Abstract:There is concern that the global burden of coronavirus disease of 2019 (COVID-19) due to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection might yield an increased occurrence of Guillain-Barré syndrome (GBS). It is currently unknown whether concomitant SARS-CoV-2 infection and GBS are pathophysiologically related, what biomarkers are useful for diagnosis, and what is the optimal treatment given the medical comorbidities, complications, and simultaneous infection. We report a patient who de… Show more
“…Similarly, Demirci Otluoglu et al noted CSF protein was 0.4 mg/L (0.04 mg/dL) and Dharsandiya et al indicated the CSF protein was 39 g/dL (3,900 mg/dL), but both authors described the protein as normal, and Matos et al reported a CSF protein of 0.78 mg/dL, but noted it was mildly elevated; we presumed these were meant to be 0.4g/L (40 mg/dL), 39 mg/dL, and 78 mg/dL, respectively [ 150 , 151 , 200 ]. There were 27/397 (7%) patients who had CSF protein >200 mg/dL (19/27 (70%) with symptoms that localized to the CNS and 8/27 (30%) with symptoms that localized to the PNS) [ 16 , 21 , 31 , 32 , 34 , 44 , 53 , 58 , 78 , 81 , 89 , 104 , 113 , 127 , 128 , 160 , 170 , 173 , 176 , 184 , 199 , [220] , [221] , [222] , 245 ]. Fig.…”
We sought to review the literature on cerebrospinal fluid (CSF) testing in patients with COVID-19 for evidence of viral neuroinvasion by SARS-CoV-2. Methods: We performed a systematic review of Medline and Embase between December 1, 2019 and November 18, 2020 to identify case reports or series of patients who had COVID-19 diagnosed based on positive SARS-CoV-2 polymerase chain reaction (PCR) or serologic testing and had CSF testing due to a neurologic symptom. Results: We identified 242 relevant documents which included 430 patients with COVID-19 who had acute neurological symptoms prompting CSF testing. Of those, 321 (75%) patients had symptoms that localized to the central nervous system (CNS). Of 304 patients whose CSF was tested for SARS-CoV-2 PCR, there were 17 (6%) whose test was positive, all of whom had symptoms that localized to the central nervous system (CNS). The majority (13/17, 76%) of these patients were admitted to the hospital because of neurological symptoms. Of 58 patients whose CSF was tested for SARS-CoV-2 antibody, 7 (12%) had positive antibodies with evidence of intrathecal synthesis, all of whom had symptoms that localized to the CNS. Of 132 patients who had oligoclonal bands evaluated, 3 (2%) had evidence of intrathecal antibody synthesis. Of 77 patients tested for autoimmune antibodies in the CSF, 4 (5%) had positive findings. Conclusion: Detection of SARS-CoV-2 in CSF via PCR or evaluation for intrathecal antibody synthesis appears to be rare. Most neurological complications associated with SARS-CoV-2 are unlikely to be related to direct viral neuroinvasion.
“…Similarly, Demirci Otluoglu et al noted CSF protein was 0.4 mg/L (0.04 mg/dL) and Dharsandiya et al indicated the CSF protein was 39 g/dL (3,900 mg/dL), but both authors described the protein as normal, and Matos et al reported a CSF protein of 0.78 mg/dL, but noted it was mildly elevated; we presumed these were meant to be 0.4g/L (40 mg/dL), 39 mg/dL, and 78 mg/dL, respectively [ 150 , 151 , 200 ]. There were 27/397 (7%) patients who had CSF protein >200 mg/dL (19/27 (70%) with symptoms that localized to the CNS and 8/27 (30%) with symptoms that localized to the PNS) [ 16 , 21 , 31 , 32 , 34 , 44 , 53 , 58 , 78 , 81 , 89 , 104 , 113 , 127 , 128 , 160 , 170 , 173 , 176 , 184 , 199 , [220] , [221] , [222] , 245 ]. Fig.…”
We sought to review the literature on cerebrospinal fluid (CSF) testing in patients with COVID-19 for evidence of viral neuroinvasion by SARS-CoV-2. Methods: We performed a systematic review of Medline and Embase between December 1, 2019 and November 18, 2020 to identify case reports or series of patients who had COVID-19 diagnosed based on positive SARS-CoV-2 polymerase chain reaction (PCR) or serologic testing and had CSF testing due to a neurologic symptom. Results: We identified 242 relevant documents which included 430 patients with COVID-19 who had acute neurological symptoms prompting CSF testing. Of those, 321 (75%) patients had symptoms that localized to the central nervous system (CNS). Of 304 patients whose CSF was tested for SARS-CoV-2 PCR, there were 17 (6%) whose test was positive, all of whom had symptoms that localized to the central nervous system (CNS). The majority (13/17, 76%) of these patients were admitted to the hospital because of neurological symptoms. Of 58 patients whose CSF was tested for SARS-CoV-2 antibody, 7 (12%) had positive antibodies with evidence of intrathecal synthesis, all of whom had symptoms that localized to the CNS. Of 132 patients who had oligoclonal bands evaluated, 3 (2%) had evidence of intrathecal antibody synthesis. Of 77 patients tested for autoimmune antibodies in the CSF, 4 (5%) had positive findings. Conclusion: Detection of SARS-CoV-2 in CSF via PCR or evaluation for intrathecal antibody synthesis appears to be rare. Most neurological complications associated with SARS-CoV-2 are unlikely to be related to direct viral neuroinvasion.
“…We reviewed all the cases excluded by Abu-Rumeileh et al also and found no positive ganglioside antibodies among those excluded patients. We have identified seven more reported individual cases, which have not been included in any case review to date [ 11 , 12 , 13 , 14 , 15 , 16 , 17 ]. Including our current case, there are 83 individual cases of COVID-19 related GBS or MFS being reported to date.…”
“…Overall, we identified 51 COVID-19-associated GBS cases which we included in this study. However, among these patients, there were five (5) cases who met the GBS symptom criteria, but did not have documentation of nerve conduction study results [9,47,50,52]; as we could not conclude whether they involved demyelination or axonal neuropathy, these cases were not included in the classification of GBS subtypes.…”
Section: Demographic and Clinical Characteristics Of The Covid-19-assmentioning
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.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
