Cranial neuropathy during severe acute respiratory syndrome coronavirus 2 infection: a case report

Cranial neuropathy has been reported in association with coronavirus disease 2019. Multiple reports have highlighted the possibility of Miller Fisher syndrome as a delayed immune-mediated response to severe acute respiratory syndrome coronavirus 2 infection. However, cranial neuropathy during the infectious phase of coronavirus disease 2019 with positive cerebrospinal fluid polymerase chain reaction has not been reported to date.

We report a 53-year-old Iranian woman who presented with right ptosis, diplopia, and headache without any respiratory symptoms of coronavirus disease 2019. Further evaluations revealed severe acute respiratory syndrome coronavirus(SARS CoV) 2 in the patient's nasopharyngeal sample and cerebrospinal fluid. The patient's neurological symptoms improved after treatment with remdesivir and corticosteroids.

We suggest that cranial nerve-related symptoms can occur in the context of acute severe acute respiratory syndrome coronavirus 2 infection via direct viral invasion and secondary immune-mediated injury following primary infection. Clinicians should consider coronavirus disease 2019 in patients with symptoms related to cranial nerve involvement, even without systemic or respiratory symptoms of this viral infection.