srjcmsSRJCMSSRJCMS2788-8851https://doi.org/10.47310/srjcms.2022.v02i01.022Polyneuritis Cranialis in COVID-19 Patients Requires Comprehensive Work-Up to Apply Appropriate TreatmentJosefFinstererDanielMatovuWe eagerly read the article by Gogia et al. about a 58yo male with left peripheral facial nerve palsy and a left sensory trigeminal nerve lesion four days after onset of clinical COVID-19 [1]. Work-up included only the clinical exam, blood tests, and a cerebral MRI without contrast medium. Under valacyclovir only partial remission could be achieved but for suspected respiratory deterioration, the patient received steroids, and convalescent plasma. The study is appealing but raises concerns that require discussion.  The main shortcoming of the study is that the patient did not undergo investigations of the cerebro-spinal fluid (CSF) [1]. Since the patient had developed nausea and vomiting, and a focal neurological deficit, it is crucial to exclude meningitis and encephalitis. Since the patient presented with polyneuritis cranialis it is also crucial to exclude any Guillain-Barre syndrome (GBS) subtype, including polyneuritis cranialis. Knowing the results of CSF investigations is essential for deciding which type of treatment should be applied.  Another shortcoming is that no explanation was provided as why the patient presented with dysphagia. Since the clinical neurologic exam was not indicative of cranial nerve IX or X involvement, we should be told if there were any indications for a brainstem lesion or even a supra-tentorial lesion that could explain dysphagia.  The conclusions are contradictory to what has been presented in the case description. In the conclusions the authors claim that patients with COVID-19 should be carefully investigated by serial neurological exams, neuroimaging, CSF investigations, neurophysiology, and eventually biopsy. However, in the case description neither the results of the CSF investigations nor those of nerve conduction studies (NCSs) have been provided. Those who claim adherence to standards should adhere first. It is not comprehensible why the patient did not receive steroids or immunoglobulins. Assuming that polyneuritis cranialis in the index patient was related to the acute viral infection and the immune response against the virus, it is mandatory to investigate the patient for an abnormal immunological response by measuring immunological parameters, such as cytokines, chemokines, or glial markers in the CSF. They have been previously reported to be upregulated in patents with GBS or polyneuritis cranialis [2]. A further shortcoming is that the long-term outcome of the SARS-CoV-2 infection and the polyneuritis cranialis was not provided. Missing is a discussion about the deterioration of the respiratory situation. We should know if this was due to affection of the respiratory muscles in GBS or only due to worsening pneumonia. This delineation is crucial as it may determine the treatment significantly. We should know if the patient profited from steroids and convalescent plasma also with regard to polyneuritis cranialis.  Missing is the application of contrast medium, as it may help to document that cranial nerve lesions [3,4].  Overall, the interesting report has several limitations, which challenge the results, their interpretation, and the outcome of the index patient. These limitations should be addressed to improve the diagnostic and therapeutic management of future patient SARS-CoV-2 associated polyneuritis cranialis.