COVID-19-Associated Guillain-Barre Syndrome: Atypical Para-infectious Profile, Symptom Overlap, and Increased Risk of Severe Neurological Complications

Abstract

The concurrence of COVID-19 with Guillain-Barre syndrome (GBS) can increase the likelihood of neuromuscular respiratory failure, autonomic dysfunction, and other life-threatening symptoms. Currently, very little is known about the underlying mechanisms, clinical course, and prognostic implications of comorbid COVID-19 in patients with GBS. We reviewed COVID-19associated GBS case reports published since the outbreak of the pandemic, with a database search up to August 2020, including a manual search of the reference lists for additional relevant cases. Fifty-one (51) case reports of COVID-19 patients (aged 23-84 years) diagnosed with GBS in 11 different countries were included in this review. The results revealed atypical manifestations of GBS, including para-infectious profiles and onset of GBS without antecedent COVID-19 symptoms. Although all tested patients had signs of neuroinflammation, none had SARS-CoV-2 in the cerebrospinal fluid (CSF), and only four (4) patients had antiganglioside antibodies. The majority had a 1-to 10-day time interval between the onset of COVID-19 and GBS symptoms, and many had a poor outcome, with 20 out of the 51 (39.2%) requiring mechanical ventilation, and two deaths within 12 to 24 h. The atypical manifestations of COVID-19-associated GBS, especially the para-infectious profile and short time interval between the onset of the COVID-19 and GBS symptoms, increase the likelihood of symptom overlap, which can complicate the treatment and result in worsened disease progression and/or higher mortality rates. Inclusion of a neurological assessment during diagnosis of COVID-19 might facilitate timely identification and effective management of the GBS symptoms and improve treatment outcome.

Myoclonus and cerebellar ataxia associated with COVID-19: a case report and systematic review

“…Miller Fisher syndrome and GBS associated with COVID-19 indicate that molecular mimicry between SARS-CoV-2 and the nervous system may play a role in pathogenesis. Interestingly, some cases of GBS associated with COVID-19 had concurrent neurological and COVID-19 symptoms [ 62 ] and suggest that distinct but overlapping para-infectious and post-infectious mechanisms may be contributory.…”

Parainfectious Guillain Barre Syndrome in a Patient Diagnosed with COVID-19

“…Respiratory failure via GBS and the requirement of mechanical ventilation were reported as 17%-30% [7]. Besides, para-infectious COVID-19-related GBS cases were found riskier for ventilator requirement [5]. In the present case, GBS symptoms developed on the third-day of symptom onset of COVID-19.…”

“…He had rapid progressive neurological ndings resulting in quadriplegia, facial paralysis, and dysphagia. Cranial neuropathies including facial paralysis consist of a rare form of GBS [5]. The diagnostic criteria for GBS can be evaluated with the Brighton Criteria [6], and our patients presented all the de ned criteria.…”

“…The neurological ndings and CSF examination were consistent with GBS. CSF examination revealed no pleocytosis but increased protein levels, and albumin-cytological dissociation was identi ed [5]. In addition, the test for SARS CoV-2 PCR in CSF was negative.…”

“…The review of published 37 COVID-19 cases with GBS revealed that the mean-time between COVID-19 symptoms onset and GBS symptoms onset was 11 ± 6.5 days [2]. Another review of 51 COVID-19-related GBS cases reported that 70.5% of the patients were post-infectious whilst 24.5% were para-infectious [5].…”