Third cranial nerve palsy presenting with unilateral diplopia and strabismus in a 24-year-old woman with COVID-19

Abstract

Patient: Female, 24-year-old Final Diagnosis: Third cranial nerve palsy in a women presenting COVID-19 Symptoms: Ophthalmoplegia Medication: — Clinical Procedure: — Specialty: Ophthalmology Objective: Background: Case Report: Conclusions: Rare disease Coronavirus disease (COVID 19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and is the causative agent of a serious disease that is of great global public health concern. Palsy of the third cranial nerve is very rare in patients with confirmed 2019 novel coronavirus disease (COVID-19). We describe the case of a patient with an incomplete palsy of the left third cranial nerve sparing the pupils in the context of SARS-CoV-2 virus infection. We report the case of a 24-year-old woman with confirmed COVID-19, which presented with acute onset of diplopia and strabismus of the left eye that occurred 3 days after the start of general symptoms. The patient had no significant medical history. Based on detailed ophthalmic and neurological examination, acute pain-less incomplete palsy of the third cranial nerve was suspected. Oculo-cerebral magnetic resonance angiogra-phy was unremarkable. Blood tests revealed mild normocytic regenerative anemia. According to the Moroccan recommendations, chloroquine and azithromycin were started. After what, a quick improvement of exotropia and diplopia was observed, and complete recovery was obtained by the sixth day of treatment. No adverse ef-fects of the treatment were noted. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause neurological complications such as cranial nerve palsy. The pathological mechanism remains unclear. Full recovery of the ocular motricity is pos-sible, and prognosis depends on the severity of the respiratory illness.