SARS-CoV-2 infection. We previously described the first case of COVID-19 vaccine-related Bell's palsy; here we report an 18-month clinical and electromyographic follow-up and discuss the implications of receiving further vaccine doses in patients with positive disease history.

[Bell's Palsy Secondary to COVID-19 Vaccine Pfizer: Case report]

BACKGROUND: BNT162b2 (Pfizer-BioNTech) is a nucleosidemodified mRNA vaccine formulated with lipid nanoparticles for the prevention of COVID-19 disease caused by SARSCoV-2 infection. In early December 2020, BNT162b2 received an emergency use authorization, initial efficacy and safety data have been released, consumer / patient information sheets for vaccines distributed in North America do not warn of Bell's palsy as a possible adverse effect. We reported the case of a patient who developed Bell's palsy on the right side in less than 3 hours after the application of the first dose of the Pfizer-BioNTech COVID-19 vaccine. CLINICAL CASE: 32-year-old latina woman who developed right facial paralysis after receiving the first dose of the BNT162b2 mRNA vaccine on April 7, 2021;with right facial paresis, absence of forehead wrinkles, lip-buccal sulcus and nasolabial fold;spasms of the facial and periorbital muscles, laterocervical pain;possible etiologies were ruled out, prednisone, gabapentin and topiramate. CT without alterations, achieving gradual improvement;until full functional recovery after 15 days. With benign evolution, congruent with the natural history of the disease, classifying it as idiopathic Bell's palsy. CONCLUSIONS: Although a causal relationship cannot be established, the time and mode of appearance of the paralysis suggested a relationship with the application of the BNT162b2 vaccine. Given the recommendation of the health authorities to monitor the cases of Bell's palsy, and the surveillance of events supposedly attributable to vaccination (ESAVI) and as it is the first case reported in the literature, in the mexican population, we believe that this case should be shared with the scientific community in a timely manner.

Using Bayesian Belief Network to Solve Abnormal Symptoms after Vaccination under Modern Information Technology

Rare side effects are weakening confidence in the vaccine. The question is how we interpret the data. Within 15 months after the discovery of the new coronavirus, a variety of effective and safe vaccines against the new coronavirus were available. After receiving the new coronavirus vaccine, some people developed facial paralysis, thigh pain, and even cerebral venous thrombosis. Although these side effects are very rare, and there is a lack of clarity whether there is a causal relationship with the vaccine or not, such news may undermine the confidence of the global vaccine. In order to maintain the confidence of the public, adverse events after vaccination are called ordinary events, and deaths occurring within a few days after vaccination are also interpreted as being caused by their latent diseases. From the following research, the issue of causality divides the vaccinated population into healthy groups and long-term patient groups, and use Bayesian belief network to analyze whether there are symptoms or abnormal events after vaccination as well as the probability distribution of rare illness, death, etc., in order to understand the relationship among each other. Therefore, suspending the administration of COVID vaccine is not a zero-risk option. The reality is that nothing is without risk. Measures to mitigate a risk must be balanced with competitive hazards. Risk seems to be an and vague concept. Risk can be reduced, but it can never be eliminated. The advantage of the Bayesian model is that it is easy to bring the data of various variables into the graph and calculate the posterior data from the known data to strengthen the persuasiveness of vaccination. By using Bayesian Network with PGM Module of Pytorch, the death probability of these two groups can be calculated under abnormal symptoms or without them. The simulation result of death after inoculation is lower than that of normal state without Covid-19 pandemic. © 2021 ACM.

Guillain-Barré Syndrome with Bilateral Peripheral Facial Nerve Paralysis After COVID-19 Infection

Isolated bilateral peripheral facial paralysis in Guillain-Barré syndrome (GBS) is also quite rare. This case meets the diagnostic criteria of GBS with isolated bilateral peripheral facial paralysis following the coronavirus disease-2019 (COVID-19) infection. A 48-year-old male patient with bilateral peripheral facial nerve paralysis on neurological examination and without other abnormalities was admitted to the emergency department, 18 days after a COVID-19 infection. An increase in cell-free protein (albuminocytological dissociation) in the patient’s cerebrospinal fluid and demyelinating polyneuropathy in electrophysiological examinations suggested GBS in the patient. Facial paralysis findings were completely resolved after 5 days of intravenous immune globulin therapy. Physicians must closely monitor patients’ neurological signs because of the possible association between GBS and COVID-19. © 2021 by Turkish Neurological Society Turkish Journal of Neurology published by Galenos Publishing House.

[Isolated facial diplegia as an atypical variant of Guillain-Barre syndrome after suspected SARS-CoV-2 infection] / Diplejía facial aislada como variante atípica del síndrome de Guillain-Barré tras sospecha de infección por SARS-CoV-2.

Introduction: Since the SARS-CoV-2 pandemics began, multiple cases of Guillain-Barre syndrome secondary to COVID-19 have been described. Its typical presentation consists of the triad of paresthesia, ascending muscle weakness and areflexia, although there are several regional variants such as facial diplegia. Case presentation: Two weeks after a contact with a confirmed case of COVID-19, a 35-year-old woman presents with viral myopericarditis. Laboratory studies for autoimmune diseases come back negative, as well as multiple viral serologies. She presents anti-SARS-CoV-2 IgG, with negative PCR. A week after discharge she presents with palsy of both facial nerves, without other neurological abnormalities. She undergoes examination with cranial CT without findings, and an EMG which shows bilateral alteration of facial nerves. She refuses the performance of a lumbar puncture. Discussion: Facial diplegia can occur because of several illnesses, such as meningeal or brainstem tumors, infectious agents, Guillain-Barre syndrome, autoimmune diseases, trauma, metabolic causes or congenital causes. In our patient, having discarded other etiologies with imaging and analytical studies, the most probable cause is the Guillain-Barre syndrome. It is possibly secondary to SARS-CoV-2 infection given the presence of anti-SARS-CoV-2 IgG antibodies after contact with a confirmed case. Conclusion: This case supports the hypothesis that COVID-19 may trigger the Guillain-Barre syndrome, specifically as facial diplegia, which is an atypical variant that should be known to be early diagnosed and treated as part of this syndrome.

Introducción: Desde que se inició la pandemia por el SARS-CoV-2, se han descrito numerosos casos de síndrome de Guillain-Barré secundario a la COVID-19. Su presentación típica es la triada de parestesias, debilidad muscular ascendente y arreflexia, aunque hay diversas variantes regionales como la diplejía facial. Presentación del caso: Mujer de 35 años que, dos semanas después de un contacto estrecho con un caso confirmado de COVID-19, ingresa por miopericarditis probablemente viral, con estudio de autoinmunidad negativo, múltiples serologías virales negativas y positividad para IgG anti-SARS-CoV-2 con PCR negativa. Una semana tras el alta presenta paresia de ambos nervios faciales sin otras alteraciones neurológicas. Se realiza TAC craneal sin hallazgos y EMG que evidencia afectación bilateral de los nervios faciales. La paciente rechaza realización de punción lumbar Discusión: La diplejía facial puede ocurrir en el contexto de diversas patologías, como tumores meníngeos o troncoencefálicos, agentes infecciosos, síndrome de Guillain-Barré, patologías autoinmunes, traumatismos, causas metabólicas o causas congénitas. En el caso descrito tras descartar mediante pruebas de imagen y analíticamente el resto de etiologías, y dada la presentación clínica, permanece como causa más probable el síndrome de Guillain-Barré, posiblemente secundario a infección por SARS-CoV-2 dada la positividad de IgG anti-SARS-CoV-2 tras un contacto con un caso confirmado. Conclusión: Este caso apoya la hipótesis de que la COVID-19 puede desencadenar el síndrome de Guillain-Barré, específicamente en forma de diplejía facial, una variante atípica que se debe conocer para su identificación y manejo precoz como parte de este síndrome.

POST-COVID-RELATED GUILLAIN-BARRÉ SYNDROME INVOLVING BILATERAL FACIAL NERVES AND LOWER EXTREMITIES

A lumbar puncture was performed and cerebrospinal fluid (CSF) analysis revealed elevated total protein with albuminocytological disproportion but otherwise normal. B Introduction: b SARS-CoV-2 has established itself as a deadly virus for its acute disease and its post viral complications including Gullain Barre (GBS). Two weeks prior to presentation, he reported flu-like symptoms and testing positive for COVID. [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

UNILATERAL DIAPHRAGMATIC PARALYSIS SECONDARY TO COVID-19

While current publications highlight the importance of this condition in mechanically ventilated patients, our case demonstrates that unilateral diaphragmatic paralysis can occur in COVID-19 patients in the outpatient setting who were also treated with bamlanivimab. The patient decided on conservative therapy instead of surgical intervention, and his dyspnea improved upon follow-up. B Discussion: b Unilateral diaphragmatic paralysis is emerging as a complication of COVID-19 in the acute and chronic stages. The patient subsequently underwent a sniff test via chest fluoroscopy that revealed paradoxical motion of the right hemidiaphragm and normal excursion of the left hemidiaphragm. [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)