From the Departments of Glaucoma and Neuro-Ophthalmology (C.G.-O., S.R.-R., F.d.A.-G.) and Neurology (R.G.-M.), University Hospital "Príncipe de Asturias," Alcalá de Henares; Department of Glaucoma (C.G.-O.), "Martínez de Carneros" Clinic; Department of Neurology (A.M.-G., E.S.P.-M., L.B.-G., J.B.-L.), University Hospital "12 de Octubre"; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); and the Department of Medicine (J.B.-L.), Universidad Complutense, Madrid, Spain.
Neurology. 2020 Aug 4;95(5):e601-e605. doi: 10.1212/WNL.0000000000009619. Epub 2020 Apr 17.
To report 2 patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who presented acutely with Miller Fisher syndrome and polyneuritis cranialis, respectively.
Patient data were obtained from medical records from the University Hospital "Príncipe de Asturias," Alcalá de Henares, and the University Hospital "12 de Octubre," Madrid, Spain.
A 50-year-old man presented with anosmia, ageusia, right internuclear ophthalmoparesis, right fascicular oculomotor palsy, ataxia, areflexia, albuminocytologic dissociation, and positive testing for anti-GD1b-immunoglobulin G antibody. Five days previously, he had developed a cough, malaise, headache, low back pain, and fever. A 39-year-old man presented with ageusia, bilateral abducens palsy, areflexia, and albuminocytologic dissociation. Three days previously, he had developed diarrhea, a low-grade fever, and poor general condition. Oropharyngeal swab test for SARS-CoV-2 by qualitative real-time reverse transcriptase PCR assay was positive in both patients and negative in the CSF. The first patient was treated with IV immunoglobulin and the second with acetaminophen. Two weeks later, both patients made a complete neurologic recovery, except for residual anosmia and ageusia in the first case.
Our 2 cases highlight the rare occurrence of Miller Fisher syndrome and polyneuritis cranialis during the coronavirus disease 2019 (COVID-19) pandemic. These neurologic manifestations may occur because of an aberrant immune response to COVID-19. The full clinical spectrum of neurologic symptoms in patients with COVID-19 remains to be characterized.
报告 2 例分别以Miller Fisher 综合征和颅神经炎为首发表现的严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染患者。
从西班牙阿尔卡拉德埃纳雷斯的“普林西佩王子大学医院”和马德里的“12 月 12 日大学医院”的病历中获取患者数据。
一名 50 岁男性以嗅觉缺失、味觉丧失、右侧核间性眼肌麻痹、右侧束状动眼神经麻痹、共济失调、反射消失、白蛋白细胞分离和抗 GD1b-免疫球蛋白 G 抗体阳性为首发表现。5 天前，他出现咳嗽、不适、头痛、下腰痛和发热。一名 39 岁男性以味觉丧失、双侧展神经麻痹、反射消失和白蛋白细胞分离为首发表现。3 天前，他出现腹泻、低热和一般状况不佳。两名患者的口咽拭子 SARS-CoV-2 定性实时逆转录酶 PCR 检测均为阳性，而脑脊液检测均为阴性。第一例患者接受 IV 免疫球蛋白治疗，第二例患者接受对乙酰氨基酚治疗。2 周后，两名患者的神经功能均完全恢复，仅第一例患者残留嗅觉缺失和味觉丧失。
我们的 2 例病例强调了在冠状病毒病 2019（COVID-19）大流行期间Miller Fisher 综合征和颅神经炎的罕见发生。这些神经表现可能是由于对 COVID-19 的异常免疫反应引起的。COVID-19 患者的神经系统症状的完整临床谱仍有待确定。
