Abducens Nerve Palsy Due to Coronavirus Disease (COVID-19)

Kristian Goenawan; Indra Tri Mahayana

doi:10.36452/jkdoktmeditek.v29i3.2805

Authors

Kristian Goenawan Department of Ophthalmology, Faculty of Medicine and Health Sciences, Universitas Kristen Krida Wacana, Jakarta, Indonesia
Indra Tri Mahayana Department of Ophthalmology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia

DOI:

https://doi.org/10.36452/jkdoktmeditek.v29i3.2805

Keywords:

abducens nerve paralysis, corona, COVID-19

Abstract

The main causes of N.VI paralysis in adults are microvascular disease, vasculopathy, tumors, and inflammatory conditions. However, recent studies suggest that neurotropic viruses may be the etiology of N.VI paralysis. COVID-19 also has neurotropic and neuroinvasive capabilities that make the eye susceptible to bilateral optic neuritis, papilledema, and cranial nerve paralysis, the most common of which is abducens nerve palsy. The aim of this literature review is to review studies that describe the occurrence of abducens nerve palsy in COVID-19 patients. The literature search began in the period April-May 2022 from the Google Scholar database (https://scholar.google.com/). This mini review used the AMSTAR (Assessment of Multiple Systemic Review 2, including randomized and nonrandomized studies) checklist and reviewers independently agreed on the selection of eligible studies and reached consensus regarding which studies to include with inclusion criteria. This mini review found that 75% of cases were strongly associated with viral infection and 25% of cases were strongly associated with COVID-19 vaccination. Only 50% of cases report improvement in abducens nerve palsy. This has the implication that with the increasing prevalence of COVID-19 worldwide, ophthalmologists should be aware that abducens nerve palsy may be part of COVID-19.

References

Lucio LL, Freddi TdAL, Ottaiano AC, editors. The abducens nerve: anatomy and pathology. Semin Ultrasound CT MR. 2022 Oct;43(5):414-9. doi: 10.1053/j.sult.2022.04.008.

Gupta S, Arora S, Gupta S, Jesrani G, Gupta M. Abducens nrve palsy: a sole presentation of isolated cerebellar tuberculoma. Journal of Dr NTR University of Health Sciences| Volume. 2021;10(3)

Aghdam KA, Zand A, Sanjari MS. Isolated unilateral sixth nerve palsy in a patient with nasopharyngeal carcinoma. Romanian Journal of Ophthalmology. 2019;63(4):375.PMCID: 6943290

Sbai AA, Es-Sahli F, Lachgar A, Elayoubi F. Concomitant abducens and facial nerve palsies following bone temporal fracture: case report. Annals of Medicine and Surgery. 2022;80:104318.DOI: 10.1016/j.amsu.2022.104318

Lee MS, Galetta SL, Volpe NJ, Liu GT. Sixth nerve palsies in children. Pediatric neurology. 1999;20(1):49-52.DOI: 10.1016/s0887-8994(98)00090-3

Chang MY, Borchert MS, Fraser C, Mollan S. Etiology and outcomes of acquired pediatric sixth nerve palsies. Journal of Neuro-Ophthalmology. 2022;42(1):e254-e9.DOI: 10.1097/WNO.0000000000001390

Evans MJ, Ellis HL, Self JE. Aetiologies of acquired pediatric sixth nerve palsies in a U.K. based population. Strabismus. 2022;30(4):196-9.DOI: 10.1080/09273972.2022.2138919

Peters III GB, Bakri SJ, Krohel GB. Cause and prognosis of nontraumatic sixth nerve palsies in young adults. Ophthalmology. 2002;109(10):1925-8.DOI: https://doi.org/10.1016/S0161-6420(02)01226-5

Elder C, Hainline C, Galetta SL, Balcer LJ, Rucker JC. Isolated abducens nerve palsy: update on evaluation and diagnosis. Current neurology and neuroscience reports. 2016;16(8):1-7.DOI: 10.1007/s11910-016-0671-4

Jung EH, Kim S-J, Lee JY, Cho B-J. The incidence and etiology of sixth cranial nerve palsy in Koreans: a 10-year nationwide cohort study. Scientific Reports. 2019;9(1):18419.DOI: 10.1038/s41598-019-54975-5

Anilkumar A, Tan E, Cleaver J, Morrison HD. Isolated abducens nerve palsy in a patient with asymptomatic Sars-Cov-2 infection. Journal of Clinical Neuroscience. 2021;89:65-7.DOI: 10.1016/j.jocn.2021.04.011

Bingöl Kızıltunç P, Seven MY, Atilla H. Isolated abducens nerve palsy due to Covid-19. Strabismus. 2022:1-3.DOI: https://doi.org/10.1080/09273972.2021.2022718

Medeiros ALd, Martins T, Kattah M, Soares AKA, Ventura LO, Ventura CV, et al. Isolated abducens nerve palsy associated with coronavirus disease: an 8-month follow-up. Arquivos Brasileiros de Oftalmologia. 2021.DOI: https://doi.org/10.5935/0004-2749.20220063

Pawar N, Ravindran M, Padmavathy S, Chakrabarty S. Acute abducens nerve oalsy after Covid-19 vaccination in a young adult. Indian journal of ophthalmology. 2021;69(12):3764-6.DOI: 10.4103/ijo.IJO_1968_21

Ben-David GS, Halachmi-Eyal O, Shyriaiev H, Brikman S, Dori G, Briscoe D. Diplopia from abducens nerve paresis as a presenting symptom of Covid-19: a case report and review of literature. Arquivos brasileiros de oftalmologia. 2021.DOI: https://doi.org/10.5935/0004-2749.20220028

Veisi A, Najafi M, Hassanpour K, Bagheri A. Facial and abducens nerve palsies following Covid-19 vaccination: report of two cases. Neuro-Ophthalmology. 2022;46(3):1-4.DOI: 10.1080/01658107.2022.2032204

Pereira A, Haslett RS. Acute abducens nerve palsy following the second dose of the Astrazeneca Covid-19 vaccine. Journal of Pediatric Ophthalmology & Strabismus. 2021;58(6):e49-e50.DOI: 10.3928/01913913-20210920-01

Falcone MM, Rong AJ, Salazar H, Redick DW, Falcone S, Cavuoto KM. Acute abducens nerve palsy in a patient with the novel coronavirus disease (Covid-19). Journal of American Association for Pediatric Ophthalmology and Strabismus. 2020;24(4):216-7.DOI: 10.1016/j.jaapos.2020.06.001

Francis JE. Abducens palsy and anosmia associated with Covid-19: a case report. The British and Irish orthoptic journal. 2021;17(1):8.DOI: 10.22599/bioj.167

Pascual-Goñi E, Fortea J, Martínez-Domeño A, Rabella N, Tecame M, Gómez-Oliva C, et al. Covid-19-associated ophthalmoparesis and hypothalamic involvement. Neurology® Neuroimmunology & Neuroinflammation. 2020;7(5).DOI: 10.1212/NXI.0000000000000823

Corrêa DG, da Cruz Jr H, Celso L, Lopes FCR, Rangel CdC, de Araújo Henriques, et al. Magnetic resonance imaging features of Covid-19-related cranial nerve lesions. Journal of neurovirology. 2021;27(1):171-7.DOI: https://doi.org/10.1007/s13365-020-00934-0

Mbchb DM, Meyer D. Bilateral abducens nerve palsy: an initial presentation of Covid-19. South African Ophthalmology Journal2021.URL:https://hdl.handle.net/10520/ejc-nm_saoj_v16_i3_a6

Manolopoulos A, Katsoulas G, Kintos V, Koutsokera M, Lykou C, Lapaki K-M, et al. Isolated abducens nerve palsy in a patient with Covid-19: a case report and literature review. The Neurologist. 2021.DOI: 10.1097/NRL.0000000000000382

Reyes-Capo DP, Stevens SM, Cavuoto KM. Acute abducens nerve palsy following Covid-19 vaccination. Journal of American Association for Pediatric Ophthalmology and Strabismus. 2021;25(5):302-3.DOI: 10.1016/j.jaapos.2021.05.003

Voitenkov V, Gorelik EY, Scripchenko N, Marchenko N, Klimkin A, Bedova M. Acute Covid-19-associated bilateral neuropathy of the abducens nerve in a child. Journal Infectology. 2021;13(3):131-4.DOI: https://doi.org/10.22625/2072-6732-2021-13-3-131-134

Gutiérrez-Ortiz C, Méndez-Guerrero A, Rodrigo-Rey S, San Pedro-Murillo E, Bermejo-Guerrero L, Gordo-Mañas R, et al. Miller Fisher syndrome and polyneuritis cranialis in Covid-19. Neurology. 2020;95(5):e601-e5.DOI: https://doi.org/10.1212/WNL.0000000000009619

Cascella M, De Blasio E, Cascella M, De Blasio E. Pathophysiology of Covid-19-associated neurotoxicity. Features and management of acute and chronic neuro-Covid. 2022:1-41.DOI: https://doi.org/10.1007/978-3-030-86705-8_1