Isolated post SARS-CoV-2 diplopia
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LETTER TO THE EDITORS
Isolated post SARS‑CoV‑2 diplopia Alice Faucher1 · Pierre‑Antoine Rey2 · Elise Aguadisch3 · Bertrand Degos1,4 Received: 10 May 2020 / Revised: 6 June 2020 / Accepted: 8 June 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Dear sirs, On March 31, 2020, a 21-year-old man presented to Avicenne Hospital with a 3-day history of cough, dyspnea, and fever. His body temperature was 38.1 °C, his respiratory rate was 28 breaths/min and the oxygen saturation was 97% on ambient air. A chest computed tomography (CT) showed lingula and left base bronchopneumopathy and was classified as moderate damage of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The real-time polymerasechain-reaction (PCR) nasal testing returned positive for SARS-CoV-2. Regarding the initial hypercapnic decompensation, a non-invasive ventilation was used, and he was treated by Cefotaxime, Rovamycine and Hydroxychloroquine. Secondary worsening of his respiratory condition led to orotracheal intubation and referral in intensive care unit for 6 days. There was no evidence for pulmonary embolism, and the patient, whose body mass index was over 40 kg. m−2, received preventive anticoagulation with low molecular weight heparin twice per day. He finally left the hospital on April 14th. On April 15th, the patient came back for a binocular horizontal diplopia which began 48 h before, with a quick installation mode, without blurred vision nor red or painful eyes. There was no clinical variation of his symptomatology, no
* Bertrand Degos [email protected] 1
Service de Neurologie, APHP, Hôpital Avicenne, Hôpitaux Universitaires de Paris-Seine Saint Denis, Sorbonne Paris Nord, Bobigny, France
2
Service d’Ophtalmologie, APHP, Hôpital Avicenne, Hôpitaux Universitaires de Paris-Seine Saint Denis, Sorbonne Paris Nord, Bobigny, France
3
Urgences-SAMU 93, APHP, Hôpital Avicenne, Hôpitaux Universitaires de Paris-Seine Saint Denis, Sorbonne Paris Nord, Bobigny, France
4
Dynamics and Pathophysiology of Neuronal Networks Team, Center for Interdisciplinary Research in Biology, UMR7241/INSERM U1050, MemoLife Labex, Collège de France, CNRS, 75005 Paris, France
headache, no fever and no respiratory symptoms. He had no medical history of strabismus or ametropia, he had no cardiovascular risk factor, apart from obesity. Oculomotor examination showed a strabismus with a constant exotropia of the left eye in primary position (Fig. 1a) and normal pupillary light reflex. There were no ptosis, no Horner’s syndrome, no cerebellar syndrome and no exercise-induced fatigability. The rest of the examination only showed vivid and diffused osteotendinous reflexes, with bilateral Hoffmann sign. The Hess-Lancaster test evidenced the partial left third cranial nerve palsy (Fig. 1b). Brain MRI showed several arterial micro-ectasia (Fig. 1c), but no parenchymal abnormalities or meningeal contrast enhancement and no sign of ocular myositis. Exhaustive blood analyses did not show any viral (HIV infection or Lyme’s disease
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