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Isolated Abducens Nerve Palsies from COVID-19 Infections: Clinical Features and Outcomes
You-Jiang Tan1,2, Shawn Zhen-Ji Lin1
1Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore.
Neurology India
|June 24, 2025
Summary
Isolated abducens nerve palsies are an uncommon complication of COVID-19, typically occurring early in mild infections. Most patients recover well, even without steroids, suggesting observation is a reasonable management approach.
Area of Science:
- Neurology
- Infectious Diseases
- Ophthalmology
Background:
- Isolated abducens nerve palsies secondary to COVID-19 are infrequently documented.
- The clinical presentation and optimal management of these palsies remain poorly understood.
Purpose of the Study:
- To delineate the clinical characteristics of isolated abducens nerve palsies associated with COVID-19 infection.
- To establish evidence-based guidelines for managing these neurological complications.
Main Methods:
- A comprehensive literature review was conducted.
- Clinical data from patients with isolated abducens nerve palsy and COVID-19 were systematically analyzed.
Main Results:
- Sixteen cases across 15 studies (2020-2023) were identified, with a median patient age of 44 years.
- Palsies typically manifested early in the course of COVID-19 (median 5.5 days), were unilateral, and often occurred in individuals with no prior medical history.
- Diplopia was a common symptom (88%), with most cases showing complete or near-complete recovery within a median of 26 days, irrespective of treatment, including observation alone.
Conclusions:
- Isolated abducens nerve palsies represent an early, albeit rare, complication of COVID-19, predominantly in milder infections.
- Prognosis is generally favorable, with significant and prompt recovery observed in the majority of cases, even without corticosteroid intervention.
- Initial management may involve observation and early outpatient follow-up; reassessment for alternative etiologies is advised if recovery is not evident within one month.
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