In this paper, the authors describe a case of facial nerve palsy as a neurological manifestation of Covid-19 Infection. A 27-year-old man was admitted to the isolation ward of a tertiary healthcare centre in Singapore with symptoms of myalgia, cough and fever for 4 days. He also complained of a new left- sided throbbing headache with no associated photophobia or neck stiffness. Chest radiography did not show any infiltrates but a nasopharyngeal swab returned positive for SARS-CoV-2 on real-time polymerase chain reaction (RT-PCR) assay. On the third day of hospitalisation (day 6 of illness), he developed left facial weakness, which was preceded by left retro-auricular pain and dysgeusia. Neurological exam revealed involvement of the left frontalis, orbicularis oculi, buccinator, and orbicularis oris, consistent with a left lower motor neuron type facial nerve palsy. Cerebrospinal fluid PCR for herpes simplex virus, varicella zoster virus, Epstein-Barr virus and cytomegalovirus, and RT-PCR for SARS-CoV-2 were negative. MRI of the brain showed enhancement of the left facial nerve. The patient was started on prednisone and valacyclovir for treatment of Bell’s palsy. Lopinavir/ritonavir was also initiated with the intention of reducing SARS-CoV-2 viral replication. The authors concluded that this single case report only suggests a possible association between isolated cranial neuropathies and COVID-19 and that more cases would be required to support causality.
by Marialuisa Zedde and Francesco Cavallieri