Peripheral facial nerve palsy as a presenting symptom of COVID-19 infection: A case report

New corona virus named as COVID-19 can presented not only by respiratory symptoms, but also with other organs involvement such as gastrointestinal, cardiac, renal and neurological symptoms. We reported a patient who presented with peripheral facial nerve palsy and evaluations revealed COVID-19 infection. We suggest from this case, that COVID-19 infection may be a potential cause of facial paralysis and during this terrible pandemic, neurologists will need to be vigilant for the any neurological manifestation or neurological complications of covid-19.

Can COVID-19 Cause Peripheral Facial Nerve Palsy?

Background/Objective: The aim of our study is to evaluate the relationship between peripheral facial paralysis and the patients who had a contact with a Coronavirus Disease 2019 (COVID-19) patient or had COVID-19.Methods: Patients with a history of contact with a COVID-19 patient or having COVID-19 disease, who were admitted to the emergency department for peripheral facial paralysis in the last 6 months were included in the study. Facial paralysis grade at first presentation, treatment modality, treatment duration, post-treatment facial paralysis grade, and additional findings were analyzed.Results: A total of 34 patients, 20 females and 14 males, were included into the study. Nasal-oropharyngeal Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) test taken from patients with a history of contact, and patients having COVID-19 disease were determined as positive in 5 and 3 patients, respectively. Peripheral facial paralysis was detected as an initial finding in 5 of these 8 patients, and paralysis developed in 7 to 12 days after the diagnosis of the COVID-19 disease in the remaining 3 patients. The grade of first admission paralysis did not change in one patient in the (+) group, while improvement was observed in all patients in the (-) group.Conclusion: Neuroinvasive potential of COVID-19 in central and peripheral nervous system was reported in current literature. Our study indicates peripheral facial palsy can also be encountered during the clinical course of COVID-19 and should be considered as a finding of this disease.

Ramsay Hunt Syndrome complicated by Cerebral venous thrombosis (case report)

Context: Ramsay Hunt syndrome is a condition caused by the Varicella-Zoster Virus in the geniculate ganglion and leads to peripheral facial nerve palsy and erythematous vesicular rash in the affected area. It is a rare disorder but is the second most common cause of peripheral facial nerve palsy without trauma. Cerebral venous thrombosis is a rare cerebrovascular disease and responsible for only 0.5% of all strokes. Among its causes are oral contraceptives, infection in the central nervous system, systemic inflammations, and thrombophilia. Case report: We report the case of a previously healthy 29 years old woman diagnosed with Ramsay Hunt syndrome followed by cerebral venous thrombosis two weeks later. Her first admission to the hospital was due to pain in the face and a pulsing type right hemicranial headache. It started in the cervical region and was irradiated to the right retroorbital and auricular area, with difficulty contracting the right eyelid, otalgia, and vertigo. She used oral contraceptives, had two cesarean deliveries, and quitted smoking at 20 years old. She had multidirectional and bilateral nystagmus with fast phase to the left, right peripheral face paralysis, and crusts in the right ear canal. The patient was treated with aciclovir and prednisone, with good recovery. Two weeks later, she returned because of two episodes of convulsion and headache. Brain CTA (computed tomography angiography) showed cerebral venous thrombosis. Conclusion: Cerebral venous thrombosis is a rare complication of Ramsay Hunt Syndrome. It is important to stay alert to the development of vascular complications in these patients.