Facing acute neuromuscular diseases during COVID-19 pandemic: focus on Guillain–Barré syndrome

Abstract

In December 2019, a cluster of cases with 2019 Novel Coronavirus pneumonia from Wuhan, China, aroused worldwide concern due to an escalating outbreak in all the countries in the world. Coronavirus belongs to a family of single-stranded RNA viruses, which includes severe acute respiratory syndrome (SARS-CoV) and Middle East respiratory syndrome (MERS-CoV), that have caused human epidemics with high fatality. The spectrum of the novel coronavirus disease (SARS-Co-2 or COVID-19) ranges from asymptomatic infections to fatal pneumonia, and differs from other viral pulmonary infections. MERS-CoV is known to be potentially neuroinvasive. Extensive reports from China documented central and peripheral nervous system involvement in patients with COVID-19, and identified in angiotensin converting enzyme2 (ACE2), which is present in multiple human organs, the functional receptor for this virus. Guillain-Barré syndrome (GBS) has recently been associated to COVID-19 rising concern among physicians. This review summarizes the current state of knowledge on GBS during or after COVID-19 infection, attempting to clarify the pathophysiology of the associated respiratory dysfunction and failure. Keywords Guillain-Barré syndrome • COVID-19 • MERS-CoV • SARS-CoV • Acute respiratory distress (ARDS) • Acute axonal • Demyelinating neuropathy Abbreviations ACE2 Angiotensin converting enzyme 2 ARDS Acute respiratory distress syndrome AIDP Acute inflammatory demyelinating neuropathy AMAN Acute motor axonal neuropathy AMSADN Acute motor and sensory axonal demyelinating neuropathy CIP Critical illness polyneuropathy CIM Critical illness myopathy MERS-CoV Middle East respiratory syndrome coronavirus RT-PCR Real-time reverse-transcriptase-polymerase-chain-reaction SARS-CoV Severe acute respiratory syndrome coronavirus TMPRSS2 Transmembrane protein serine protease 2

Neurological manifestations of coronavirus disease 2019: exploring past to understand present

“…Central nervous system 1. Infective • Acute encephalitis [ 13 , 14 ] • Acute encephalitis [ 1 ] • Bickerstaff encephalitiswith GBS [ 15 ] • Acute necrotizing hemorrhagicencephalitis [ 16 , 17 ] • Viral encephalitis [ 18 – 20 ] • Meningoencephalitis [ 21 ] • Rhombencephalitis [ 22 ] 2. Vascular • Ischemic stroke [ 23 ] • Ischemic stroke[ 1 ] • Ischemic stroke with large vesselocclusion [ 11 , 24 ] • Intracerebral hemorrhage,subarachnoidhemorrhage [ 25 , 26 ] • CVST [ 27 – 29 ] • PRES [ 30 – 33 ] • Microvascular occlusivedisorder [ 34 ] 3.…”

“…Infective • Acute encephalitis [ 13 , 14 ] • Acute encephalitis [ 1 ] • Bickerstaff encephalitiswith GBS [ 15 ] • Acute necrotizing hemorrhagicencephalitis [ 16 , 17 ] • Viral encephalitis [ 18 – 20 ] • Meningoencephalitis [ 21 ] • Rhombencephalitis [ 22 ] 2. Vascular • Ischemic stroke [ 23 ] • Ischemic stroke[ 1 ] • Ischemic stroke with large vesselocclusion [ 11 , 24 ] • Intracerebral hemorrhage,subarachnoidhemorrhage [ 25 , 26 ] • CVST [ 27 – 29 ] • PRES [ 30 – 33 ] • Microvascular occlusivedisorder [ 34 ] 3. Immunological • ADEM [ 35 ] • MS like illness [ 35 – 38 ] • ADEM[ 15 ] • Post infectious ADEM [ 38 , 39 ] • Acute transverse myelitis [ 40 – 43 ] • Anti-NMDA encephalitis [ 44 ] • Generalized and diaphragmaticmyoclonus [ 45 , 46 ] • Opsoclonus and ocularflutter [ 47 ] 4.…”

“…Extrapyramidal features • Parkinsonism [ 48 ] • Parkinsonism [ 49 , 50 ] 5. Miscellaneous (includingnon-specific features) • Alzheimer’s like dementia [ 48 ] • Schizophrenia like illness [ 48 ] • Headache, confusion, dizziness,seizures [ 1 , 5 , 10 , 11 , 24 , 51 – 54 ] • Alzheimer and schizophrenia like illness expected in future B. Peripheral nervous system 1.…”

“…Peripheral nervous system 1. Neuropathy • CIN [ 1 ] • GBS [ 15 ] • CIN [ 15 ] • Sensory neuropathy [ 15 ] • Olfactory and tastedysfunction [ 1 , 11 , 52 , 55 – 57 ] • GBS [ 58 ] • MFS and polyneuritiscranialis [ 58 ] • Facial diplegia [ 58 ] • Sensory neuropathy • CIN [ 59 ] 2. Neuromuscular junction • Myasthenia gravis [ 60 ] 3.…”

“…An outbreak of atypical pneumonia caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was initially reported in December 2019 from Wuhan in China [ 1 ]. The resulting disease is now termed as coronavirus disease 2019 (COVID-19).…”