Background : Novel Coronavirus Disease 2019 (COVID-19) has affected more than 89 million people worldwide. As the pandemic rages on, more complications of the disease are recognized including stroke, cardiovascular disease, thromboembolic events, encephalopathy, seizures and more. Peripheral nervous system involvement, particularly Guillain-Barre Syndrome (GBS) are of special interest given the increasing reports of cases related to COVID-19. Because of the potentially delayed onset of symptoms polyradiculoneuropathy and weakness after the traditional COVID-19 symptoms, it is vitally important for emergency physicians to be vigilant and consider this as part of their differential diagnosis. GBS usually occurs after an infectious insult, and a variety of culprit pathogens have been identified in the literature. Case Report : We describe a case of 35-year-old man who developed GBS after being diagnosed with COVID-19 infection. The patient displayed classic symptoms of neuropathy, areflexia, and lower extremity weakness. CSF evaluation demonstrated albuminocytologic dissociation seen in GBS, though anti-ganglioside autoantibodies were negative. These antibodies are often negative and thus do not exclude the diagnosis. The patient responded clinically to intravenous immunoglobulin therapy and was discharged home. Why Should an Emergency Physician Be Aware of This? : This case report contributes to further evidence that COVID-19 joins other organisms as causes of GBS. ED physicians are the first point of contact for many patients. Increased awareness of this complication of COVID-19 will lead to higher detection. Prompt recognition could lead to speedier and more complete neurologic recovery of affected patients.

Background: Comprehensive stroke centers (CSC) provide around the clock complex services when compared primary stroke centers (PSC) for acute ischemic stroke patients. As most stroke treatments are time-sensitive, a delay in admitting these patients due to transfer from PSC can cause an increased degree of dependence and disability and poorer outcomes. This is due to CSC’s having more robust availability of intravenous, intra-arterial, and endovascular revascularization therapies. We propose that patients that are transferred to a CSC from PSC have increased onset to puncture times and are more likely to have a larger degree of disability compared to those who are directly admitted to comprehensive stroke centers. Methods: Patients were evaluated over a 30-month period from January 2016- July 2018 using retrospective data from a university affiliated community based comprehensive stroke center. The time of onset of symptoms were recorded as well as the puncture times for stroke thrombectomy patients. Patients were separated by arrival mode and times were analyzed using average calculations. Modified Rankin Scores for all of the patients were collected using existing registry data and follow up visits. GraphPad Quick Calcs Web site was used to obtain descriptive statistics and intergroup differences. Results: A total of 1,412 ischemic stroke patients from January 2016 to July 2018 were studied. The patients that were transferred from other facilities (n=70) took longer to initiate acute interventional treatment than those that arrived via EMS from the field (n=156); 474 minutes vs 389 minutes respectively; from the onset of symptoms to recanalization (a delay of more than an hour). The patients that were transferred from other facilities had a median mRS score of 3, while the patients that arrived by EMS from the field had a median MRS score of 1 at 90 days. The multivariate analysis performed took into account the risk factors and initial clinical severity. The 90 days’ outcome were statistically significantly different (p<0.01). Conclusion: Patients that arrive to the CSC via EMS are promptly triaged and treated sooner than those that arrive to PSC’s prior to being transferred to CSC’s. This loss of time results in a statistically significant poorer outcome.

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