Isolated bitemporal hemianopia in a patient with COVID-19

Introduction. Symptoms of lesions of the I, VII and IX pairs of cranial nerves during SARS-CoV-2 infection are observed in about a third of cases. Isolated bitemporal hemianopia as a symptom of optic nerve damage at the chiasmal level in patients with COVID-19 has not been described yet.

Case report. A 65-year-old man with a history of arterial hypertension and myocardial infarction and confirmed COVID-19 infection with severe lung damage on computed tomography. Patient developed bitemporal hemianopia, confirmed by the Donders test, on the second day of hospitalization. CT scan revealed no lesions and organic pathology in the parachiasmatic region and in the substance of the brain. Two days later, there was a complete restoration of lateral vision.

Discussion. The most likely cause of bitemporal hemianopia was microthrombotic or inflammatory lesion at the chiasmal level. Risk factors for thrombotic complications: male gender, age 65, history of cardiovascular diseases, increased D-dimer levels, and signs of systemic inflammation (increased levels of C-reactive protein, fibrinogen, lactate dehydrogenase, and ferritin). An alternative hypothesis for the development of chiasmal syndrome may be direct viral invasion SARS-CoV-2 of the central nervous system.