ABSTRACT
The complete features of the neurological complications of coronavirus disease 2019 (COVID-19) still need to be elucidated, including associated cranial nerve involvement. In the present study we describe cranial nerve lesions seen in magnetic resonance imaging (MRI) of six cases of confirmed COVID-19, involving the olfactory bulb, optic nerve, abducens nerve, and facial nerve. Cranial nerve involvement was associated with COVID-19, but whether by direct viral invasion or autoimmunity needs to be clarified. The development of neurological symptoms after initial respiratory symptoms and the absence of the virus in the cerebrospinal fluid (CSF) suggest the possibility of autoimmunity.
Subject(s)
Abducens Nerve/diagnostic imaging , COVID-19/diagnostic imaging , Cranial Nerve Diseases/diagnostic imaging , Facial Nerve/diagnostic imaging , Olfactory Bulb/diagnostic imaging , Optic Nerve/diagnostic imaging , Abducens Nerve/immunology , Abducens Nerve/pathology , Abducens Nerve/virology , Adult , Aged , Autoimmunity , COVID-19/immunology , COVID-19/pathology , COVID-19/virology , Cranial Nerve Diseases/immunology , Cranial Nerve Diseases/pathology , Cranial Nerve Diseases/virology , Facial Nerve/immunology , Facial Nerve/pathology , Facial Nerve/virology , Female , Humans , Magnetic Resonance Imaging , Male , Neuroimaging , Olfactory Bulb/immunology , Olfactory Bulb/pathology , Olfactory Bulb/virology , Optic Nerve/immunology , Optic Nerve/pathology , Optic Nerve/virology , SARS-CoV-2/pathogenicityABSTRACT
OBJECTIVE: To report 2 patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who presented acutely with Miller Fisher syndrome and polyneuritis cranialis, respectively. METHODS: Patient data were obtained from medical records from the University Hospital "Príncipe de Asturias," Alcalá de Henares, and the University Hospital "12 de Octubre," Madrid, Spain. RESULTS: A 50-year-old man presented with anosmia, ageusia, right internuclear ophthalmoparesis, right fascicular oculomotor palsy, ataxia, areflexia, albuminocytologic dissociation, and positive testing for anti-GD1b-immunoglobulin G antibody. Five days previously, he had developed a cough, malaise, headache, low back pain, and fever. A 39-year-old man presented with ageusia, bilateral abducens palsy, areflexia, and albuminocytologic dissociation. Three days previously, he had developed diarrhea, a low-grade fever, and poor general condition. Oropharyngeal swab test for SARS-CoV-2 by qualitative real-time reverse transcriptase PCR assay was positive in both patients and negative in the CSF. The first patient was treated with IV immunoglobulin and the second with acetaminophen. Two weeks later, both patients made a complete neurologic recovery, except for residual anosmia and ageusia in the first case. CONCLUSIONS: Our 2 cases highlight the rare occurrence of Miller Fisher syndrome and polyneuritis cranialis during the coronavirus disease 2019 (COVID-19) pandemic. These neurologic manifestations may occur because of an aberrant immune response to COVID-19. The full clinical spectrum of neurologic symptoms in patients with COVID-19 remains to be characterized.