[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.

[Guillain-Barre syndrome with cranial nerve damage as complication of COVID-19]. / Sindrom Giiena­Barre s preimushchestvennym porazheniem kranial'nykh nervov kak oslozhnenie COVID-19.

The article presents a clinical example of Guillain-Barre syndrome with a predominant involvement of cranial nerves, which developed after COVID-19. Comprehensive clinical and laboratory diagnostics, including examination of cerebrospinal fluid, electromyography, examination for possible etiological infectious agents, was carried out. A course of pathogenetic therapy was used in the form of plasmapheresis sessions, supportive therapy. A good clinical effect was obtained. To this moment, only a few cases of the development of Guillain-Barré syndrome after a new coronavirus infection have been described. The peculiarity of our case is the development of a clinical picture of insufficiency of predominantly cranial nerves with subclinical involvement of the nerves of the extremities.

COVID-19 associated cranial nerve neuropathy: A systematic review.

The involvement of cranial nerves is being increasingly recognised in COVID-19. This review aims to summarize and discuss the recent advances concerning the clinical presentation, pathophysiology, diagnosis, treatment, and outcomes of SARS-CoV-2 associated cranial nerve mononeuropathies or polyneuropathies. Therefore, a systematic review of articles from PubMed and Google Scholar was conducted. Altogether 36 articles regarding SARS-CoV-2 associated neuropathy of cranial nerves describing 56 patients were retrieved. Out of these 56 patients, cranial nerves were compromised without the involvement of peripheral nerves in 32 of the patients, while Guillain-Barre syndrome (GBS) with cranial nerve involvement was described in 24 patients. A single cranial nerve was involved either unilaterally or bilaterally in 36 patients, while in 19 patients multiple cranial nerves were involved. Bilateral involvement was more prevalent in the GBS group (n=11) as compared to the cohort with isolated cranial nerve involvement (n=5). Treatment of cranial nerve neuropathy included steroids (n=18), intravenous immunoglobulins (IVIG) (n=18), acyclovir/valacyclovir (n=3), and plasma exchange (n=1). The outcome was classified as "complete recovery" in 21 patients and as "partial recovery" in 30 patients. One patient had a lethal outcome. In conclusion, any cranial nerve can be involved in COVID-19, but cranial nerves VII, VI, and III are the most frequently affected. The involvement of cranial nerves in COVID-19 may or may not be associated with GBS. In patients with cranial nerve involvement, COVID-19 infections are usually mild. Isolated cranial nerve palsy without GBS usually responds favorably to steroids. Cranial nerve involvement with GBS benefits from IVIG.

Cranial nerves impairment in post-acute oropharyngeal dysphagia after COVID-19.

BACKGROUND: According to literature, after COVID-19, patients may require rehabilitation care because of different degrees of physical impairments. Neurologic disorders are often described but no specific data about postacute cranial nerves involvement and possible correlation with dysphagia development are yet available. CASE REPORT: The patient is a 69-year-old man who presented acquired weakness and dysphagia with clinical cranial nerves impairment of lingual, IX, X and XII after SARS-CoV-2 infection, without electrophysiological alterations. He underwent rehabilitation program for two months, with slow recovery. However, at discharge residual hypoglossal nerve deficit sign was present. CLINICAL REHABILITATION IMPACT: This single case expands knowledge about clinical picture after SARS-CoV-2 disease. Is important to notice that cranial, particularly bulbar nerves could be involved as late complications. Thus, we discuss about risk factors, the nature of the damage and the impact in dysphagia pathophysiology and recovery. If supported by further studies, this case may help to understand dysphagia features in these patients.

COVID-19 presenting with nystagmus. / COVID-19 asociada a nistagmo.

This case reports a 20-year-old female patient who was in northern Italy when the state of emergency was declared on the 31st of January 2020, developing 15days after return to Spain upper respiratory symptoms characterized by fever, headache and anosmia that was treated as sinusitis. Three weeks later presented with dizziness and an intermittent horizontal nystagmus with rotatory component. Otorhinolaryngology and neurological examination including MRI were normal. COVID-19 IgG antibodies where positive. In the context of the ongoing pandemic, and associating the symptoms with positive IgG antibodies, we can consider the infection of SARS-CoV-2 as a probable cause of the acquired nystagmus.

Cytokine Storm in COVID19: A Neural Hypothesis.

Cytokine storm in COVID-19 is characterized by an excessive inflammatory response to SARS-CoV-2 that is caused by a dysregulated immune system of the host. We are proposing a new hypothesis that SARS-CoV-2 mediated inflammation of nucleus tractus solitarius (NTS) may be responsible for the cytokine storm in COVID 19. The inflamed NTS may result in a dysregulated cholinergic anti-inflammatory pathway and hypothalamic-pituitary-adrenal axis.

Happy Hypoxemia in COVID-19-A Neural Hypothesis.

Many COVID-19 patients are presenting with atypical clinical features. Happy hypoxemia with almost normal breathing, anosmia in the absence of rhinitis or nasal obstruction, and ageusia are some of the reported atypical clinical findings. Based on the clinical manifestations of the disease, we are proposing a new hypothesis that SARS-CoV-2 mediated inflammation of the nucleus tractus solitarius may be the reason for happy hypoxemia in COVID-19 patients.