Guillain-Barré Syndrome with Facial Diplegia Related to SARS-CoV-2 Infection

Chan, Jason L.; Ebadi, Hamid; Sarna, Justyna R.

doi:10.1017/cjn.2020.106

Cited by 65 publications

(86 citation statements)

References 15 publications

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“…9 In another patient, GBS was the presenting feature and COVID-19 symptoms never developed although chest CT revealed ground glass opacities. 30 The mean interval between onset of COVID-19 and GBS symptoms in the remaining 36 patients was 11.5 days (IQR: 7.7-16; range: 3-28 days). In 11/42 (26.2%) patients, the COVID-19 symptomatology clinically resolved before the onset of GBS.…”

Section: Resultsmentioning

confidence: 93%

Guillain-Barré syndrome in SARS-CoV-2 infection: an instant systematic review of the first six months of pandemic

Uncini

Vallat

Jacobs

2020

J Neurol Neurosurg Psychiatry

132

155

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A systematic review from 1 January to 30 June 2020 revealed 42 patients with Guillain-Barré syndrome (GBS) associated with SARS-CoV-2 infection. Single cases and small series were reported from 13 countries, the majority from Europe (79.4%) and especially from Italy (30.9%). SARS-CoV-2 infection was demonstrated by nasopharyngeal swab (85.7%) and serology (14.3%). Median time between COVID-19 and GBS onset in 36 patients was 11.5 days (IQR: 7.7–16). The most common clinical features were: limb weakness (76.2%), hypoareflexia (80.9 %), sensory disturbances (66.7 %) and facial palsy (38.1%). Dysautonomia occurred in 19%, respiratory failure in 33.3% and 40.5% of patients were admitted in intensive care unit. Most patients (71.4%) had the classical clinical presentation but virtually all GBS variants and subtypes were reported. Cerebrospinal fluid (CSF) albumin-cytological dissociation was found in 28/36 (77.8%) and PCR for SARS-CoV-2 was negative in 25/25 patients. Electrodiagnosis was demyelinating in 80.5% and levels 1 and 2 of Brighton criteria of diagnostic certainty, when applicable, were fulfilled in 94.5% patients. Antiganglioside antibodies were positive in only 1/22 patients. Treatments were intravenous immunoglobulin and/or plasma exchange (92.8%) with, at short-time follow-up, definite improvement or recovery in 62.1% of patients. One patient died. In conclusion, the most frequent phenotype of GBS in SARS-CoV-2 infection is the classical sensorimotor demyelinating GBS responding to the usual treatments. The time interval between infectious and neuropathic symptoms, absence of CSF pleocytosis and negative PCR support a postinfectious mechanism. The abundance of reports suggests a pathogenic link between SARS-CoV-2 infection and GBS but a case-control study is greatly needed.

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Section: Resultsmentioning

confidence: 93%

Guillain-Barré syndrome in SARS-CoV-2 infection: an instant systematic review of the first six months of pandemic

Uncini

Vallat

Jacobs

2020

J Neurol Neurosurg Psychiatry

132

155

View full text Add to dashboard Cite

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“…The main ndings were albuminocytological dissociation with an average of proteins of 96,6 mg/dL, and white cell counts ranging from 0 to 9 cells/µL, without other pathologic ndings. SARS-CoV-2 tests were negative in all the CSF samples [40,41,44,45,73,74,[78][79][80]. Concomitant Campylobacter jejuni infection and Lyme disease were also ruled out [47,76].…”

Section: Peripheral Neuropathiesmentioning

confidence: 98%

“…Variable sensory abnormalities have also been described [12]. Nerve conduction and electromyography studies carried out in 16 patients with GBS and COVID-19 reported acute in ammatory demyelinating polyneuropathy in 12 cases [44,47,[73][74][75][76][77][78][79][80], sensory-motor axonal neuropathy in 3 cases [73,81], and acute motor axonal neuropathy in 1 case [7]. Three patients with GBS presented enhancement of the caudal nerve roots on spine MRI [72,73].…”

Section: Peripheral Neuropathiesmentioning

confidence: 99%

Central and peripheral nervous system involvement by COVID-19: A systematic review of the pathophysiology, clinical manifestations, neuropathology, neuroimaging, electrophysiology, and cerebrospinal fluid findings

Guerrero

Barragán

Martinez

et al. 2020

Preprint

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Background: SARS-CoV-2 can affect the human brain and other neurological structures. An increasing number of publications report neurological manifestations in patients with COVID-19. However, no studies have comprehensively reviewed the clinical and paraclinical characteristics of the central and peripheral nervous system's involvement in these patients. This study aimed to describe the features of the central and peripheral nervous system involvement by COVID-19 in terms of pathophysiology, clinical manifestations, neuropathology, neuroimaging, electrophysiology, and cerebrospinal fluid findings.Methods: We conducted a comprehensive systematic review of all the original studies reporting patients with neurological involvement by COVID-19, from December 2019 to June 2020, without language restriction. We excluded studies with animal subjects, studies not related to the nervous system, and opinion articles. Data analysis combined descriptive measures, frequency measures, central tendency measures, and dispersion measures for all studies reporting neurological conditions and abnormal ancillary tests in patients with confirmed COVID-19.Results: A total of 143 observational and descriptive studies reported central and peripheral nervous system involvement by COVID-19 in 10723 patients. Fifty-one studies described pathophysiologic mechanisms of neurological involvement by COVID-19, 119 focused on clinical manifestations, 4 described neuropathology findings, 62 described neuroimaging findings, 28 electrophysiology findings, and 60 studies reported cerebrospinal fluid results. The reviewed studies reflect a significant prevalence of the nervous system's involvement in patients with COVID-19, ranging from 22.5% to 36.4% among different studies, without mortality rates explicitly associated with neurological involvement by SARS-COV-2. We thoroughly describe the clinical and paraclinical characteristics of neurological involvement in these patients. Conclusions: Our evidence synthesis led to a categorical analysis of the central and peripheral involvement by COVID-19 and provided a comprehensive explanation of the reported pathophysiological mechanisms by which SARS-CoV-2 infection may cause neurological impairment. International collaborative efforts and exhaustive neurological registries will enhance the translational knowledge of COVID-19's CNS and PNS involvement and generate strategies for therapeutic decision-making.Registration: This review is registered in PROSPERO (CRD42020193140), July 24, 2020.

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“…Most common manifestations of COVID-19 included fever (73.6%, 53/72), cough (72.2%, 52/72), dyspnea and/or pneumonia (63.8%, 46/72), hypo-/ageusia (22.2%, 16/72), hypo-/anosmia (20.8%, 15/72), and diarrhea (18.1%, 13/72). One of the two asymptomatic subjects never developed fever, respiratory symptoms, or pneumonia [10], whereas the other patient showed an asymptomatic pneumonia at chest computed tomography (CT) [12]. In all but six patients with available data [22,24,36,44,45,52], SARS-CoV-2 RT-PCR with naso-or oropharyngeal swab or fecal exam was positive at first or following tests.…”

Section: Clinical Picture Diagnosis and Therapy Of Covid-19mentioning

confidence: 98%

“…In all (n = 72) but four patients [10,37,40,56], GBS manifestations developed after those of COVID-19 [median (IQR): 14 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), min 2-max 33 days]. Differently, COVID-19 symptoms began concurrent in one case [37], 1 day [40] and 8 days [55] after GBS onset in two other cases and never developed in another one [10] (Table 1).…”

Section: Clinical Features Of Gbs Spectrummentioning

confidence: 99%

Guillain–Barré syndrome spectrum associated with COVID-19: an up-to-date systematic review of 73 cases

et al. 2020

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Since coronavirus disease-2019 (COVID-19) outbreak in January 2020, several pieces of evidence suggested an association between the spectrum of Guillain-Barré syndrome (GBS) and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Most findings were reported in the form of case reports or case series, whereas a comprehensive overview is still lacking. We conducted a systematic review and searched for all published cases until July 20th 2020. We included 73 patients reported in 52 publications. A broad age range was affected (mean 55, min 11-max 94 years) with male predominance (68.5%). Most patients showed respiratory and/or systemic symptoms, and developed GBS manifestations after COVID-19. However, asymptomatic cases for COVID-19 were also described. The distributions of clinical variants and electrophysiological subtypes resemble those of classic GBS, with a higher prevalence of the classic sensorimotor form and the acute inflammatory demyelinating polyneuropathy, although rare variants like Miller Fisher syndrome were also reported. Cerebrospinal fluid (CSF) albuminocytological dissociation was present in around 71% cases, and CSF SARS-CoV-2 RNA was absent in all tested cases. More than 70% of patients showed a good prognosis, mostly after treatment with intravenous immunoglobulin. Patients with less favorable outcome were associated with a significantly older age in accordance with previous findings regarding both classic GBS and COVID-19. COVID-19-associated GBS seems to share most features of classic post-infectious GBS and possibly the same immune-mediated pathogenetic mechanisms. Nevertheless, more extensive epidemiological studies are needed to clarify these issues.

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Guillain-Barré Syndrome with Facial Diplegia Related to SARS-CoV-2 Infection

Cited by 65 publications

References 15 publications

Guillain-Barré syndrome in SARS-CoV-2 infection: an instant systematic review of the first six months of pandemic

Guillain-Barré syndrome in SARS-CoV-2 infection: an instant systematic review of the first six months of pandemic

Central and peripheral nervous system involvement by COVID-19: A systematic review of the pathophysiology, clinical manifestations, neuropathology, neuroimaging, electrophysiology, and cerebrospinal fluid findings

Guillain–Barré syndrome spectrum associated with COVID-19: an up-to-date systematic review of 73 cases

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