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Case Report: Unilateral Sixth Cranial Nerve Palsy Associated With COVID-19 in a 2-year-old Child
Katrin Knoflach1, Eva Holzapfel1, Timo Roser1
1Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany.
Insights
A pediatric case of sixth nerve palsy following COVID-19 infection is detailed. This post-infectious complication in children is self-limiting, highlighting the neurological effects of SARS-CoV-2.
Area of Science:
- Neurology
- Infectious Diseases
- Pediatrics
Background:
- Neurological symptoms, including in acute coronavirus disease 2019 (COVID-19) and multisystemic inflammatory syndrome in children (MIS-C), have been reported in pediatric patients.
- The spectrum of neurological manifestations in children associated with SARS-CoV-2 infection requires further elucidation.
Observation:
- A 2-year-old boy developed unilateral acute sixth nerve palsy post-SARS-CoV-2 infection.
- Palsy onset occurred 7 days after acute symptoms resolved and 3 weeks after respiratory symptoms began.
- SARS-CoV-2 IgG was detected in serum and cerebrospinal fluid.
Findings:
- The patient experienced a prolonged but self-limiting course of sixth nerve palsy.
- Full recovery was achieved after three and a half months.
- This case expands the neurological spectrum of pediatric COVID-19.
Implications:
- Sixth cranial nerve involvement can be a post-infectious, self-limiting complication of pediatric SARS-CoV-2 infection.
- Clinicians should consider post-infectious sixth nerve palsy in children with recent respiratory infections or COVID-19 exposure.
- Awareness is crucial for timely diagnosis and management of neurological sequelae in pediatric COVID-19 cases.
Abstract:
Children have been described to show neurological symptoms in acute coronavirus disease 2019 (COVID-19) and multisystemic inflammatory syndrome in children (MIS-C). We present a 2-year-old boy's clinical course of unilateral acute sixth nerve palsy in the context of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Onset of the palsy in the otherwise healthy boy occurred seven days after symptoms attributed to acute infection had subsided respectively 3 weeks after onset of respiratory symptoms. SARS-CoV-2 specific IgG was detected in serum as well as in cerebrospinal fluid. The patient showed a prolonged but self-limiting course with a full recovery after three and a half months. This case illustrates in a detailed chronological sequence that sixth cranial nerve involvement may occur as post-infectious, self-limiting complication of pediatric SARS-CoV-2-infection thus expanding the neurological spectrum of symptoms for children with COVID-19. Clinicians should be aware of the possibility of post-infectious sixth nerve palsy related to SARS-CoV-2-infection particularly in view of recent respiratory tract infection or confirmed cases of SARS-CoV-2-infection amongst the patient's close contacts.
