Guillain–Barré syndrome as a parainfectious manifestation of SARS-CoV-2 infection: A case series

Abolmaali, Meysam; Heidari, Mahnaz; Zeinali, Marjan; Moghaddam, P. K.; Ghamsari, Mona Ramezani; Makiani, Mahin Jamshidi; Mirzaasgari, Zahra

doi:10.1016/j.jocn.2020.11.013

Cited by 34 publications

(31 citation statements)

References 13 publications

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“…In this systematic review of 43 patients, 40 subjected to staitical analysis with a spectrum of CNS inflammatory disorders in COVID-19 patients, the most common presentation was that of acute myelitis, often transverse, followed by ADEM, CLOCC/MERS, and AHNE/AHLE. The timing of neuroinflammatory complications relative to initial symptoms of COVID-19 infection and the rarity of detection of SARS-CoV-2 in CSF or CNS, suggest that most of these particular CNS syndromes reviewed in this paper are parainfectious/postinfectious disorders [ 9 , 20 – 22 ]. The patients in this review exhibited a wide variety of neurological symptoms of which the most common presentation in myelitis was urinary retention and lower limb weakness [ 22 – 37 ].…”

Section: Discussionmentioning

confidence: 99%

“…These manifestations appear to be an amalgamation of systemic disease complications including systemic inflammatory mediators, nervous system and vasculature inflammation, or the effects of direct viral invasion. The neuroinflammation associated with COVID-19 could be either from direct viral neuroinvasion leading to inflammation and cytokine release or from delayed autoimmune dysregulation or molecular mimicry leading to autoimmune/inflammatory syndromes that is parainfectious/ postinfectious [9][10][11]. Currently, there is insufficient knowledge about the effects of SARS-CoV-2 on central nervous system (CNS) inflammation involving brain, optic nerve and spinal cord.…”

Section: Introductionmentioning

confidence: 99%

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COVID-19 and neuroinflammation: a literature review of relevant neuroimaging and CSF markers in central nervous system inflammatory disorders from SARS-COV2

Sriwastava

Tandon

Podury³

et al. 2021

J Neurol

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Background The literature on neurological manifestations in COVID-19 patients has been rapidly increasing with the pandemic. However, data on CNS inflammatory disorders in COVID-19 are still evolving. We performed a literature review of CNS inflammatory disorders associated with coronavirus disease-2019 . Methods We screened all articles resulting from a search of PubMed, Google Scholar and Scopus, using the keywords; "SARS-CoV-2 and neurological complication", "SARS-CoV-2 and CNS Complication" looking for reports of transverse myelitis, longitudinally extensive transverse myelitis, neuromyelitis optica, myelitis, Myelin Oligodendrocyte Glycoprotein Antibody Disorder (MOGAD), Acute Disseminated Encephalomyelitis (ADEM), Acute Hemorrhagic Necrotizing Encephalitis/Acute Hemorrhagic Leukoencephalitis (AHNE/AHLE), Cytotoxic lesion of the Corpus Callosum/Mild Encephalopathy Reversible Splenium Lesion(CLOCC/MERS) and Optic neuritis published between December 01, 2019 and March 15, 2021. Results Our literature search revealed 43 patients meeting the diagnosis of myelitis, including Transverse Myelitis, ADEM, AHNE/AHLE or CLOCC/MERS and Optic neuritis. Acute myelitis was most commonly associated with non-severe COVID-19 and all reported cases of AHNE/AHLE had severe COVID-19 infection. Based on IDSA/ATS criteria of either requiring vasopressor for septic shock or mechanical ventilation, 49% (n = 18) patients were considered to have a severe COVID infection. There were 7 (n = 19%) fatalities. Conclusion To our knowledge, this is among the first reviews that includes the clinical features, neuroimaging, CSF findings and outcomes in COVID-19-associated CNS inflammatory disorders. Our observational review study reveals that although rare, myelitis, ADEM, AHNE and CLOCC can be associated with COVID-19 infection. Further studies using MRI imaging and CSF analysis in early diagnosis and intervention of these disorders are warranted.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

COVID-19 and neuroinflammation: a literature review of relevant neuroimaging and CSF markers in central nervous system inflammatory disorders from SARS-COV2

Sriwastava

Tandon

Podury³

et al. 2021

J Neurol

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“…Common neurological symptoms of COVID-19 are headache, dizziness, dysgeusia/ageusia, hyposmia/anosmia, seizure, stroke, and encephalopathy [ 2 ]. There have been reported cases of Guillain-Barré Syndrome (GBS) associated with COVID-19 from different parts of the world [[ [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [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] ],[ [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] ,…”

Section: Introductionmentioning

confidence: 99%

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

Elzouki¹,

Osman²,

Ahmed³

et al. 2021

Travel Medicine and Infectious Disease

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Background /Aims: Corona virus disease 2019 (COVID 19) is a pandemic infectious disease of 2020, which often presents with respiratory and gastrointestinal symptoms. The behavior of the virus and its full clinical picture has not been fully studied yet. Many case reports and case series have been running in order to elaborate different presentations and associations. Pulmonary and gastrointestinal features of COVID-19 infection are well outlined; however, neurological manifestations are less defined. Case presentation We report two adult cases of COVID-19 infection presented with acute Guillain-Barre Syndrome (GBS), and a literature review on the causal association between COVID-19 and GBS. Conclusion Our two case reports in addition to literature review of 116 published cases may help offer insight into the clinical course of COVID-19 infection. Our two COVID-19 patients presented with neurological manifestations of GBS which were not preceded with any respiratory, gastrointestinal or other systemic infection. This leads us to raise the possibility of establish direct causal association between COVID-19 infection and GBS. Physicians should have high clinical suspicions when encounter GBS patient during the current COVID-19 pandemic and consider co-existence of COVID-19 infection that may warrant SARS-CoV-2 testing, isolation precautions, and specific treatment for Covid-19 infection.

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“…Despite smaller proportion, these patients have long-term permanent neurological sequelae or even have fatal outcomes. In this sense, there is a lot of interest in the association of COVID-19 and the development of Guillain-Barre syndrome, which in almost all cases, occurs during the acute phase of the infection [14] . The manifestation of this neuropathy associated with SARS-Cov-2 infection has been attributed to the strong immune response that triggers during the infectious process, with followup activation of pro-inflammatory cytokine cascades [15] .…”

Section: Guillain-barre Syndromementioning

confidence: 99%

Post-COVID 19 neurological syndrome: Implications for sequelae’s treatment

Camargo-Martínez

Lozada-Martínez

Escobar-Collazos

et al. 2021

Journal of Clinical Neuroscience

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Study design Literature review. Objectives Describe the implications of post-COVID syndrome due to neurological sequelae including treatment and the differences that may exist between this group of patients and those who present these events not associated with COVID-19. Methods A non-systematic review of the literature was carried out in PubMed and Science Direct databases, using the keywords “Post-acute COVID-19 syndrome”; “Neurological complications”; “Neurologic Manifestations” “COVID-19″ and ”Rehabilitation“, as well as synonyms, which were combined with the operators ”AND“ and ”OR“. Results The COVID-19 viral caustive agent, SARS-CoV-2, has a high affinity for human angiotensin-converting enzyme 2 receptor on type II pneumocytes. This receptor is also expressed in neurons and glial cells. Based on the foregoing and other not so clear mechanisms, it is stated that SARS-CoV-2 has tropism for the nervous system, being evident through the neurological manifestations observed in patients with mild, moderate and severe phenotype of the disease such as anosmia, ageusia, headache, cerebrovascular accidents, Guillain-Barré syndrome, seizures, and encephalopathy. This can generate severe sequelae and even fatal outcomes in those affected. Conclusions Neurological complications caused by COVID-19 are frequent and represent a risk that compromises the functional capacity and the life of patients. The suspicion of these conditions, the strict control of metabolic alterations and cardiovascular risk factors, the effective and safe treatment of these entities, are a current challenge throughout the pandemic. The rehabilitation process in these patients is a challenge. This is due to the limitations generated by multi-organ damage, as well as risk of brain death.

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Guillain–Barré syndrome as a parainfectious manifestation of SARS-CoV-2 infection: A case series

Cited by 34 publications

References 13 publications

COVID-19 and neuroinflammation: a literature review of relevant neuroimaging and CSF markers in central nervous system inflammatory disorders from SARS-COV2

COVID-19 and neuroinflammation: a literature review of relevant neuroimaging and CSF markers in central nervous system inflammatory disorders from SARS-COV2

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

Post-COVID 19 neurological syndrome: Implications for sequelae’s treatment

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