Posted on Authorea 31 Jul 2021 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.162770612.28957408/v1 — This a preprint and has not been peer reviewed. Data may be preliminary. MD MD Aldeeb Review Maya Literature and Report Case patient A COVID-19 a in a ophthalmoparesis is Isolated infection.It We COVID-19 palsy. of abducens manifestation isolated possible an have a to as found mononeuropathy COVID-19. was of cranial and presentation of diplopia rare literature developed English who available patient the positive reviewed COVID-19 a reporting are We Abstract 2021 31, July 5 4 3 2 1 Imam Yahia Dr. Aldeeb Maya report case review A literature patient and COVID-19 a in ophthalmoparesis Isolated a on ohv nioae buesply ervee h vial nls ieaueo cranial of literature English available the reviewed We and diplopia palsy. developed abducens who emerging isolated patient are positive an reports COVID-19 have pathogen, a respiratory to reporting a primarily found are We is was it manifestation. while neurological pandemic, global of a caused has COVID-19 Abstract [email protected] E-mail: +97450035145 Tel: Qatar Doha, Corporation, Medical Hamad Education Medical of Department Aldeeb, Maya Author *Corresponding Title: Short 4 3 2 1 aa eia Corporation Medical Qatar Hamad in disease medicine infectious Cornell of Weil department Education corporation, Medical medical of Hamad Department Corporation Center Medical Research Hamad Medical Corporation Medical Hamad erlg eto,Nuocec nttt,HmdMdclCroain Doha. Corporation, Medical Hamad Institute, Neuroscience section, Qatar. Neurology Doha, Qatar, in Qatar. Medicine Doha, Cornell Corporation, Weil Medical Hamad Disease, Qatar. Infectious Doha, of Corporation, Department Medical Hamad education Medical of Department 3 ai mmMB,FC(dn,Mc FAAN MSc, FRCP(Edin), MBBS, Imam Yahia , OI n buespalsy Abducens and COVID 1 oae Samara Mohamed , 1 oamdSmr MD Samara Mohammad , 5 2 are Oraiby Samreen , 1 are riyMBBS Oraiby Samreen , 1 3,4 2 aa Howady Faraj , 1 aa oayMD Howady Faraj , 3 ay Patro Satya , 2 ay Patro Satya , 4 and , Posted on Authorea 31 Jul 2021 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.162770612.28957408/v1 — This a preprint and has not been peer reviewed. Data may be preliminary. hooun,aihoyi,adcfraoea e u oa rtcla httm.H loue neecover hydroxy- eye an with used review: treated up. also Literature follow was 6 He outpatient his patient time. 10, and that The day isolation at By home protocol 5.2%. diplopia. to local his was our with HBA1c per helped an as which ceftriaxone and and negative azithromycin, also chloroquine, showed was polymerase it lumbar screen bacilli, negative. fast A Autoimmune and were acid was Tuberculosis D), course. culture and level. and pressure its & glucose opening (PCR) or C normal and reaction nerve a protein, (figure have chain the normal to cultures, involving done (CSF) negative fluid enhancement was with cerebrospinal nor acellular, the contrast showed lesions, and with mass performed head was intracranial out. puncture any the ruled of was of evidence thrombosis (MRI) no venous Imaging cerebral and Resonance (CTV) pressure limits Magnetic venography intracranial normal with increased Tomography within with Computed saturation underwent lesions oxygen first mass and and patient and vitals The upper had Right, oxygen. patient supplemental gaze. and without unremarkable, left unremarkable was with was examination examination eye fundoscopy. nerve General left cranial and Other the reflexes B). in pupillary (figure acuity, convergence abduction his visual as of after well including day limitation as intact, a clear were stared a gazes that lower taste. was left or there the smell examination, to of On looking loss on no X-ray pronounced had chest COVID-19. more he for his diplopia manifestation, positive binocular diarrhea, initial was of and swab complained cough nasopharyngeal also A), vomiting, He (figure with infiltrates admitted zone was lower healthy, bilateral showed previously male, 48-year-old March of a A end and to pneumonia 2019 COVID-19 December mild presentation: from a Case English with in patient published a cases in similar ophthamloparesis 2021. of isolated review of rare literature case is comprehensive ageusia a and here headache, anosmia present as from We such apart nonspecific patient COVID-19 were in manifestations involvement neurological nerve common agitation most and the dizziness, that shown is have virus Studies the well-understood. of not invasiveness neurovascular still the but system, papers reported respiratory animals research are the and and is humans virus reports, in the case demonstrated of studies, spread target rapidly primary then, has the Since virus published While the status. be China, “Pandemic” Wuhan, to in a 2019, started gaining December world, early in the coronavirus throughout the of outbreak the Coron- Since Syndrome (Middle Respiratory CoV Acute MERS- (Severe Introduction: ; CoV Thrombosis) SARS- Venous ; (Cerebral Coronavirus) CVT avirus) Syndrome Reaction), Chain Respiratory (Cerebrospinal CSF (Polymerase Eastern Imaging); PCR Resonance ; (Magnetic MRI Fluid) Venography); with Tomography (Computed CTV Abbreviations: should pandemic. symptoms current respiratory the with in presentation association particularly rare Keywords in infection, a palsy COVID-19 is abducens it of isolated that suspicion an found the We that raise suggest infection. We COVID-19 of COVID-19. manifestation of possible a as mononeuropathy : OI-9 ilpa buesply erlgclmanifestations Neurological palsy, Abducens Diplopia, COVID-19, 4,5 3,1 te aiettosicuesrk,siue,adencephalopathy and seizures, stroke, include manifestations Other . ikn h iu oamra lnclmnfsain novn aiu systems. various involving manifestation, clinical myriad a to virus the linking 2,3 oee,sm erlgclmnfsain nCVD1 patients COVID-19 in manifestations neurological some However, . th ev as a mrvdrmral n a discharged was and remarkably improved has palsy nerve 2 8,7 . 4,6 Cranial . Posted on Authorea 31 Jul 2021 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.162770612.28957408/v1 — This a preprint and has not been peer reviewed. Data may be preliminary. eateto eia dcto aa eia oprto,Dh,Qatar. Doha, Corporation, Medical Hamad education Medical of Department Aldeeb 1.Maya Library National Qatar Coauthors: the by provided Funding Hamad Access at Open program Residency support. Medicine their Family and for department Corporation Neurology Medical the acknowledge to like would We request on available is and Acknowledgment: patient the by signed consent Photographic statement: interest Ethical of conflicts pandemic no have current authors the The in of COVID-19. for presentation symptoms testing acute respiratory and Statement The without cause Disclosure inflammation. or underlying the of with for involvement enticement investigations nerve or prompt neuro-invasiveness cranial should virus with the patient to a 6 The attest rare. may is and involvement nerve cranial COVID-19 Post bulb, olfactory and neuro- nerve cases) Conclusion: the olfactory the of of the invasion 60% through viral nerves to direct system cranial up or other nervous in inflammation, central present widespread the is either (anosmia access through gaining be Gutierrez and patients to what MERS-CoV epithelium to postulated and is similar SARs-CoV in injury is described of case previously our our been unlike has in pneumonia the injury seen Neurological COVID-19 with CSF severe aseptic in especially frequent acellular, COVID-19, more the al. with be Furthermore, et to mild. patients seems was in it which explored, usual case virus being the than still of suspected potential are thrombogenic COVID-19 thrombosis, more its the vein due about being cerebral possibly and reports CVT causes, increasing palsies infectious and nerve stroke, stroke motor pressure, prior intracranial ocular with increased known isolated as no such of course causes with type serious long patient common and most a size the in small is palsy palsy nerve abducens abducens Unilateral pneumonia. isolated COVID-19 unilateral, mild with a (1). case and table co-morbidities, a in reporting, summarized are are We cases The reso- weeks. had 6 and to treatment days conservative Discussion: 14 to favorably after our responded ophthalmoparesis to who the ageusia, patients (similar of anosmia, 6 patients lution breath, in 6 of documented oxygen. of shortness were supplemental out fever, Outcomes and required 4 as, patients palsy; the in such 2 nerve after unremarkable symptoms whereas days third was mild cough, 3-8 had and had and manifested two done patients usually patients, was 7 but interestingly, varied MRI nine patient), ophthalmoparesis symptoms. 42 of of was respiratory Out onset patients of healthy. Miller The the palsy. start previously of and nerve age were post-intubation, sixth mean them had The ill, seven of possible ;66.7%). critically most a (6/9 patients as 2-71); majority mononeuropathy excluded (range the cranial were We to Females secondary patients. COVID-19. ophthalmoparesis Fischer with of patients manifestation 9 1 of neurological total from a Scholar with Google articles and PubMed searched We 1,6 a eotdatog h ieec htorptethdn gui raoma. anosmia or ageusia no had patient our that difference the although reported has 1,9 . 1,4 hsas odtu o otCVD1 neto.Awru oecuemore exclude to workup A infection. COVID-19 post for true hold also this , 1,8 rpgyakn nrtord xnltasotthrough transport axonal retrograde on piggybacking or , st eebr21 oteedo ac 01 efudsix found we 2021, March of end the to 2019 December 3 th ev smr omnyaetdta h others the than affected commonly more is nerve 1,5 hl h erlgclmnfsain of manifestations neurological the While . 1,7 h mechanism The . ± 41years 14.1 Posted on Authorea 31 Jul 2021 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.162770612.28957408/v1 — This a preprint and has not been peer reviewed. Data may be preliminary. .Dni ,GoV aa ,e l OI-9peetn ihohhloaei rmcailnrepalsy. nerve cranial from ophthalmoparesis with presenting COVID-19 Unilateral al. with et Presenting J, Kahan Palsy V, Nerve Neurology Gao Cranial M, Dinkin Third COVID-19 COVID-19. 9. in with al. Woman Findings et 24-Year-Old Common S, a Boutgayout Ageusia: in 2020:e925897-e925897. H, Strabismus and Nassih and Anosmia Diplopia S, G. Belghmaidi Riu De 8. G, Deiana G, Salzano Patients. LA, Vaira 7. COVID-19. of Neurobiology CA. Raji doi:10.3233/JAD-200581 S, Infection. Meysami 19. SARS-CoV-2 A, Coronavirus Severe Mian M, in With Fotuhi Features Patients 6. Neurologic Hospitalized al. of et doi:10.1056/NEJMc2008597 H, Manifestations Merdji 2020;382(23):2268-2270. Neurologic S, . Kremer J, al. Helms et 5. M, Wang China. Wuhan, H, in Jin 2019 Disease L, throm- Mao dysfunction, vascular 4. ICU: the in COVID-19 Facing 06059-6 M. inflammation. respiratory Legrand dysregulated the CS, and in Deutschman role bosis, a DE, play Leisman may SARS-CoV2 3. of potential neuroinvasive patients. The Wuhan, COVID-19 T. in of Hashikawa coronavirus W, failure novel 2019 Bai with Y, infected Li patients 2. of features Clinical al. et X, Li China. Y, Wang C, Huang 1. References: Doha. Corporation, [email protected] Medical Hamad Institute, Neuroscience section, Qatar Neurology Doha, Qatar, in Medicine Cornell Weil imam Yahia 6. Qatar [email protected] Doha, Qatar, in Medicine Cornell Weil Patro: Satya 5. Qatar. Doha, Corporation, [email protected] Medical Hamad Disease, Infectious of Department Howady: Faraj 4. Qatar. Doha, Corporation, [email protected] Medical Hamad education Medical of Department Oraiby Samreen 3. Qatar. Doha, Corporation, [email protected] Medical Hamad education Medical of Department Samara 2.Mohamed [email protected] actLn Engl Lond Lancet h Laryngoscope The 009()2123 doi:10.1212/WNL.0000000000009700 2020;95(5):221-223. . 0035123:9-0.doi:10.1016/S0140-6736(20)30183-5 2020;395(10223):497-506. . 00107:77 doi:10.1002/lary.28692 2020;130(7):1787. . e Virol Med J AANeurol JAMA nesv aeMed Care Intensive ulse nieMrh1,22.doi:10.1002/jmv.25728 2020. 11, March online Published . 007()6360 doi:10.1001/jamaneurol.2020.1127 2020;77(6):683-690. . 4 004()10-18 doi:10.1007/s00134-020- 2020;46(6):1105-1108. . lhiesDsJAD Dis Alzheimers J mJCs Rep Case J Am ulse online Published . 2020;76(1):3- . nlJMed J Engl N Posted on Authorea 31 Jul 2021 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.162770612.28957408/v1 — This a preprint and has not been peer reviewed. Data may be preliminary. isolated-ophthalmoparesis-in-a-covid-19-patient-a-case-report-and-literature-review OPHTHALMOPARESIS.docx 1 Table cause file and Hosted potential neuroinvasive have may review. virus perspective COVID-19 020-00851-2 SS. a Negah infection. complications: A, COVID-19 neurological Shahbazi A, from Sepehrinezhad anosmia 19. Acute S. Mermelstein doi:10.1136/practneurol-2020-002583 SARS, to Related Ames-Guerrero Literature 18. C, the of Lastarria-Perez Review V, A COVID-19. Munive Disease: and T, Induced MERS, Coronavirus Tairo-Cerron in polyneuritis BN, Components and Neurological Chino-Vilca RJ. syndrome JA, Fisher Zegarra-Valdivia Miller 17. al. et hospitalized S, in Rodrigo-Rey COVID-19. thromboembolism in A, venous cranialis Mendez-Guerrero of C, Incidence Gutierrez-Ortiz al. 16. et TF, case Haaps a van COVID-19. adults: M, with older patients Coppens in With S, palsies Patients nerve Middeldorp sixth 6 15. ipsilateral literature. recurrent in the isolated of Palsy of review 6 Causes and J. Nerve series Albretson Cranial JW, Chan Isolated 14. MJ. Dinkin CA, Oliveira doi:10.1097/WNO.0000000000001146 JM, Bhatt Infection. CE, COVID-19 Greer 13. asymptomatic an in doi:10.1016/j.jaapos.2021.02.001 palsy 2021. nerve 6, Oculomotor CV. March Ventura COVID-19. TMM, palsy Higino with ARVP, nerve Lucena child abducens MR, Oliveira Acute de KM. (COVID-19).12. Cavuoto disease S, Falcone coronavirus DW, novel Redick the H, JAAPOS with Salazar patient AJ, a Rong in Report. MM, Case Falcone A 11. COVID-19: with Associated doi:10.22599/bioj.167 Anosmia and 2021;17(1):8-12. Palsy . Abducens JE. Francis 10. 002()2627 doi:10.1016/j.jaapos.2020.06.001 2020;24(4):216-217. . er-ptamlO ot mNuoOhhlo Soc Neuro-Ophthalmol Am North J Off Neuro-Ophthalmol J Neurology AO ffPb mAscPdarOhhlo Strabismus Ophthalmol Pediatr Assoc Am Publ Off AAPOS J erlRsInt Res Neurol hobHeotJTH Haemost Thromb J 009()e0-65 doi:10.1212/WNL.0000000000009619 2020;95(5):e601-e605. . lnOhhlo uk NZ Auckl Ophthalmol Clin vial at available 0022:6885 doi:10.1155/2020/6587875 2020;2020:e6587875. . https://authorea.com/users/377042/articles/532295- Neurovirol J 001()19-02 doi:10.1111/jth.14888 2020;18(8):1995-2002. . 5 mAscPdarOhhlo Strabismus Ophthalmol Pediatr Assoc Am J 0593337 doi:10.2147/OPTH.S78319 2015;9:373-377. . 002()3439 doi:10.1007/s13365- 2020;26(3):324-329. . rc Neurol Pract 2020;20(4):343-344. . 2020;40(4):520-522. . ulse online Published . rI rhp J Orthopt Ir Br Posted on Authorea 31 Jul 2021 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.162770612.28957408/v1 — This a preprint and has not been peer reviewed. Data may be preliminary. 6 Posted on Authorea 31 Jul 2021 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.162770612.28957408/v1 — This a preprint and has not been peer reviewed. Data may be preliminary. 7