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Updated: Oct 29, 2025
Single-stage Dynamic Reanimation of the Smile in Irreversible Facial Paralysis by Free Functional Muscle Transfer
Published on: March 1, 2015
[Patient treated for severe Covid-19 with paralysis of cranial nerves]
Kristina Engström1, Amanj Saber2
1överläkare, öron-, näs- och halskliniken, Universitetssjukhuset Örebro; öron-, näs- och halsmottagningen, Karlskoga lasarett.
Insights
Severe COVID-19 patients may develop neurological issues like cranial nerve palsy. This case highlights facial, hypoglossal, and vagus nerve paralysis in a ventilated patient, likely from a combination of the virus and intensive care unit (ICU) procedures.
Area of Science:
- Neurology
- Infectious Diseases
- Critical Care Medicine
Background:
- Severe COVID-19 can lead to neurological complications, including cranial nerve palsies.
- Intensive care unit (ICU) interventions, such as prolonged intubation and prone positioning, may also pose risks to cranial nerves.
Purpose of the Study:
- To report a case of multiple cranial nerve palsies in a patient with severe COVID-19.
- To discuss the potential etiologies, including viral damage and mechanical compression, of these neurological deficits.
Main Methods:
- Case report of a patient with severe COVID-19 requiring mechanical ventilation.
- Clinical examination and observation of neurological deficits during and after ICU care.
Main Results:
- The patient developed left-sided facial nerve palsy while intubated.
- Post-extubation, she exhibited hoarseness, dysphagia, left hypoglossal nerve paralysis (tongue deviation), and left vagus nerve paralysis (vocal cord paralysis).
Conclusions:
- Cranial nerve palsies are a potential neurological complication of severe COVID-19.
- The observed deficits were likely caused by a combination of direct viral effect and nerve compression during ICU management.
- Facial nerve palsy is noted to be more prevalent in COVID-19 patients.
Abstract:
Patients with Covid-19 can experience neurological complications, for example cranial nerve palsy. We present a case with a patient treated for severe Covid-19 infection. She was intubated for 16 days and was ventilated in the prone-position for several hours a day during her care in the intensive care unit (ICU). She developed paralysis of the left facial nerve, observed while intubated. After extubation the patient was hoarse and had dysphagia and examination showed paralysis of the left hypoglossal nerve with the tongue deviating to the left and of the left vagus nerve causing a paralysis of the left vocal cord. It is impossible to know whether the paralysis of the three cranial nerves was due to direct damage by the Covid-19 virus or due to compression of the nerves during the ICU care. As facial nerve palsy has been shown to be more common in patients with Covid-19, we believe that the paralysis in our patient was due to a combination of both.
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