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Late peripheral facial paralysis after COVID-19: a rapid systematic review and two case reports

Thalitta Mendes Cavalcante1, Vanessa Terezinha Gubert2,3, Carolina de Deus Lima1, Larissa Anjos Luciano1, Mariana Garcia Croda1, James Venturini1,2, Antonio Luiz Dal Bello Gasparoto2, Wellyngton Matheus Souza Santiago2, Ana Rita Coimbra Motta-Castro2,4, Fernanda Paes Reis3, Ana Paula da Costa Marques5, Aline Pedroso Lorenz5, Wellington Santos Fava6, Marina Castilhos Souza Umaki Zardin6, Cláudia Elizabeth Volpe Chaves3,7, Gabriel Pereira Braga3, Anamaria Mello Miranda Paniago1,2, Sandra Maria do Valle Leone de Oliveira2,4 [ + show more ]

J Venom Anim Toxins incl Trop Dis, 2022, 28:e20220020
Received: 23 April 2022 | Accepted: 16 August 2022 | Published online: 17 October 2022


Peripheral facial paralysis (PFP) has been shown to be a neurological manifestation of COVID-19. The current study presents two cases of PFP after COVID-19, along with a rapid review of known cases in the literature. Both case reports were conducted following CARE guidelines. We also performed a systematic review of PFP cases temporally related to COVID-19 using PubMed, Embase, and Cochrane Library databases on August 30, 2021, using a rapid review methodology. The two patients experienced PFP 102 and 110 days after COVID-19 symptom onset. SARS-CoV-2 RNA was detected in nasal samples through reverse-transcription real-time polymerase chain reaction (RT-qPCR) testing. Anosmia was the only other neurological manifestation. PFP was treated with steroids in both cases, with complete subsequent recovery. In the rapid review, we identified 764 articles and included 43 studies. From those, 128 patients with PFP were analyzed, of whom 42.1% (54/128) were male, 39.06% (50/128) female, and in 23 cases the gender was not reported. The age range was 18 to 59 (54.68%). The median time between COVID-19 and PFP was three days (ranging from the first symptom of COVID-19 to 40 days after the acute phase of infection). Late PFP associated with COVID-19 presents mild symptoms and improves with time, with no identified predictors. Late PFP should be added to the spectrum of neurological manifestations associated with the long-term effects of SARS-CoV-2 infection as a post COVID-19 condition.


Keywords: SARS-CoV-2 infection; Peripheral facial paralysis; Post-COVID; Neurological manifestation.

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