Case Report: Guillain–Barré Syndrome Associated With COVID-19

Khedr, Eman M.; Shoyb, Ahmed; Mohamed, Khaled O.; Karim, Ahmed A.; Saber, Mostafa

doi:10.3389/fneur.2021.678136

Cited by 6 publications

(8 citation statements)

References 36 publications

(48 reference statements)

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“…In the same case series, there is a patient who developed AIDP symptoms one day after COVID-19 symptoms, but PCR for SARS-CoV-2 was negative in the CSF. The same pattern of para-infectious GBS was also observed in other case reports [ 20 , 36 , 37 ]. On the other hand, in a study comparing the COVID-19 associated GBS incidence with the general GBS incidence for the same period a year before the pandemic, no epidemiological and phenotypical association between SARS-CoV-2 and GBS was found [ 12 ].…”

Section: Discussionsupporting

confidence: 87%

Peripheral nervous system involvement associated with COVID-19. A systematic review of literature

et al. 2023

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There is increasing evidence of both central and peripheral nervous system (PNS) involvement in COVID-19. We conducted this systematic literature review to investigate the characteristics, management and outcomes of patients with PNS, including the types and severity of cranial nerves (CN) involvement. We systematically searched on PubMed for studies reporting adult patients diagnosed with COVID-19 and PNS involvement until July 2021. From 1670 records, 225 articles matched the inclusion criteria, with a total of 1320 neurological events, in 1004 patients. There were 805 (61%) CN, 350 (26.5%) PNS, and 165 (12.5%) PNS plus CN events. The most frequently involved CN were the facial, vestibulo-cochlear and olfactory nerve in 27.3%, 25.4% and 16.1%, respectively. Guillain-Barre syndrome spectrum was identified in 84.2% of PNS events. We analysed 328 patients reported in 225 articles with CN, PNS, and PNS plus CN involvement. The patients with CN involvement were younger (mean age 46.2±17.1, p = .003), and were more frequently treated as outpatients (p < .001), mostly with glucocorticoids (p < .001). Patients that had PNS with or without CN involvement were more likely to be hospitalized (p < .001), and to receive intravenous immunoglobulins (p = .002) or plasma exchange (p = .002). Patients with CN, PNS, and PNS plus CN had severe COVID -19 disease in 24.8%, 37.3%, 34.9% respectively. The most common neurological outcome was mild/moderate sequelae in patients with CN, PNS, and PNS plus CN in 54.7%, 67.5% and 67.8% respectively (p = .1) and no significant difference was found between the three categories regarding death, disease severity, time from disease onset to neurological symptoms, lack of improvement and complete recovery. CN involvement was the most frequent PNS finding. All three categories of PNS involvement were rather associated to non-severe COVID-19 but it may be an important cause of hospitalization and post COVID-19 sequelae.

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Section: Discussionsupporting

confidence: 87%

Peripheral nervous system involvement associated with COVID-19. A systematic review of literature

et al. 2023

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“…He also had a rapid improvement in his condition with the standard five-dose IVIG therapy further supporting GBS as the likely mechanism of his acute symptoms. This patient’s COVID-19 infection occurred approximately five weeks prior to the onset of symptoms contrasts with other reports of post-COVID-19 GBS reporting times typically less than three weeks [ 6 - 8 ]. This patient also presented with a rapid onset and progression of symptoms with bowel and bladder involvement occurring within 36 hours.…”

Section: Discussioncontrasting

confidence: 77%

Neurological Consequences of COVID-19: A Curious Case of Delayed Onset Guillain-Barre

Devarakonda¹,

Stumpe²,

Saucier³

et al. 2022

Cureus

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SARS-CoV-2 is responsible for causing the COVID-19 pandemic and over 4 million deaths globally. Clinical symptoms range from asymptomatic infection, viral syndrome, and pneumonia, to acute respiratory distress syndrome. Guillain-Barre syndrome (GBS), an acute demyelinating inflammatory polyneuropathy, may be a manifestation of infection and must be recognized quickly by clinicians to avoid neurological deterioration in these patients. Here, we present an interesting case of GBS in a patient with a previous COVID-19 infection. A 63-year-old male with a past medical history of hypertension, chronic obstructive pulmonary disease, obesity, and recent COVID-19 infection just five weeks prior to the presentation without COVID-19 vaccination presented to a family medicine clinic due to a history of falls as well as lower extremity numbness, weakness, and paresthesias for the past 36 hours. The patient’s MRI and lumbar puncture were unremarkable and the patient was transferred to a tertiary care center. The patient was diagnosed with GBS secondary to his COVID-19 infection five weeks prior. He received a standard five-dose regimen of 400 mg/kg/day of intravenous immunoglobulin and demonstrated rapid improvement in response to therapy. Temporal factors associated with disease such as the seemingly delayed onset of symptoms after COVID-19 viral infection in comparison to other cases of GBS, as well as the rapid progression of symptomatology, are of note. Healthcare providers should still consider GBS as a possibility in patients with a relatively distant history of COVID-19 infections. Rapid progression of symptoms should also be monitored as this may result in earlier respiratory morbidity and mortality in the absence of appropriate diagnosis and treatment.

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“…Included case reports ( n = 39) had a mean score of 6.385 ± 1.41 with scores ranging from 2 to 8 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 10 case series had a mean score of 5.60 ± 2.01, and scores ranged from 3 to 9. 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 The detailed results of the quality assessment are provided in Supporting Information: File S1 . The quality of our systematic review was assessed using AMSTAR 2 criteria.…”

Section: Methodsmentioning

confidence: 99%

“…Included case reports (n = 39) had a mean score of 6.385 ± 1.41 with scores ranging from 2 to 8 12-50 10 case series had a mean score of 5.60 ± 2.01, and scores ranged from 3 to 9. [51][52][53][54][55][56][57][58][59] The detailed results of the quality assessment are provided in Supporting Information: File S1. The quality of our systematic review was assessed using AMSTAR 2 criteria.…”

Section: Quality Assessmentmentioning

confidence: 99%

Facial palsy as a manifestation of COVID‐19: A systematic review of cases

Khurshid

Sohail

et al. 2022

Health Science Reports

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Background and Aims Facial palsy is a rare complication of the COVID‐19 infection. Herein, we conducted a systematic review of all published cases of facial palsy post‐COVID‐19 infection in an attempt to educate the general population and medical practitioners regarding the likely occurrence of facial palsy in COVID‐19 patients, its detection, effective treatment plan, and prognosis of the condition. Methods We searched PubMed, Google Scholar, and Directory of Open Access Journals (DOAJ) from December 1, 2019 to September 21, 2021. Results We included 49 studies bearing accounts of 75 cases who had facial palsy. The mean age of patients was 42.9 ± 19.59 years, with a male‐to‐female ratio of 8:7. The majority of the cases were reported from Brazil ( n = 14), USA ( n = 9), Turkey ( n = 9), and Spain ( n = 9). Noticeably, 30.14% of COVID‐19 patients were diagnosed with Guillain‐Barré syndrome. In total, 22.97% of patients complained of bilateral facial paralysis ( n = 17), whereas ipsilateral paralysis was observed in 77.03% ( n = 57). These were common complaints of Lagophthalmos, otalgia, facial drooping, dysarthria, and compromised forehead wrinkling. The treatment regimen mainly included the use of corticosteroids ( n = 51) (69.86%), antivirals ( n = 23) (31.51%), IVIG ( n = 18) (24.66%), antibiotics ( n = 13) (17.81%), antiretroviral ( n = 9) (12.33%), and antimalarial ( n = 8) (10.96%) medications. In all, 35.62% of patients ( n = 26) adhered to a combination of antiviral and corticosteroid‐based therapy. Positive treatment outcomes were observed in 83.58% ( n = 56) of cases. In contrast, 10 patients (14.93%) showed nonsignificant recovery, out of which 3 (4.48%) died from the disease. Conclusion The association of facial palsy with COVID‐19 is controversial and therefore requires further investigation and published work to confirm a causal relationship. However, physicians should not overlook the likelihood of facial palsy post‐COVID‐19 infection and treat it accordingly.

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Case Report: Guillain–Barré Syndrome Associated With COVID-19

Cited by 6 publications

References 36 publications

Peripheral nervous system involvement associated with COVID-19. A systematic review of literature

Peripheral nervous system involvement associated with COVID-19. A systematic review of literature

Neurological Consequences of COVID-19: A Curious Case of Delayed Onset Guillain-Barre

Facial palsy as a manifestation of COVID‐19: A systematic review of cases

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