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

• Published in: Canadian journal of neurological sciences Vol. 47; no. 6; pp. 852 - 854
• Main Authors: Chan, Jason L., Ebadi, Hamid, Sarna, Justyna R.
• Format: Journal Article
• Language: English
• Published: New York, USA Cambridge University Press 01.11.2020
• Subjects: Apheresis; Betacoronavirus; Blood; Case reports; Cerebral Angiography; Computed Tomography Angiography; Coronavirus Infections - complications; Coronavirus Infections - diagnosis; Coronaviruses; COVID-19; Dysarthria; Electrodiagnosis; Epidemics; Facial Nerve - diagnostic imaging; Facial Paralysis - diagnosis; Facial Paralysis - etiology; Facial Paralysis - physiopathology; Facial Paralysis - therapy; Guillain-Barre syndrome; Guillain-Barre Syndrome - diagnosis; Guillain-Barre Syndrome - etiology; Guillain-Barre Syndrome - physiopathology; Guillain-Barre Syndrome - therapy; Humans; Hypotheses; Immunoglobulins, Intravenous - therapeutic use; Immunologic Factors - therapeutic use; Infections; Letter to the Editor; Lung - diagnostic imaging; Lungs; Magnetic Resonance Imaging; Male; Middle Aged; Neural Conduction; Pandemics; Patients; Pneumonia, Viral - complications; Pneumonia, Viral - diagnosis; Respiratory diseases; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Tomography, X-Ray Computed; Zika virus; Acute inflammatory demyelinating polyneuropathy; COVID-19; Peripheral nervous system; Cranial neuropathy; Polyradiculoneuropathy
• ISSN: 0317-1671; 2057-0155
• DOI: 10.1017/cjn.2020.106

[...]neurological manifestations of COVID-19 are becoming increasingly recognized and include impairment of smell and taste, acute cerebrovascular disease, and encephalopathy.1 Guillain-Barré syndrome (GBS) is the most common cause of weakness due to acute polyradiculoneuropathy and consists of immune-mediated demyelinating and axonal forms.2 It is typically post-infectious, with onset occurring within 4 weeks of symptoms of respiratory tract or gastrointestinal infection in two-thirds of patients.2 Cases of GBS associated with COVID-19 have been rarely but increasingly reported.3–12 A 58-year-old, right-hand-dominant male who was otherwise healthy presented with acute-onset bilateral facial weakness, dysarthria, and paresthesia in his feet. Initial vital signs included a temperature of 36.6 °C, maximum heart rate of 140 beats/minute, maximum blood pressure of 187/103 mmHg, maximum respiratory rate of 34 breaths/minute, and an oxygen saturation of 96% on room air, with resolution of tachycardia, hypertension, and tachypnea within 12 hours. Computed tomography (CT) and CT angiography (CTA) of the head and neck did not demonstrate any intracranial or vascular abnormalities but demonstrated ground-glass opacities in both lung apices, consistent with COVID-19 (Figure 1B). [...]of writing, at least 14 cases of GBS associated with COVID-19 have been reported worldwide: 12 cases presented with symmetric, progressive, ascending weakness,3-11 1 case with facial diplegia,5 and 1 case with Miller Fisher syndrome.12 In the 13 cases where COVID-19 symptoms preceded GBS symptoms, the interval ranged from 5 to 24 days.4-12 Of the 12 cases with electrophysiological studies, 4 had an axonal process4,5 and 8 had a demyelinating process.3,5,7–11 CSF RT-PCR testing for SARS-CoV-2 was negative in 8 cases.5,8,11,12 All 14 cases were treated with IVIG, with 2 cases receiving a second cycle of IVIG and 1 case receiving subsequent plasma exchange.3–12 Typically, infections such as Campylobacter jejuni, cytomegalovirus, Epstein–Barr virus, influenza A virus, Mycoplasma pneumoniae, Haemophilus influenzae, and Zika virus are thought to cause GBS through an autoimmune reaction via molecular mimicry.2 The mechanisms of GBS associated with COVID-19 are unclear.