Facial and Abducens Nerve Palsies Following COVID-19 Vaccination: Report of Two Cases

Abstract

A broad spectrum of neurological side effects has been reported after immunisation for COVID-19, including functional neurological disorders, cerebral vascular events, cerebral venous thrombosis, intracerebral haemorrhage, neuroleptic malignant syndrome, cranial nerve palsies, and otologic manifestations. Multiple cranial neuropathies have also been reported following vaccination in which involvement of VII nerve is the most prevalent, followed by the VI, III, and IV nerves. We describe two male patients, one with with facial nerve palsy and the other with abducens nerve palsy following COVID-19 vaccination. The patient with facial nerve palsy received the AstraZeneca vaccine 2 days before the symptoms began. In contrast, the patient with the abducens palsy had received his first dose of the Sinopharm vaccine 7 days previously. Both patients demonstrated a gradual recovery within the next 2 months. Further studies are required to investigate the proper relationship between cranial nerve palsies and vaccinations.

Keywords: COVID-19; Seventh nerve palsy; facial nerve palsy; sixth nerve palsy; vaccination.

Figure 1.

Left facial nerve palsy in patient 1, 2 days after COVID-19 vaccination. (a) Partial loss of the nasolabial fold and an asymmetrical smile. (b) Incomplete eye closure and lack of ability to raise the forehead on the involved side.

Figure 2.

Abducens nerve palsy in patient 2, 7 days after COVID-19 vaccination. The top row demonstrates a small esotropia in the primary position and 50% limitation in abduction of the right eye. The esotropia and abduction deficiency had resolved 2 months later (bottom row).