Neuromuscular Complications in COVID-19:  A Review of the Literature

Pike-Lee, Tiffany; Li, Yuebing; Wolfe, Gil I.

doi:10.17161/rrnmf.v1i3.13816

Cited by 2 publications

(3 citation statements)

References 24 publications

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“…Early recognition and treatment with IVIG or plasma exchange/plasmapheresis (PLEX), along with supportive care, remains the mainstay of therapy (30)(31)(32).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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Guillain–Barré syndrome (GBS) is a potentially fatal, immune-mediated disease of the peripheral nervous system that is usually triggered by infection. Only a small number of cases of GBS associated with COVID-19 infection have been published. We report here five patients with GBS admitted to the Neurology, Psychiatry, and Neurosurgery Hospital, Assiut University/Egypt from July 1 to November 20, 2020. Three of the five patients were positive for SARS-CoV-2 following polymerase chain reaction (PCR) of nasopharyngeal swabs on day of admission and another one had a high level of IgM and IgG; all had bilateral ground-glass opacities with consolidation on CT chest scan (GGO) and lymphopenia. All patients presented with two or more of the following: fever, cough, malaise, vomiting, and diarrhea with variable duration. However, there were some peculiarities in the clinical presentation. First, there were only 3 to 14 days between the onset of COVID-19 symptoms and the first symptoms of GBS, which developed into flaccid areflexic quadriplegia with glove and stocking hypoesthesia. The second peculiarity was that three of the cases had cranial nerve involvement, suggesting that there may be a high incidence of cranial involvement in SARS-CoV-2-associated GBS. Other peculiarities occurred. Case 2 presented with a cerebellar hemorrhage before symptoms of COVID-19 and had a cardiac attack with elevated cardiac enzymes following onset of GBS symptoms. Case 5 was also unusual in that the onset began with bilateral facial palsy, which preceded the sensory and motor manifestations of GBS (descending course). Neurophysiological studies showed evidence of sensorimotor demyelinating polyradiculoneuropathy, suggesting acute inflammatory polyneuropathy (AIDP) in all patients. Three patients received plasmapheresis. All of them had either full recovery or partial recovery. Possible pathophysiological links between GBS and COVID-19 are discussed.

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“…Early recognition and treatment with IVIG or plasma exchange/plasmapheresis (PLEX), along with supportive care, remains the mainstay of therapy (30)(31)(32).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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“…The most severe manifestation leads to acute respiratory failure [ [15] , [16] , [17] ]. Overlap of respiratory paralysis in GBS and COVID-19 infection makes it critically important for the physicians to diagnose and manage GBS early in all patients of COVID-19, recognizing that respiratory compromise due to GBS may be rapidly progressive but treatable with a high success rate in COVID-19 patients [ 14 , [18] , [19] , [20] ].…”

Section: Introductionmentioning

confidence: 99%

“…Although many microorganisms, viruses, bacteria and mycoplasma have been identified as triggers for GBS, including influenza, HIV, Zika virus, SARS and MERS, EBV, CMV, C. Jejuni [ 10 , 11 , 13 , [21] , [22] , [23] , [24] , [25] ]; new cases reported during the current pandemic have led to the recognition of GBS as a neurological complication of SARS-CoV-2, rather than being present coincidentally [5, [ 5 , 8 , 15 , 16 , 18 , [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] ]. Early recognition and treatment with intravenous immunoglobulin (IVIG) or plasma exchange/plasmapheresis (PLEX), along with supportive care remains the mainstay of therapy [ 14 , 17 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

Guillain Barré Syndrome and its variants as a manifestation of COVID-19: A systematic review of case reports and case series

Sriwastava

Kataria

Tandon

et al. 2021

Journal of the Neurological Sciences

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Background The COVID-19 pandemic caused by SARS-COV-2 began in Wuhan, China in December 2019. Reports of COVID-19 with central (CNS) and peripheral nervous (PNS) system manifestations are emerging. In this systematic review, we compared and summarized the demographics, clinical features, Brighton criteria, immunological and laboratory findings with a focus on modified Erasmus GBS Outcome Score (mEGOS) in SARS-CoV-2 patients with GBS and its variants. Methods Based on PRISMA guidelines, we searched three databases (PubMed, Scopus, and Google Scholar) for studies on COVID-19 and GBS between December 1, 2019 to July 15, 2020. For descriptive analysis, we studied two groups with: 1) acute inflammatory demyelinating polyradiculoneuropathy (AIDP) variant, and 2) Non-AIDP/Other variants. We compared mEGOS scores for patients in both groups along with other key clinical features. Results Of the 50 GBS cases identified from 37 studies, 33 (66%) had acute inflammatory demyelinating polyradiculopolyneuropathy (AIDP) while 17 (34%) were of other (non-AIDP) variants. There mEGOS scores did not differ between AIDP patients and AMAN/AMSAN patients. Majority of the AIDP (66.7%) and AMAN/AMSAN (57.2%) patients belonged to Brighton level 1 indicating maximum diagnostic certainty. Conclusion To our knowledge, this is among the first reviews that includes GBS variants and the clinical prediction tool mEGOS for prognostication in COVID-19 patients. Further research is needed to assess whether IVIG is preferable over plasmapheresis in this population of GBS patients. It would also be crucial to follow these patients over time to identify the long-term disability as well as treatment outcomes.

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Neuromuscular Complications in COVID-19: A Review of the Literature

Cited by 2 publications

References 24 publications

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

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

Guillain Barré Syndrome and its variants as a manifestation of COVID-19: A systematic review of case reports and case series

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