Title : Case Report - Facial Nerve Palsy associated with COVID-19 infeccion
Abstract:
The number of cases reporting the frequent impact on the nervous system due to SARS-COV-2 infection is increasing and raising justifiable concerns. This impact, usually manifested in more severe cases of the disease, can lead to the most diverse neurological disorders. Among the causes of these neurological sequelae, the affinity for the ACE2 receptors of the virus, the neurotrophic potential, the recurrent infection of astrocytes, pericytes, macrophages and the malfunction of the immune system stand out. The latter involves an exacerbated immune system response, triggering a cytokine storm, as well as an autoimmune reaction. Facial nerve palsy appeared in several case reports after the presentation of the common symptoms of the disease and subsequent confirmation of diagnosis with medical exams. Bearing that in mind, our objective was to report the case of a patient who developed bilateral facial nerve palsy to evidence this potential manifestation of COVID-19. The medical records of a 46-year-old patient without comorbidities with Bilateral Facial Palsy at the Hospital were obtained. In that document, it is stated that the described paralysis occurred seven days after the onset of symptoms of COVID-19. Concomitantly, the patient presented paresthesia in four limbs, dysarthria and dyspnea. After performing tests, he was diagnosed with bilateral VII cranial (facial) palsy, secondary to SARS-COV-2 infection, and then started therapy with human immunoglobulin, responding positively to treatment. SARS-CoV-2 can manifest itself in several ways, focusing on respiratory symptoms. However, the considerable increase in exposed cases of damage to the neurological system caused by this infection confirms that the investigation and deepening of the subject is stimulated, since the high affinity with ACE2, its viral replication in the nasal mucosa and the triggering of the cytokine storm can lead to serious complications to the patient, leading to death. Neurological disorders are a real possibility in the clinical experience of the new coronavirus pandemic, and it is necessary to pay attention to the possible damage caused by hypoxia and the inflammatory processes of the disease, especially in risk group patients. Under the exposed case, it was verified that the use of human immunoglobulin reduced the severity of the current disease of the infectious processes, allowing a partial or total recovery of the clinical picture of facial paralysis in a short period of time. Despite the success, considering the etiology of the paralysis and the physiology of SARS-CoV-2 in the nervous system and the patient's history, the need for further studies to elucidate all the mechanisms involved in the clinical manifestations caused by this infection is unquestionable, so that new effective treatments can be developed, as well as to facilitate the identification of the most advisable therapy in each case, in order that damages are mitigated.
What will audience learn from your presentation?
• In view of the dimension of the pandemic caused by the new coronavirus and the uniqueness of its mechanism of action, which makes it capable of infecting several systems, in addition to the Respiratory System, neurological sequelae cannot be ruled out. In view of the above, we verified a diversity of reports of patients who had Nervous System involvement and had from milder symptoms, such as headaches, to more serious and of great concern, such as stroke, meningo encephalitis, acute myelitis, Guillain-Barré Syndrome, among others.
• Neurological disorders subsequent to the disease were reported during the worldwide pandemic. results of current research demonstrating the mechanisms that lead to inflammation of the nervous system, highlighting the malfunction of the immune system and the most affected cells, such as astrocytes. and experts. Pericytes are cells present in blood capillaries throughout the body, including those that supply nerves.
• In addition, COVID-19 has a high affinity for ACE2 (angiotensin-2 converting enzyme), whose function is related to the regulation of blood pressure, therefore, its expression occurs to promote cardiocerebral vascular protection and attenuate the mechanisms of blood pressure. atherosclerosis. However, there is high expression of this enzyme in the nasal mucosa, particularly in the ciliated epithelium and cup cells, where viral replication seems to be the greatest, as evidenced by the highest viral titers in the nose.
• SARS-COV-2 infection often causes increased luminal pressure in blood vessels, coagulopathy and prothrombin time, factors that contribute to secondary cerebral hemorrhage. Other studies show the virus can trigger a cytokine storm - an inflammatory response uncontrollable by the immune system - can develop a hyper-inflammatory syndrome, leading to death, and infect macrophages and glial cells that are capable of secreting pro-inflammatory factors.
• The relationship of high levels of IFN-1 in the late phase of the disease results in more harmful outcomes due to the activation of the cGASSTING pathway generated by the infection, which is involved in the destruction tissue in response to IFN-1 production. This response can lead to exacerbated inflammation and damage to central nervous system (CNS) tissue.
