Guillain-Barré syndrome related to COVID-19 infection

Alberti, Paola; Beretta, Simone; Piatti, M.; Karantzoulis, Aristotelis; Piatti, Maria Luisa; Santoro, Patrizia; Viganò, Martina; Giovannelli, G; Pirro, Fiammetta; Montisano, Danilo Antonio; Appollonio, Ildebrando; Ferrarese, Carlo

doi:10.1212/nxi.0000000000000741

Cited by 335 publications

(381 citation statements)

References 8 publications

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“…5,7,9 Reports are now emerging of similar associations with COVID-19 and GBS, and with GBS variants, including the Miller-Fisher syndrome. [41][42][43][44][45][46] The largest series to date, describes five patients. 47 In this series, all patients developed GBS 5 to 10 days following COVID-19 symptom onset.…”

Section: Post-infectious and Immune-mediated Complications Of Sars-cov-2mentioning

confidence: 99%

COVID‐19: A Global Threat to the Nervous System

Koralnik

Tyler

2020

Annals of Neurology

429

403

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In less than 6 months, the severe acute respiratory syndrome‐coronavirus type 2 (SARS‐CoV‐2) has spread worldwide infecting nearly 6 million people and killing over 350,000. Initially thought to be restricted to the respiratory system, we now understand that coronavirus disease 2019 (COVID‐19) also involves multiple other organs, including the central and peripheral nervous system. The number of recognized neurologic manifestations of SARS‐CoV‐2 infection is rapidly accumulating. These may result from a variety of mechanisms, including virus‐induced hyperinflammatory and hypercoagulable states, direct virus infection of the central nervous system (CNS), and postinfectious immune mediated processes. Example of COVID‐19 CNS disease include encephalopathy, encephalitis, acute disseminated encephalomyelitis, meningitis, ischemic and hemorrhagic stroke, venous sinus thrombosis, and endothelialitis. In the peripheral nervous system, COVID‐19 is associated with dysfunction of smell and taste, muscle injury, the Guillain‐Barre syndrome, and its variants. Due to its worldwide distribution and multifactorial pathogenic mechanisms, COVID‐19 poses a global threat to the entire nervous system. Although our understanding of SARS‐CoV‐2 neuropathogenesis is still incomplete and our knowledge is evolving rapidly, we hope that this review will provide a useful framework and help neurologists in understanding the many neurologic facets of COVID‐19. ANN NEUROL 2020;88:1–11 ANN NEUROL 2020;88:1–11

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Section: Post-infectious and Immune-mediated Complications Of Sars-cov-2mentioning

confidence: 99%

COVID‐19: A Global Threat to the Nervous System

Koralnik

Tyler

2020

Annals of Neurology

429

403

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“…A total of 18 patients reported in 14 papers [12][13][14][15][16][17][18][19][20][21][22][23][24][25] were included in this review. The 14 selected papers consisted of 13 case reports and one series.…”

Section: Study Selectionmentioning

confidence: 99%

“…Table 4 shows the diagnostic ancillary tests, outcome and treatment. Fourteen cases were from Europe [12,[16][17][18][19][20][22][23][24][25], one from the USA [13], one from China [14], one from Iran [15] and one from Morocco [21]. Ten patients were males whilst eight were females.…”

Section: Study Selectionmentioning

confidence: 99%

Guillain–Barré syndrome associated with SARS‐CoV‐2 infection. A systematic review

Sanctis

Doneddu

Viganó

et al. 2020

Euro J of Neurology

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Guillain-Barr e syndrome (GBS) incidence can increase during outbreaks of infectious illnesses. A few cases of GBS associated with coronavirus disease 2019 (COVID-19) infection have been reported. The aim was to identify specific clinical features of GBS associated with COVID-19. PubMed, Embase and Cochrane were searched from 1 November 2019 to 17 May 2020 and included all papers with full text in English, Spanish, French or Italian, reporting original data of patients with GBS and COVID-19. Data were extracted according to a predefined protocol. A total of 18 patients reported in 14 papers were included in this review. All the patients were symptomatic for COVID-19, with cough and fever as the most frequently reported symptoms. The interval between the onset of symptoms of COVID-19 and the first symptoms of GBS ranged from À8 to 24 days (mean 9 days; median 10 days). Most of the patients had a typical GBS clinical form predominantly with a demyelinating electrophysiological subtype. Mechanical ventilation was necessary in eight (44%) patients. Two (11%) patients died. Published cases of GBS associated with COVID-19 report a sensorimotor, predominantly demyelinating GBS with a typical clinical presentation. Clinical features and disease course seem similar to those observed in GBS related to other etiologies. These results should be interpreted with caution since only 18 cases have been heterogeneously reported so far.

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“…GBS occurred in 5/1200 (0.4%) patients with COVID-19 in one of the studies [13]. There were six other case report of GBS, one Miller Fisher syndrome, and two polyneuritis cranialis [14,[24][25][26][27][28][29][30]. Interestingly, neurotropism of human coronaviruses has been suggested by in vitro and in vivo studies that showed that certain strains of the viruses could persist in the human CNS by targeting oligodendrocytic and neuroglial cell lines [41].…”

Section: Discussionmentioning

confidence: 99%

“…Thirty-one patients experienced a cerebrovascular complication, with 27 ischemic strokes [11,[19][20][21][22][23], 3 hemorrhagic strokes [11,15,23] and 1 cerebral venous sinus thrombosis [11]. There were 15 patients with GBS [13,14,[24][25][26][27][28][29][30] or its variants, 6 reported as encephalitis [12,18,[31][32][33], one with seizures [34], one with acute hemorrhagic necrotizing encephalopathy [16] one reported as transverse myelitis [35], and one reported as ADEM [36]. Nine of these cases were reported as fatal.…”

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confidence: 99%

Neurological Complications of COVID-19: A Systematic Review of Literature

Sriwastava

Srivastava

Kataria

et al. 2020

Preprint

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Abstract Background: To study the nature and frequency of occurrence of “significant” neurological complications in coronavirus disease-2019 (COVID-19) via a systematic review of the literature.Methods: We screened all articles resulting from a search of PubMed, Cochrane, Google Scholar and Scopus, using the keywords "COVID-19 and CNS", "SARS-CoV-2 and CNS”, “COVID-19 and neurological manifestation”, “SARS2 and neurological manifestation” and “COVID-19 and Brain” looking for reports of significant neurological manifestations that would potentially have an impact on the outcome.Results: Twenty-six articles met the inclusion criteria. The significant neurological diagnoses reported were stroke, Guillain Barre Syndrome (GBS) and its variants, encephalitis, seizures, acute hemorrhagic necrotizing encephalopathy, acute disseminated encephalomyelitis (ADEM) and transverse myelitis. Although stroke, predominantly ischemic, was observed in ~ 6% of COVID-19 patients from Wuhan, China, mortality in this cohort was 38%. Of the 24 pooled patients with reports of etiology, 17 had large vessel occlusions. GBS occurred in 5/1200 (0.4%) of the COVID-19 cohort from Italy. One of the six reported encephalitis cases, the ADEM case and the report of transverse myelitis do not have data for conclusive diagnosis.Conclusion: The most frequent significant neurological association with COVID-19 is stroke, predominantly ischemic. In a cohort from Wuhan, China, this was as frequent as ~ 6%, with a 38% mortality. Most common reported etiology is large vessel occlusion. Other reported significant neurological complications are GBS/variants, encephalitis, seizures and acute hemorrhagic necrotizing encephalopathy. The reports of ADEM and transverse myelitis lacked diagnostically conclusive data.

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Guillain-Barré syndrome related to COVID-19 infection

Cited by 335 publications

References 8 publications

COVID‐19: A Global Threat to the Nervous System

COVID‐19: A Global Threat to the Nervous System

Guillain–Barré syndrome associated with SARS‐CoV‐2 infection. A systematic review

Neurological Complications of COVID-19: A Systematic Review of Literature

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