Concurrent tonic pupil and trochlear nerve palsy in COVID-19

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 diplopi...

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Bibliographic Details
Published in:Journal of neurovirology 2020-12, Vol.26 (6), p.970-972
Main Authors: Ordás, Carlos M., Villacieros-Álvarez, Javier, Pastor-Vivas, Ana-Isabel, Corrales-Benítez, Álvaro
Format: Article
Language:English
Subjects:
Anti-Inflammatory Agents - therapeutic use
Biomedical and Life Sciences
Biomedicine
Case Report
COVID-19 - complications
Diplopia - drug therapy
Diplopia - virology
Humans
Immunology
Infectious Diseases
Male
Middle Aged
Neurology
Neurosciences
Prednisone - therapeutic use
SARS-CoV-2
Tonic Pupil - drug therapy
Tonic Pupil - virology
Trochlear Nerve Diseases - drug therapy
Trochlear Nerve Diseases - virology
Virology
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Summary: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.
ISSN:1355-0284
1538-2443
DOI:10.1007/s13365-020-00909-1