Discussion:
We are reporting, a case with unilateral, isolated abducens nerve palsy
in a patient with no known prior co-morbidities, and a mild COVID-19
pneumonia.
Unilateral abducens palsy is the most common type of isolated ocular
motor nerve palsies possibly due its small size and long
course1,4, this also hold true for post COVID-19
infection. A workup to exclude more serious causes such as increased
intracranial pressure, stroke, infectious causes, and cerebral vein
thrombosis, with stroke and CVT being more suspected than usual in
patients with COVID-19, especially with the increasing reports about the
thrombogenic potential of the virus1,5. While the
neurological manifestations of COVID-19 are still being explored, it
seems to be more frequent in severe COVID-19 pneumonia unlike our case
which was mild. Furthermore, the acellular, aseptic CSF seen in our case
is similar to what Gutierrez et al.1,6 has reported
although the difference that our patient had no ageusia or anosmia .
Neurological injury has been previously described in SARs-CoV and
MERS-CoV patients1,7. The mechanism of injury is
postulated to be through either widespread inflammation, or direct viral
invasion of the neuroepithelium and gaining access the central nervous
system through the olfactory nerve and olfactory bulb, (anosmia is
present in up to 60% of the cases)1,8 , or
piggybacking on retrograde axonal transport through other cranial
nerves1,9.