1. Pediatric Infectious Diseases Unit, Department of Pediatrics. CHULC, Lisbon, Portugal
2. Child Neurology Unit, Department of Pediatrics. CHULC, Lisbon, Portugal
3. Department of Ophthalmology. CHULC, Portugal
- Poster apresentado no 39º Congresso Anual da Sociedade Europeia de Doenças Infecciosas Pediátricas (ESPID), 24-29 maio 2021
Background The spectrum of COVID-19 neurological manifestations is expanding and clinicians struggle to diagnose its uncommon forms. Diplopia and ophthalmoplegia have been seldomly described in the setting of SARS-CoV2 infection.
Case Presentation 9-year-old girl with SARS-CoV-2 infection one month before presenting with 3-day long fever, vomiting and bilateral red eye. Nine days later, she started complaining of diplopia on right gaze. At this moment, there was no fever or red eyes, headache, pain with eye movements or impairment of visual acuity. Neurological examination was positive only for limited right eye abduction. Brain and orbit CT and MRI revealed no structural abnormalities. The ophthalmological examination disclosed bilateral optic disk oedema and OCT was consistent with bilateral papilledema. There was no visual acuity deficit or indirect inflammatory signs. Lumbar puncture opening pressure was 22cmH2O, and there was no CSF pleocytosis, elevated protein or intra-thecal synthesis of immunoglobulin. Comprehensive blood chemistry revealed an erythrocyte sedimentation rate of 98mm/h without other markers of systemic inflammation. Nasal swab SARS-CoV2 PCR was negative but antibodies were present in both serum and CSF. Other infectious aetiologies were excluded. A 7-day course of oral prednisolone 1mg/kg/day was decided. The girl recovered completely in one month.
Learning Points/Discussion The case presented fulfils American Academy of Neurology criteria for probable Pseudotumor Cerebri Syndrome (PTCS) and this diagnosis would explain transient papilledema without visual impairment and VI nerve palsy. Although it is true that the absence of headache is unexpected for this syndrome, the alternative diagnosis of bilateral optic neuritis without visual impairment seems more unlikely. The complete recovery after corticosteroids adds little to the diagnosis, considering that most secondary PTCS resolve after resolution of its cause or after lumbar puncture.