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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2020; 78(10): 667
DOI: 10.1590/0004-282X20200127
Editorial

Facial palsy as a neurological complication of SARS-CoV-2

Paralisia facial como complicação neurológica da SARS-CoV-2
Bruno Niemeyer de Freitas RIBEIRO 
1   Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro RJ, Brazil.
,
Edson MARCHIORI 
2   Universidade Federal do Rio de Janeiro, Rio de Janeiro RJ, Brazil.
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A 26-year-old male patient was admitted with symptoms of cough and fever for three days. Chest computed tomography showed multiple and bilateral ground-glass opacities, predominantly peripheral, some with superimposed intralobular septal thickening ([Figure 1]). Nasopharyngeal swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on real-time reverse-transcription-polymerase-chain reaction (RT-PCR) assay was positive. On the eighth day of illness, he developed right facial weakness consistent with facial nerve palsy. Magnetic resonance imaging of the brain showed enhancement of the right facial nerve ([Figure 2]).

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Figure 1 Chest computed tomography showing multiple and bilateral ground-glass opacities, predominantly peripheral (A and B), some with superimposed intralobular septal thickening (B) (white arrows).
Zoom Image
Figure 2 Contrast enhanced magnetic resonance of the skull showing enhancement of the right facial nerve (white arrows), in the axial (A) and coronal (B) planes.

Neurological manifestations of coronavirus disease 2019 (COVID-19) have been associated with immune-mediated injuries rather than direct viral neurotropism, occurring in about 36% of patients, including strokes, vasculitis and Guillain-Barré[1],[2],[3]. We emphasize that it is paramount to be aware of the possibility of facial paralysis in these patients.


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Conflict of interest:

There is no conflict of interest to declare.

Authors’ contributions:

BNFR: Elaboration of the manuscript; EM: Manuscript revision.


  • References

  • 1 Goh Y, Beh DL, Makmur A, Somani J, Chan ACY. Pearls and oy-sters: facial nerve palsy as a neurological manifestation of Covid-19 infection. Neurology 2020 Aug;95(8):364-7. https://doi.org/10.1212/WNL.20200127202001279863
  • 2 Caamaño DSJ, Beato RA. Facial diplegia, a possible atypical variant of Guillain-Barré Syndrome as a rare neurological complication of SARS-CoV-2. J Clin Neurosci. 2020 Jul;77:230-2. https://doi.org/10.1016/j.jocn.2020.05.016
  • 3 Oliveira RM, Santos DH, Olivetti BC, Takahashi JT. Bilateral trochlear nerve palsy due to cerebral vasculitis related to COVID-19 infection. Arq Neuro-Psiquiatr. 2020 Jun;78(6):385-6. https://doi.org/10.1590/0004-282X20200052

Address for correspondence

Bruno Niemeyer de Freitas Ribeiro

Publication History

Received: 11 August 2020

Accepted: 16 August 2020

Article published online:
13 June 2023

© 2020. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Goh Y, Beh DL, Makmur A, Somani J, Chan ACY. Pearls and oy-sters: facial nerve palsy as a neurological manifestation of Covid-19 infection. Neurology 2020 Aug;95(8):364-7. https://doi.org/10.1212/WNL.20200127202001279863
  • 2 Caamaño DSJ, Beato RA. Facial diplegia, a possible atypical variant of Guillain-Barré Syndrome as a rare neurological complication of SARS-CoV-2. J Clin Neurosci. 2020 Jul;77:230-2. https://doi.org/10.1016/j.jocn.2020.05.016
  • 3 Oliveira RM, Santos DH, Olivetti BC, Takahashi JT. Bilateral trochlear nerve palsy due to cerebral vasculitis related to COVID-19 infection. Arq Neuro-Psiquiatr. 2020 Jun;78(6):385-6. https://doi.org/10.1590/0004-282X20200052

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Zoom Image
Figure 1 Chest computed tomography showing multiple and bilateral ground-glass opacities, predominantly peripheral (A and B), some with superimposed intralobular septal thickening (B) (white arrows).
Zoom Image
Figure 2 Contrast enhanced magnetic resonance of the skull showing enhancement of the right facial nerve (white arrows), in the axial (A) and coronal (B) planes.