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Concurrent tonic pupil and trochlear nerve palsy in COVID-19
Carlos M Ordás1, Javier Villacieros-Álvarez2, Ana-Isabel Pastor-Vivas3
1Department of Neurology, Hospital Rey Juan Carlos, Universidad Rey Juan Carlos, Móstoles, Madrid, Spain. ordas.carlos@gmail.com.
Journal of Neurovirology
|September 10, 2020
Summary
This study details a rare case of Adie's pupil and trochlear nerve palsy following COVID-19 infection. This highlights potential neurological complications of the virus.
Area of Science:
- Neurology
- Infectious Diseases
- Ophthalmology
Background:
- Neurological complications following SARS-CoV-2 infection are diverse and continually being documented.
- Understanding these post-infectious sequelae is crucial for comprehensive patient care.
Observation:
- A 62-year-old male presented with acute binocular vertical diplopia, blurred vision, and a dilated left pupil.
- Symptoms began two weeks after a flu-like illness, later confirmed as COVID-19.
- Clinical examination revealed right trochlear nerve palsy and a left mydriatic pupil consistent with Adie's pupil.
Findings:
- Diagnostic workup, including MRI and chest X-ray, yielded normal results.
- SARS-CoV-2 antibodies were positive (IgM low, IgG high), while antiganglioside antibodies were negative.
- Pilocarpine testing confirmed Adie's pupil; prednisone treatment resolved diplopia but not the mydriasis.
Implications:
- This case represents the first reported instance of Adie's pupil as a post-COVID-19 complication.
- An immune-mediated mechanism is suspected for these concurrent neurological and ophthalmological findings.
- Further research is warranted to elucidate the pathophysiology and long-term implications of COVID-19-associated neurological manifestations.
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