Published in:
01-12-2020 | Guillain-Barré Syndrome | Case Report
Concurrent tonic pupil and trochlear nerve palsy in COVID-19
Authors:
Carlos M. Ordás, Javier Villacieros-Álvarez, Ana-Isabel Pastor-Vivas, Álvaro Corrales-Benítez
Published in:
Journal of NeuroVirology
|
Issue 6/2020
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Abstract
Since COVID-19 was first reported, different neurological complications have been acknowledged, but their description is constantly evolving. We report a case of concurrent tonic pupil and trochlear nerve palsy in this context. A 62-year-old man reported a 5-day history of binocular vertical diplopia and blurred vision in his left eye, noticing that his left pupil was dilated. He had suffered a flu-like syndrome 2 weeks before. Clinical exam showed a right trochlear nerve palsy and a left mydriatic pupil. MRI, X chest ray, and analytical results were normal. Antibodies for SARS-CoV-2 were positive (low IgM and high IgG titers). Antiganglioside antibodies were negative. A 0.125% pilocarpine test confirmed Adie’s pupil diagnosis. The patient was treated with a tapered prednisone dose with resolution of his diplopia but no change in Adie’s pupil. This is the first case reporting Adie’s pupil as a postinfectious manifestation of COVID-19. An immune-mediated mechanism is presumed.