Eye Disorders and Neuro-ophthalmic Manifestations of COVID-19

Growing data are confirming the association between the novel coronavirus disease (COVID-19) and eye disorders, including ocular alterations and neuro-ophthalmic manifestations. The main pathophysiological mechanisms considered included a direct infection through the ocular surface, a post-viremia secretion of the virus from the lacrimal glands, and a viral dissemination through the bloodstream. According to the different ways of contagion, different structures could be involved.The most common ocular symptoms reported in COVID-19 patients were dry eye, redness, tearing, itching and pain. Among symptomatic patients, most of them presented conjunctivitis. Considering the posterior chamber, retinal artery and vein occlusions were described in few clinical reports;moreover, some studies presented cases of paracentral acute middle maculopathy occurring in COVID-19 patients. The involvement of the choroid seems to be rare, and a single case of atypical choroiditis was currently described. Between neuro-ophthalmic manifestations, optic neuritis appear to be relatively frequent and generally not associated with magnetic resonance imaging abnormalities. Some reports showed the involvement of the ocular motor nerves, often presenting with palsy. Miller Fisher syndrome has been showed in rare cases;however, this association could be corroborated by the several reports describing Guillain-Barré syndrome occurrence in COVID-19 patients.In line with well-known previous viral infection, COVID-19 seems to be associated with eye involvement. Thus, ocular and neuro-ophthalmic symptoms and signs should be carefully assessed and monitored in these patients. To reach this purpose, it is critical to implement remote diagnostic techniques. Moreover, the comprehension of the pathogenetic mechanisms is still scarce and no standardized diagnostic protocol was established for these patients, making necessary further studies to improve current understandings. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Trigeminal neuralgia of COVID-19: meta-analysis

Introduction: trigeminal nerve is fifth cranial nerve carrying face sensation and dividing into ophthalmic, maxillary and mandibular divisions. Trigeminal neuralgia is clinical condition can be presenting in Covid19 patients. The current study reviews the clinical cases of trigeminal neuralgia of covid19 and explains the anatomical mechanism of pain and its radiation as present with associated symptoms. On current studies reviews entire cases covid19 since 2019 up to 2022 presenting with Trigeminal pain. It found to be a very rare reason comparing to the previous reasons such as infection, tumor, thrombosis, vasculitis, autoimmune disease leading to direct or indirect effects on trigeminal nerve demyelination. Knowing the case presentation of covid19 patient presenting with trigeminal neuralgia may lead to prevent further complications and saving patients life. Learning new clinical issues based on understanding the basic medical sciences prepare good safe physicians to raise their level of education resulting in good medical services in future. Pediatricians, internist, radiologist, ophthalmologist, Otorhinolaryngologists and surgeons has to be aware of this clinical presentation to be able to take more precaution and avid outbreak of corvid 19 infection between medical staffs in different regions of hospital such as clinics, wards, emergency rooms and operations.

The Spectrum of Neuro-COVID is Broader than Frequently Anticipated.

The spectrum of neuro-COVID is broader than anticipated. Neurological disease in COVID-19 may be due to a direct attack of the virus, due to the immune response against the virus, secondary due to affection of the heart or arteries, or due to side effects from the treatment applied against COVID-19. How to cite this article: Finsterer J. The Spectrum of Neuro-COVID is Broader than Frequently Anticipated. Indian J Crit Care Med 2023;27(5):366-367.

Neurological manifestations in patients with COVID-19

Introduction: COVID-19 pandemic represents a challenge for healthcare systems, due to the impact on different systems, such as respiratory, cardiovascular and nervous systems. Background: to describe the neurological manifestations in patients with COVID-19. Methods: a search for information was carried out in the PubMed/Medline, SciELO, EBSCO, Lilacs and Scopus databases. A search strategy was applied by combining terms and using Boolean operators. Thirty references were chosen. Results: olfactory nerves and invasion of peripheral nerve terminals are suggested as routes of entry;the presence of severe neural symptoms associated with lesions of other organs and cytokine storm is also described. Headache was the most common neurological manifestation in patients with COVID-19, and rhabdomyolysis, acute hemorrhagic necrotizing encephalopathy, Guillain Barre syndrome, meningitis and encephalitis are rare neurological entities. In Guillain Barre syndrome, the literature suggests both a post infectious and para-infectious pattern. Conclusions: COVID-19 is associated with different neurological manifestations, including headache, dizziness, vertigo, vomiting, and alterations of consciousness, stroke and others not so frequent. These symptoms as a whole should be evaluated by healthcare personnel, with a view to their rapid detection and management, in order to guarantee the disappearance of sequelae that reduce the quality of life of patients, as well as to reduce the associated mortality records.

Recognition of Prodromal Hypoglossal Nerve Palsy Presenting with Neck Pain as Primary Complaint: Findings from a Rare Case Report in Direct Access Physiotherapy during the COVID-19 Pandemic.

Neck pain (NP) is the second most common musculoskeletal disorder. Spinal cysts (SCs) are cystic dilatations of the synovial sheaths in joints and tendons. SCs are extremely rare in the cervical spine. Typically, patients are unaware of having an SC due to its asymptomatic nature; however, when cervical SC extends, its volume could compress the surrounding structures, such as the hypoglossal nerve. Isolated hypoglossal nerve palsy (HNP) is very rare and typically presents with unilateral atrophy of the musculature of the tongue and contralateral tongue deviation. Often, patients with HNP also report occipital/neck pain. A 75-year-old man with occipital/neck pain as a primary complaint. Although difficult to observe because of the filtering facepiece two mask, difficulties in articulation and sialorrhea during the interview were noticed. These latter were cues to consider CN examination that revealed CN XII palsy. This prompted a referral for further examination that revealed an SC compressing the right hypoglossal canal. The patient was not considered a surgical candidate and was managed conservatively. This case report outlines the relevant findings relating to the triage of a rare isolated hypoglossal nerve palsy from the physiotherapist's perspective within a complex setting because of the COVID-19 pandemic. Although referred with a diagnosis of cervical radiculopathy, our case highlights that skilled physiotherapists may play a fundamental role in both the recognition and, when applicable, subsequent novel management of a non-musculoskeletal presentation.

Third cranial nerve palsy due to COVID-19 infection.

We report a case of a previously healthy man in his 40s who presented with mild SARS-CoV-2 infection (COVID-19) concomitant with acute onset of left third cranial nerve palsy with restricted supraduction, adduction and infraduction. Our patient did not present any history of hypertension, hyperlipidaemia, diabetes mellitus or smoking. The patient recovered spontaneously without any antiviral treatment. To our knowledge, this is the second report of third cranial nerve palsy spontaneously resolved without any risk factors of vascular disease, specific image findings, nor any possible causes other than COVID-19. In addition, we reviewed 10 other cases of third cranial nerve palsy associated with COVID-19, which suggested that the aetiology varies greatly. As a clinician, it is important to recognise COVID-19 as a differential diagnosis for third cranial nerve palsy. Finally, we aimed to encapsulate the aetiologies and the prognosis of the third cranial nerve palsy associated with COVID-19.

Miller-Fisher syndrome following by Sputnik V vaccine: Case report.

Miller-Fisher syndrome (MFS), defined as a rare variant of Guillain-Barre syndrome (GBS), is characterized by the classic triad of ataxia, areflexia, and ophthalmoplegia. It is a demyelinating polyneuropathy resulting from a deregulated autoimmune response secondary to infection by viruses and bacteria. SMF and GBS have been described during the COVID-19 pandemic. There are some reports in the literature of GBS after vaccination for COVID-19. In contrast, reports of post-vaccination FMS for SARS-CoV-2 are scarce in the literature. A 75-year-old patient is presented who consults for asthenia, adynamia, and difficulty swallowing that progresses to respiratory distress. She refers to the application of the Sputnik V vaccine as an important antecedent. During the hospital stay, the diagnosis was made by electromyography and nerve conduction study of GBS variant SMF. The objective is to expose a post-vaccination SMF to SARS-CoV-2 with the biological Sputnik V and highlight the importance of this background for surveillance in clinical practice and future research.Copyright © 2022 Asociacion Colombiana de Infectologia. All rights reserved.

Clinical-epidemiological behavior of post-COVID-19 syndrome in patients at Andres Ortiz Polyclinic, 2021

Introduction: post-COVID-19 syndrome is the set of signs and symptoms that develop during or after an infection compatible with COVID-19, that persist for more than 12 weeks and are not explained by an alternative diagnosis. Background: to characterize the clinical-epidemiological behavior of the post-COVID-19 syndrome in patients at the Andres Ortiz Polyclinic. Method: a descriptive and cross-sectional observational study was carried out from October to December 2021, in a population of 51 subjects that was studied in its entirety. The analysis was descriptive. Results: patients with 50-59 years (n = 20;39.2%), female (n = 32;62.7%) predominated. The most frequently affected organ system was the respiratory (n = 19;37.2%), while the symptoms were: chronic fatigue (n = 15;29.4%), shortness of breath (n = 11;21.5%) and cough (n = 8, 15.6%). Among the patients with respiratory (n = 30), cardiovascular (n = 24) and neurological (n = 10) diseases, the most frequent were, respectively: pulmonary fibrosis (n = 17;56.7%), cardiac arrhythmias (n = 11;45.8%) and peripheral neuropathies (n = 5;50%). Conclusions: post-COVID-19 syndrome occurred mainly between the ages of 50 and 59, in female patients, with symptoms of chronic fatigue, shortness of breath and cough, as well as pulmonary fibrosis, cardiac arrhythmias and peripheral neuropathies as main comorbidities.

Headache, Loss of Smell, and Visual Disturbances: Symptoms of SARS-CoV-2 Infection? A Case Report.

OBJECTIVE: The purpose of this case report is to describe the main components of the history and physical examination that led to idiopathic intracranial hypertension differential diagnosis, which initially was investigated as COVID-19. METHODS (CASE DESCRIPTION): A 28-year-old woman complaining of constant headache and loss of smell and taste was suspected as SARS-CoV-2 infection by her general practitioner. She underwent 3 molecular swab tests, all negative, then decided to seek her physical therapist for relieving headache. RESULTS: The full cranial nerve examination revealed impaired olfactory (CNI), abducens (CN VI), and facial (CN VII) nerves, leading the physical therapist to refer the patient to a neurosurgeon for a suspected central nervous system involvement. The neurosurgeon prescribed a detailed MRI and an ophthalmologic examination, which allowed for the final diagnosis of idiopathic intracranial hypertension. CONCLUSION: An urgent lumbo-peritoneal shunting surgery resolved the patient's symptoms and saved her sight. Despite the ongoing COVID-19 pandemic, health care professionals must pay attention to properly investigating patients' signs and symptoms using comprehensive clinical reasoning, considering the screening for referral to specialist medical attention. IMPACT: A thorough physical examination is required for every patient even if patients' signs and symptoms are in line with apparent common and widespread pathologies. Cranial nerve evaluation is an essential component of the physical therapist assessment and decision-making process. The ongoing pandemic highlighted the fundamental assistance of physical therapists toward physicians in the screening and management of musculoskeletal diseases.

Neurological Adverse Reactions to SARS-CoV-2 Vaccines.

SARS-CoV-2 vaccines are not free of side effects and most commonly affect the central or peripheral nervous system (CNS, PNS). This narrative review aims to summarise recent advances in the nature, frequency, management, and outcome of neurological side effects from SARS-CoV-2 vaccines. CNS disorders triggered by SARS-CoV-2 vaccines include headache, cerebro-vascular disorders (venous sinus thrombosis [VST], ischemic stroke, intracerebral hemorrhage, subarachnoid bleeding, reversible, cerebral vasoconstriction syndrome, vasculitis, pituitary apoplexy, Susac syndrome), inflammatory diseases (encephalitis, meningitis, demyelinating disorders, transverse myelitis), epilepsy, and a number of other rarely reported CNS conditions. PNS disorders related to SARS-CoV-2 vaccines include neuropathy of cranial nerves, mono-/polyradiculitis (Guillain-Barre syndrome [GBS]), Parsonage-Turner syndrome (plexitis), small fiber neuropathy, myasthenia, myositis/dermatomyositis, rhabdomyolysis, and a number of other conditions. The most common neurological side effects are facial palsy, intracerebral hemorrhage, VST, and GBS. The underlying pathophysiology is poorly understood, but several speculations have been generated to explain the development of CNS/PNS disease after SARS-CoV-2 vaccination. In conclusion, neurological side effects develop with any type of SARS-CoV-2 vaccine and are diverse, can be serious and even fatal, and should be taken seriously to initiate early treatment and improve outcome and avoid fatalities.

Recovery of Corneal Innervation after Treatment in Dry Eye Disease: A Confocal Microscopy Study.

PURPOSE: To analyze the changes in corneal innervation by means of in vivo corneal confocal microscopy (IVCM) in patients diagnosed with Evaporative (EDE) and Aqueous Deficient Dry Eye (ADDE) and treated with a standard treatment for Dry Eye Disease (DED) in combination with Plasma Rich in Growth Factors (PRGF). METHODS: Eighty-three patients diagnosed with DED were enrolled in this study and included in the EDE or ADDE subtype. The primary variables analyzed were the length, density and number of nerve branches, and the secondary variables were those related to the quantity and stability of the tear film and the subjective response of the patients measured with psychometric questionnaires. RESULTS: The combined treatment therapy with PRGF outperforms the standard treatment therapy in terms of subbasal nerve plexus regeneration, significantly increasing length, number of branches and nerve density, as well as significantly improving the stability of the tear film (p < 0.05 for all of them), and the most significant changes were located in the ADDE subtype. CONCLUSIONS: the corneal reinnervation process responds in a different way depending on the treatment prescribed and the subtype of dry eye disease. In vivo confocal microscopy is presented as a powerful technique in the diagnosis and management of neurosensory abnormalities in DED.

COVID‐19 vaccination and vision loss in three older male individuals homoplasmic for m.14484T>C mutation in the ND6 gene

Purpose: To report three older male individuals, all homoplasmic for m.14484 T > C mutation in the ND6 gene, presenting onset of vision loss weeks‐months after covid vaccination. None reported a history of covid‐19 infection.Methods: All clinical data was extracted and reported here as a Case Series.Results: A 68 years old man (A) had a 3rd dose of BioNTech/Pfizer COVID‐19 vaccination on 1st Nov 2021. 10 days later his vision was 6/6 OD and 6/60 OS. By Dec 2021 VA was 6/36 OD and 6/60 OS. His nephew lost vision age of 18 years with LHON. In March 2022, visual acuities were HM OD and HM OS. In May 2022 visual acuity was HM OD, PL OS. He started on idebenone 300 mg tds.A 55 years old man (B) had a 1st dose Astra Zeneca COVID‐19 vaccination in mid Feb 2021. 12 days later, March 2021 he developed a Bell's Palsy and sensory neuropathy at the top of his legs, feet and upper arms, with difficulty walking. MRI showed enhanced optic nerves and enhanced lesions at C2. In April 2021, he lost vision in his right eye, followed by left eye in June 2021. By September 2021 vision was CF BEs. He started on idebenone 300 mg po tds. In May 2022 he was LogMAR @ 2 m 1.34 OD and MH OS.A 72 years old man (C) had his 2nd dose of BioNTech/Pfizer COVID‐19 vaccination in April 2021. In Sept 2021 he reported loss of vision in both eyes but could not date onset. He was the maternal cousin of individual B. In May 2022 vision was 3/60 OD CF OS. He started on idebenone 300 mg po tds.Conclusions: Adverse ocular events related to COVID‐19 vaccines are remarkable rare. There are >20 published case reports (~89 patients) of adverse ocular events within 28 days of COVID‐19 vaccination, with all three vaccines (Pfizer, AstraZeneca and Moderna). Reports incl. conjunctivitis, facial and abducens nerve palsy, CSR, uveitis, MEWDS, VKH, Graves' Disease, endothelial graft rejection, AAION and AZOOR. The role of vaccination in subsequent vision loss in those with underlying mitochondrial mutation is not clear.

Concurrent facial and trigeminal nerve palsies in a child following COVID-19 vaccination with the Pfizer vaccine.

We present the case of a teenaged boy who attended our Ear, Nose and Throat Emergency clinic with a left-sided lower motor neuron (LMN) facial nerve paralysis associated with sensory loss in the distribution of the ophthalmic (V1) and maxillary (V2) divisions of the trigeminal nerve. This happened 3 days following a first dose of the Pfizer-BioNTech BNT162b2 vaccine. He had a House-Brackmann grade V facial palsy, with marked inability to close the left eye. He was treated with a 10-day course of oral steroids and referred to ophthalmology for eye care. He had an MRI scan of the head, which revealed no space occupying lesions or other abnormalities. Over the 6-week period of follow-up, the patient's V1 and V2 sensation gradually resolved, along with improvement of his LMN facial nerve palsy to House-Brackmann grade 3. Despite the potential temporal relationship, it is not possible to establish a causal relationship between the patient's symptoms and the Pfizer-BioNTech BNT162b2 vaccine, thus further research is required.

MÁRIO DE ANDRADE, SUAS CARTAS E NÓS: UMA DOENÇA QUE NÃO EXISTE MAIS E A DOENÇA DOS NOSSOS DIAS 1

Aborda a identificação de Mário de Andrade (1893-1945) com o diagnóstico médico da "neurastenia" e argumenta que o escritor afirmou sua "vontade forte" ao se reconhecer portador de "nervos fracos", a principal característica dessa doença. O médico norte-americano Geoge M. Beard (1839-1883) que, em 1869, formulou o diagnóstico de neurastenia, atribuiu sua ocorrência aos tempos modernos e ao excesso de estímulos nervosos nas grandes cidades. A partir dessa reflexão histórica, ensaio uma conexão entre a experiencia existencial de Mário de Andrade e a nossa experiência diante de uma doença nova, a Covid-19, fortemente conectada ao capitalismo globalizado e à devastação ambiental e que, se não é uma doença de ordem psiquiátrica, provoca desafios a nossa estabilidade emocional. Assim como Mário foi um exímio escritor de cartas, o texto salienta a importância dos meios contemporâneos de comunicação para a manuteção de laços de sociabilidade e de amizade em tempos difíceis.Alternate :The article explores the identification of Mário de Andrade (1893-1945) with the medical diagnosis of "neurasthenia", and argues the Brazilian writer affirmed his "strong will" from the recognition of having "weak nerves", the trait of this disease. The American physician Geoge M. Beard (1839-1883) formulated the diagnosis of neurasthenia in 1869. He attributed its occurrence to modern times and large cities. Based on the historical reflection, I suggest a link between Mário de Andrade's existential experience and our experience in the face of a new disease. The Covid-19 is connected to globalized capitalism and environmental devastation, and it is a disease that challenges our emotional stability. Just as Mário was a good letter writer, I argue that social media can serve to cultivate friendship in difficult times.

Orofacial and facial pain during the new coronavirus infection (COVID-19) pandemic. Choosing a non-steroid anti-inflammator – focus on nimesulide

Doctors of various specialties face orofacial and facial pain in their practice: dentists, maxillofacial surgeons, neurologists, neurosurgeons, otorhinolaryngologists, therapists, general practitioners, traumatologists, ophthalmologists, psychotherapists, physiotherapists, aesthetic medicine doctors, anesthesiologists, plastic surgeons and other specialists. The novel coronavirus infec-tion (COVID-19) pandemic, spread by the SARS-CoV-2 virus, has become a challenge for all medical specialties and health care systems around the world. The respiratory system is the dominant target of SARS-CoV-2. The oral mucosa is also highly susceptible to SARS-CoV-2 infection, due to the wide distribution of angiotensin-converting enzyme type II receptors in the oral cavity. We searched the literature for the period from the beginning of the pandemic until August 22, 2022, on the study of the association of orofacial pain with a new coronavirus infection COVID-19 in the electronic search engines PubMed and Scopus. Analysis of the found sources indicates an increase in the frequency of various types of orofacial pain associated with 1) violation of dentoalveolar and related structures during the COVID-19 pandemic;2) temporomandibular disorders;3) with damage or disease of the cranial nerves;and 4) like manifestations of primary headache. This growth is due both directly to the infection caused by SARS-CoV-2, its complications, and to a complex of biopsychosocial factors directly related to the pandemic. In the second part of the article, as part of the review, the possibility of using nimesulide for the treatment of orofacial and facial pain during the COVID-19 pandemic is discussed. The choice of nimesulide is supported by 1) the likely coadjuvant effect of nimesulide in the treatment of COVID-19;2) positive experience with the use of nimesulide in the treatment of facial and orofacial pain in the period preceding the COVID-19 pandemic;3) the safety of using nimesulide in comorbid patients, who are the main risk group for the development and severe course of COVID-19. © 2022, Remedium Group Ltd. All rights reserved.

[Ophthalmic manifestations in COVID-19-associated multiple mononeuropathy of the cranial nerves (clinical observation)]. / Oftal'mologicheskie proyavleniya pri mnozhestvennoi mononevropatii kranial'nykh nervov, assotsiirovannoi s COVID-19 (klinicheskoe nablyudenie).

Clinical manifestations of the new coronavirus infection can vary greatly and affect different organs and systems. Despite the lack of convincing data on the possible direct damage to the structures of the eyeball by the SARS-CoV-2 virus, indirect involvement of the organ of vision both in the acute period of the disease, during the period of convalescence, and as a part of the post-COVID syndrome is common in clinical practice. The condition of the ocular surface is not given much attention during the treatment of the main disease, especially in severe cases, which can lead to serious complications and visual acuity loss after recovery. Timely measures can prevent the loss of visual acuity. This article presents a description and discusses a rare case of multiple neuropathy of the cranial nerves associated with COVID-19, with bilateral involvement of the olfactory (I), trigeminal (V), facial (VII) and sublingual (XII) nerves, as well as the right optic nerve (II), which required staged rehabilitation.

Acute Angle Closure Glaucoma Following COVID-19 Vaccination: An International Journal of Medical Toxicology and Drug Experience

Introduction: Although vaccines against COVID-19 are strongly recommended as safe and effective at alleviating the morbidity and mortality, different types of ocular complications have been reported after COVID-19 vaccination, including oculomotor nerve palsy, episcleritis, anterior uveitis, multifocal choroiditis, reactivation of Vogt-Koyanagi-Harada disease, acute macular neuroretinopathy and central serous retinopathy(1).Acute angle closure glaucoma (AACG) is an ophthalmic emergency that can be drug induced. If not promptly identified and treated, it can cause irreversible blindness.