COVID-19 infection presented as Guillain-Barre Syndrome: Report of two new cases and review of 116 reported cases and case series

Elzouki, Abdel‐Naser; Osman, Maab; Ahmed, Mohanad; Al‐Abdulmalek, Abdulrahman; Altermanini, Mohammad; Al-Ani, Haneen A.; Naeem, Muhammad; Habas, Elmukhtar

doi:10.1016/j.tmaid.2021.102169

Cited by 11 publications

(11 citation statements)

References 112 publications

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“…In summary, we agree with Elzouki et al that physicians should consider the co-existence of COVID-19 infection and SC2aG when encountering a GBS patient during the current COVID-19 pandemic and that the suspicion of SC2aG warrants SARS-CoV-2 testing, isolation precautions, and specific treatment for COVID-19 [ 1 ].…”

supporting

confidence: 86%

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Apparent onset of COVID-19 after onset of SARS-CoV-2 associated Guillain-Barre syndrome

Scorza

Finsterer

2021

Travel Medicine and Infectious Disease

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supporting

confidence: 86%

“…We read with interest the article by Elzouki et al who reviewed 116 cases of SARS-CoV-2 associated Guillain-Barre syndrome (SC2aG) from the literature and reported on two patients with SC2aG in whom Guillain Barre syndrome (GBS) was deemed to have been caused by a para-infectious mechanism rather than post-infectiously [ 1 ].…”

mentioning

confidence: 99%

Apparent onset of COVID-19 after onset of SARS-CoV-2 associated Guillain-Barre syndrome

Scorza

Finsterer

2021

Travel Medicine and Infectious Disease

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“…30% of cases resulted in poor outcomes and 6% in deaths. Most patients (75%) received intravenous immunoglobulin (IVIG), 8.5% received plasmapheresis, and 6.8% received some combination of both treatment modalities [92]. Another study found that 23.8% of patients were admitted to the hospital for COVID-19 and either developed GBS during hospitalization or were discharged and later readmitted due to neurologic symptoms.…”

Section: Polyneuropathy Myopathy and Neuromuscular Diseasementioning

confidence: 99%

“…Acute inflammatory demyelinating polyradiculopathy (AIDP), a motor and sensory demyelinating disorder, is the most common subtype of GBS observed in patients with COVID-19. Other subtypes, however, including rare variants such as Miller-Fisher syndrome, have also been observed [92].…”

Section: Polyneuropathy Myopathy and Neuromuscular Diseasementioning

confidence: 99%

Neurological Sequelae of COVID-19

Ahmad¹,

Feigen²,

Vazquez³

et al. 2022

J. Integr. Neurosci.

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Background: Though primarily a pulmonary disease, Coronavirus disease 2019 caused by the SARS-CoV-2 virus can generate devastating disease states that affect multiple organ systems including the central nervous system (CNS). The various neurological disorders associated with COVID-19 range in severity from mild symptoms such as headache, or myalgias to more severe symptoms such as stroke, psychosis, and anosmia. While some of the COVID-19 associated neurological complications are mild and reversible, a significant number of patients suffer from stroke. Studies have shown that COVID-19 infection triggers a wave of inflammatory cytokines that induce endothelial cell dysfunction and generate coagulopathy that increases the risk of stroke or thromboses. Inflammation of the endothelium following infection may also destabilize atherosclerotic plaque and induce thrombotic stroke. Although uncommon, there have also been reports of hemorrhagic stroke associated with COVID-19. The proposed mechanisms include a blood pressure increase caused by infection leading to a reduction in angiotensin converting enzyme-2 (ACE-2) levels that results in an imbalance of the renin-angiotensin system ultimately manifesting inflammation and vasoconstriction. Coagulopathy, as demonstrated by elevated prothrombin time (PT), has also been posited as a factor contributing to hemorrhagics stroke in patients with COVID-19. Other neurological conditions associated with COVID-19 include encephalopathy, anosmia, encephalitis, psychosis, brain fog, headache, depression, and anxiety. Though there are several hypotheses reported in the literature, a unifying pathophysiological mechanism of many of these disorders remains unclear. Pulmonary dysfunction leading to poor oxygenation of the brain may explain encephalopathy and other disorders in COVID-19 patients. Alternatively, a direct invasion of the CNS by the virus or breach of the blood-brain barrier by the systemic cytokines released during infection may be responsible for these conditions. Notwithstanding, the relationship between the inflammatory cytokine levels and conditions such as depression and anxiety is contradictory and perhaps the social isolation during the pandemic may in part be a contributing factor to some of the reported CNS disorders. Objective: In this article, we review the current literature pertaining to some of the most significant and common neurological disorders such as ischemic and hemorrhagic stroke, encephalopathy, encephalitis, brain fog, Long COVID, headache, Guillain-Barre syndrome, depression, anxiety, and sleep disorders in the setting of COVID-19. We summarize some of the most relevant literature to provide a better understanding of the mechanistic details regarding these disorders in order to help physicians monitor and treat patients for significant COVID-19 associated neurologic impairments. Methods: A literature review was carried out by the authors using PubMed with the search terms "COVID-19" and "Neurology", "Neurological Manifestations", "Neuropsychiatric ...

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“…Since the onset of the Covid-19 pandemic, there have been reports of the possible link between GBS and the GBS occurs with an approximate incidence of 0.16-3 cases per 100,000 annually in the general population; however, an accurate estimation of the incidence of GBS in Covid-19 patients is unknown, as a potential association remains uncertain. After a thorough literature review, found a substantial number of reported cases and case series of Covid-19 infection presented with GBS [8,9]. When compared to the same period of the previous year, we noticed that the cases of acute polyneuropathy have increased three times.…”

Section: Discussionmentioning

confidence: 77%

Increased Cases of Acute Polyneuropathy in COVID-19 Pandemic: What Awaits Neurologists?

Sinan¹,

Özlem²

2022

Int J Neurol Neurother

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Introduction:Severe acute respiratory syndrome coronavirus 2 infection 2019 primarily affects the respiratory system but central and peripheral neurological manifestations have been increasingly recognized and reported. Materials and methods:The study consisted of patients with acute polyneuropathy that developed after the Covid-19 infection. All patients were confirmed serologically for PCR positivity and typical ground glass appearance in thorax tomography in case of respiratory involvement. In 16 patients, polyneuropathy was diagnosed with an electrophysiological and neurological examination. Etiological research was conducted for all patients to exclude any other causes of acute polyneuropathy. Results:The average age of the patients was 64.3 (29-83) years; most cases were female (13 vs. 3). The interval between the onset of symptoms of Covid-19 and the first symptoms of acute polyneuropathy ranged from 11 to 63 (Mean: 21.5) days. The initial symptoms of acute polyneuropathy were lower-limb weakness and paraesthesia in 11 patients whereas generalized, flaccid tetraparesis was detected in 3 patients. Except for pure sensory symptoms, no motor findings were detected in the two patients. On electroneuromyography (ENMG), there was AMSAN in 7 patients; 7 patients had AMAN and 2 patients had AIDP findings. Five patients accepted lumbar puncture; on analysis of the CSF, one patient had normal protein level and the others showed an albumino-cytological dissociation, increased protein in the cerebrospinal fluid without increase in cell count, characteristic of the GBS. Conclusion:Awareness of the possible causal association between acute polyneuropathy and Covid-19, recommends long-term follow-up of Covid-19 patients for neurologic complications.

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COVID-19 infection presented as Guillain-Barre Syndrome: Report of two new cases and review of 116 reported cases and case series

Cited by 11 publications

References 112 publications

Apparent onset of COVID-19 after onset of SARS-CoV-2 associated Guillain-Barre syndrome

Apparent onset of COVID-19 after onset of SARS-CoV-2 associated Guillain-Barre syndrome

Neurological Sequelae of COVID-19

Increased Cases of Acute Polyneuropathy in COVID-19 Pandemic: What Awaits Neurologists?

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