Paralysis, Bell’s palsy, & other neurological disorders

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Left Bell's palsy following the first dose of mRNA-1273 SARS-CoV-2 vaccine: A case report

Cellina et al., Clinical Imaging, 2021.11

• “Even if rare, Bell's palsy has been reported as a possible side effect of COVID-19 vaccines.

• Patients presenting with symptoms of Bell's palsy should be asked about the recent administration of mRNA SARS-CoV-2 vaccines.

• Bell's palsy diagnosis is mainly clinical, based on typical symptoms.

• Brain MRI can help confirm the Bell's palsy or exclude differential diagnosis.”

“Even though no definitive link has been established, Bell's palsy has been described as a potential side effect of SARS-CoV-2 mRNA vaccines in a few reports, and the US Food and Drug Administration has recommended strict surveillance of its occurrence in the vaccinated general population.

We present the case of a previously healthy 35-year-old female patient who developed Bell's palsy 12 h after receiving the first dose of the mRNA-1273 vaccine. Her general practitioner performed the diagnosis, and corticosteroid treatment was initiated, with slow symptoms improvement. The neurologist's evaluation and a contrast-enhanced brain Magnetic Resonance Imaging revealed a subtle enhancement of the left facial nerve, confirming the diagnosis of Bell's palsy.”

Fig. 1 CISS (A) (field of view 180 × 180 mm, matrix 256 × 256, voxel size 0.6 × 0.6 × 0.6 mm, TR 5.63 ms, TE 2.48 ms, flip angle 70°) and dark fluid para-axial reconstruction (B) (Field of view 280 × 245 mm, matrix 218 × 256, voxel size 1.1 × 1.1 × 1.0, TR 6000 ms, TE 359 ms) shows the facial and vestibulocochlear nerves entering the internal auditory meatus with regular morphology and thickness (arrows).

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Peripheral facial nerve palsy associated with COVID-19

Lima et al., Journal of NeuroVirology, 2020.10

“COVID-19 pandemic revealed several neurological syndromes related to this infection. We describe the clinical, laboratory, and radiological features of eight patients with COVID-19 who developed peripheral facial palsy during infection. In three patients, facial palsy was the first symptom. Nerve damage resulted in mild dysfunction in five patients and moderate in three. SARS-Cov-2 was not detected in CSF by PCR in any of the samples. Seven out of eight patients were treated with steroids and all patients have complete or partial recovery of the symptoms. Peripheral facial palsy should be added to the spectrum of neurological manifestations associated with COVID-19.”

“Possible mechanisms related to nerve damage in idiopathic facial nerve paralysis include ischemia of vasa nervorum and demyelination induced by an inflammatory process (Zhang et al. 2020). Microthrombi and other vascular changes have been consistently reported in several postmortem studies (Silberzahn et al. 1988; Nunes Duarte-Neto et al. 2020) and may be implicated in the development of facial nerve ischemia in COVID-19 patients. Direct viral damage or an autoimmune reaction toward the nerve producing inflammation would be alternative or contributing mechanisms to dysfunction.”

Fig. 1 Axial brain MRI (T1/gadolinium) showing contrast enhancement in the distal intracanalicular portion in the tympanic and mastoid segments of the left facial nerve (red arrows)

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