Sedaghat et al.11. Sedaghat Z, Karimi N. Guillain Barre syndrome associated with COVID-19 infection: a case report. J Clin Neurosci. 2020;76:233-5. https://doi.org/10.1016/j.jocn.2020.04.062 https://doi.org/10.1016/j.jocn.2020.04.0...
|
Male |
65 |
Diabetes Mellitus 2 |
Presented neurological manifestations such as acute progressive weakness of the distal lower extremities, progressing from the distal to the proximal limbs and, shortly afterward, he presented quadriplegia and facial paresis bilaterally. |
On physical examination, the patient had normal vital symptoms and was conscious. |
CT showed diffused consolidations and ground-glass opacities in both lungs, and bilateral pleural effusion. |
Hydroxychloroquine, LPV/RTV, and Azithro- mycin. And 0.40 g/kg/day IVIg; and metformin 2 diabetes mellitus. |
RT- PCR; chest CT and EMG. |
Toscano et al.1010. Toscano G, Palmerini F, Ravaglia S, Ruiz L, Invernizzi P, Cuzzoni MG. Guillain-Barré syndrome associated with SARS-CoV-2. N Engl J Med. 2020;382(26):2574-6. https://doi.org/10.1056/NEJMc2009191 https://doi.org/10.1056/NEJMc2009191...
|
P1 – Female |
77 |
NA |
Paresthesia in the lower limbs and hands. Flaccid areflexic tetraplegia evolving to facial weakness, upper-limb paresthesia (36 h), and respiratory failure (day 6) |
Lymphocytopenia, Raised CRP, LDH, and ketonuria. |
CT scan of the thorax revealed interstitial bilateral pneumonia. |
IVIg treatment. |
RT-PCR and EMG. |
P2 – Male |
23 |
NA |
Upper and lower facial weakness, which became bilateral and complete within 2 days, accompanied by mastoid pain, loss of taste, and lower limb paresthesia. |
Lymphocytopenia, raised ferritine, CRP, LDH, and AST. |
Normal thorax imaging. |
Amoxicillin for five days and IVIg. |
RT-PCR, EMG, and brain MRI. |
P3 – Male |
55 |
NA |
Flaccid tetraparesis and facial weakness evolving to areflexia (day 2) and respiratory failure (day 5). |
Lymphocytopenia, raised CRP, LDH, AST, GGT, and ketonuria. |
A CT scan of the thorax revealed multiple bilateral, ground-glass opacities compatible with interstitial pneumonia. |
Azithromycin and received 2 cycles of IVIg. |
RT-PCR and EMG. |
P4 – Male |
76 |
NA |
Lumbar pain and lower limb weakness and, on the 4th day after admission, muscle weakness rapidly evolved to a flaccid areflexic tetraparesis. |
Lymphocytopenia, raised CRP, ketonuria. IVIg treatment resulted in motor improvement, more evident in upper limbs, but still unable to stand. |
Normal thorax imaging. |
IVIg treatment. |
RT-PCR |
P5 – Male |
61 |
NA |
Complained of asthenia, loss of taste and smell, for one week. |
Lymphocytopenia, raised CRP, LDH, and AST. Developed respiratory failure with neuromuscular features (hypercapnia, paradox respiration, acidosis) and was referred to the ICU, were he received mechanical ventilation through tracheostomy. The patient developed acinetobacter pneumonia. |
Thorax X-ray and CT showed interstitial pneumonia, without parenchymal opacities nor alveolar damage. |
Received IVIg and plasma exchange; had bacterial pneumonia during IVIg treatment, which delayed plasma exchange. |
RT-PCR and EMG. |
Padroni et al.1111. Padroni M, Mastrangelo V, Asioli GM, Pavolucci L, Abu-Rumeileh S, Piscaglia MG, et al. Guillain-Barré syndrome following COVID-19: new infection, old complication? J Neurol. 2020;267(7):1877-9. https://doi.org/10.1007/s00415-020-09849-6 https://doi.org/10.1007/s00415-020-09849...
|
Female |
70 |
NA |
Complaining of asthenia, hands and feet paresthesia, and gait difficulties progressing within 1 day. On March 4th she had developed fever (BT P= 38.5°C) and dry cough. |
Arterial blood gas analysis showed pO2=76 mmHg with normal p/f ratio (=363). The patient was intubated and mechanical ventilation was applied, because of respiratory failure due to the worsening of muscle weakness. |
A chest high-resolution computed tomography revealed some small “ground glass” areas in both lungs. |
IVIg 400mg/die for 5 days was started. |
RT-PCR and the neurological examination disclosed moderate. |
Alberti et al.1212. Alberti P, Beretta S, Piatti M, Karantzoulis A, Piatti ML, Santoro P, et al. Guillain-Barré syndrome related to COVID-19 infection. Neurol Neuroimmunol Neuroinflamm. 2020;7(4):e741. https://doi.org/10.1212/NXI.0000000000000741 https://doi.org/10.1212/NXI.000000000000...
|
Male |
71 |
Hypertension, abdominal aortic aneurysm, and lung cancer treated with surgery only in 2017 with negative oncological follow-up; no previous neurologic history was reported. |
Paresthesia at limb extremities, followed by distal weakness rapidly evolving to a severe, flaccid tetraparesis over the previous 3 days. Neurologic examination showed symmetric limb weakness, symmetric and extensive stocking-and-glove hypesthesia at the 4 limbs (more pronounced at lower limbs), absent deep tendon reflexes, and normal plantar response. Moderate low back pain were present. |
He showed hemodynamic disturbances with severe drug-resistant hypertension. Arterial blood gases indicated severe hypoxia (paO2 65 mm Hg without supplemental oxygen). Unresponsive to continuous positive airway pressure ventilation and prone positioning. The patient died a few hours later because of progressive respiratory failure. |
Brain CT scan was normal, whereas chest CT scan showed multiple bilateral ground glass opacities and consolidations, typical of COVID-19 pneumonia. |
High-dose IV immunoglobulins (0.4 g/kg/d for 5 days) were started few hours after admission, together with high-flow 60%–80% oxygen via nonrebreather mask, antiviral therapy (LPV + RTV), and hydroxychloroquine |
RT- PCR; chest CT and EMG. |
Assini et al.1313. Assini A, Benedetti L, Di Maio S, Schirinzi E, Del Sette M. New clinical manifestation of COVID-19 related Guillain-Barrè syndrome highly responsive to intravenous immunoglobulins: two Italian cases. Neurol Sci. 2020;41(7):1657-8. https://doi.org/10.1007/s10072-020-04484-5 https://doi.org/10.1007/s10072-020-04484...
|
P1 – Male |
55 |
NA |
Severe respiratory syndrome preceded by anosmia and ageusia, fever, and cough; acute onset of bilateral eyelid ptosis, dysphagia, and dysphonia. |
Neurological examination showed bilateral masseter weakness, tongue protrusion deficit due to bilateral paralysis of the hypoglossal nerve, and hyporeflexia of upper and lower limbs, without muscle weakness. The patient was moved to ICU for invasive ventilation. Lymphocytopenia. |
NA |
Hydroxychloroquine, Arbidol, RTV and LPV; IVIg. |
RT- PCR; EMG. |
P2 – Male |
60 |
NA |
Fever and cough; weakness in lower limbs with distal distribution and foot drop on the right side. |
Simultaneously, massive disorders of the vegetative nervous system, consisting of gastroplegia, paralytic ileus, and loss of blood pressure control occurred. Neurological examination showed distal weakness at four limbs, with foot drop. Tracheostomy and assisted ventilation. Blood tests showed lymphocytopenia, increased LDH and GGT, and leukocytosis. |
NA |
Hydroxychloroquine, antiretroviral therapy, and tocilizumab. IVIg therapy. |
RT-PCR and thoracic CT scan. |
Ottaviani et al.1414. Ottaviani D, Boso F, Tranquillini E, Gapeni I, Pedrotti G, Cozzio S, et al. Early Guillain-Barré syndrome in coronavirus disease 2019 (COVID-19): a case report from an Italian COVID-hospital. Neurol Sci. 2020;41(6):1351-4. https://doi.org/10.1007/s10072-020-04449-8 https://doi.org/10.1007/s10072-020-04449...
|
Female |
66 |
NA |
History of increasing difficulty walking and acute fatigue; she had mild fever and cough 10 days earlier. She also manifested a transient pruriginous dorsal rash, in addition to mild hypertension treated with beta-blockers. On evaluation, she was paraparetic with a rapidly progressive symmetric weakness in the lower limbs, leading to falls and paraplegia. Progressively developed proximal weakness in all limbs, dysesthesia, and unilateral facial palsy. |
Maintaining reasonable respiratory function with supplemental oxygen. Moreover, gas exchanges worsened with a sudden desaturation, requiring intubation and ICU admission, where she was treated for multi-organ failure along with a leg deep vein thrombosis and a superimposed bacterial infection (ab ingestis pneumonia). |
Lung CT scan showed bilateral ground glass opacities. |
IVIg; antiretroviral drugs (LPV and RTV) and hydroxychloroquine. |
RT-PCR and the neurological examination disclosed moderate (Medical Research Council grade 4/5). |
Riva et al.1515. Riva N, Russo T, Falzone YM, Strollo M, Amadio S, Del Carro U, et al. Post-infectious Guillain-Barré syndrome related to SARS-CoV-2 infection: a case report. J Neurol. 2020;267(9):2492-4. https://doi.org/10.1007/s00415-020-09907-z https://doi.org/10.1007/s00415-020-09907...
|
Male |
60 |
NA |
Three-day history of progressive limb weakness and distal paresthesia at four-limbs. His past medical history was unremarkable. Twenty days before, he had developed fever (37.7–38.5 °C), headache, and myalgia followed by anosmia and ageusia. |
Cell blood count, CRP, creatine phosphokinase, arterial blood gases, renal and hepatic function tests were normal. Anti-ganglioside antibodies tested negative. |
Chest CT scan showed bilateral ground-glass opacities, consistent with COVID-19 pneumonia. |
IVIg; |
Antibodies for SARS-CoV-2 IgM/IgG and the neurological examination disclosed moderate. |
Zhao et al.1616. Zhao H, Shen D, Zhou H, Lu J, Chen S. Guillain-Barré syndrome associated with SARS-CoV-2 infection: causality or coincidence? Lancet Neurol. 2020;19(5):383-4. https://doi.org/10.1016/S1474-4422(20)30109-5 https://doi.org/10.1016/S1474-4422(20)30...
|
Female |
61 |
NA |
Presented with acute weakness in both legs and severe fatigue. Neurological examination disclosed symmetric weakness. |
Her clinical condition improved gradually and her lymphocyte and thrombocyte counts normalized on day 20. At discharge on day 30, she had normal muscle strength in both arms and legs and return of tendon reflexes in both legs and feet. |
Chest CT showed ground-glass opacities in both lungs. |
IVIg; infection isolation room and received supportive care and antiviral drugs of arbidol, LPV, and RTV. |
RT-PCR |
Virani et al.1717. Virani A, Rabold E, Hanson T, Haag A, Elrufay R, Cheema T, et al. Guillain-Barré syndrome associated with SARS-CoV-2 infection. IDCases. 2020;20:e00771. https://doi.org/10.1016/j.idcr.2020.e00771 https://doi.org/10.1016/j.idcr.2020.e007...
|
Male |
54 |
NA |
Complaints of numbness and weakness of his lower extremities of 2-day duration. The weakness progressed. The patient complained of difficulty breathing and weakness was noted to ascend up to his nipples. |
He was electively placed on mechanical ventilator support for concerns of impending respiratory failure. His clinical course showed improvement in his respiratory status with liberation from mechanical ventilation on day 4 of IVIg therapy. Neurologically, his upper extremity weakness resolved after completion of the course of IVIg. Lower extremity weakness persisted. |
MRI of thoracic and lumbar spine that did not reveal any abnormal spinal pathology. This imaging, however, did reveal incidental findings of bilateral basilar opacities in the lungs. |
Oral amoxicillin and steroids. 400mg/kg of IVIg therapy for a planned 5-day course. Hydroxychloroquine 400 mg for the first two doses with subsequent 200 mg dose twice a day for an additional eight doses. |
RT-PCR and MRI. |
Rana et al.1818. Rana S, Lima AA, Chandra R, Valeriano J, Desai T, Freiberg W, et al. Novel coronavirus (COVID-19)-associated Guillain-Barré syndrome: case report. J Clin Neuromuscul Dis. 2020;21(4):240-2. https://doi.org/10.1097/CND.0000000000000309 https://doi.org/10.1097/CND.000000000000...
|
Male |
54 |
Hypertension, hyperlipidemia, restless leg syndrome, and chronic back pain. |
Ascending limb weakness and numbness that followed symptoms of a respiratory infection. Two weeks before presentation, he initially developed rhinorrhea, odynophagia, fevers, chills, and night sweats; he developed watery diarrhea; Over the next few days, he noted worsening paresthesias of his distal extremities bilaterally. His symptoms progressed to weakness of all limbs and difficulty voiding urine, developed progressive shortness of breath requiring intubation. Quadriparesis and areflexia with mute plantar responses. |
He was extubated on hospital day 4. On hospital day 7, he was discharged to an inpatient rehabilitation facility. While in the inpatient rehabilitation, he was noted to have resting tachycardia and persistent difficulty urinating, which eventually required an indwelling catheter. He reported burning dysesthesias in his distal extremities and trunk, and complained of diplopia, which was worse on rightward. |
Chest X-ray was negative other than an incidental finding of bibasilar lung infiltrates versus atelectasis. MRI of the thoracic and lumbar spine was reported to show no evidence of myelopathy or radiculopathy. |
Amoxicillin; metronidazole. Hydroxychloroquine and azithromycin; IVIg. |
RT-PCR; the neurological examination disclosed moderate (Medical Research Council grade 4/5) and EMG. |
Su et al.1919. Su XW, Palka SV, Rao RR, Chen FS, Brackney CR, Cambi F. SARS-CoV-2-associated Guillain-Barré syndrome with dysautonomia. Muscle Nerve. 2020;62(2):E48-9. https://doi.org/10.1002/mus.26988 https://doi.org/10.1002/mus.26988...
|
Male |
72 |
Coronary artery disease, hypertension, and alcohol abuse |
Symmetric aresthesias and ascending appendicular weakness. Seven days earlier he had mild diarrhea, anorexia, and chills, without fever or respiratory symptoms. This condition resolved in 5 days. Weakness began 6 days after diarrhea, and the patient presented 1 day after neurological symptom onset. On admission, he was afebrile with normal vital signs. Mental status and CN were normal. |
On day 3, the patient developed respiratory distress with a negative inspiratory force of −20 cm H2O and vital capacity of 1.350 mL. He was transferred to the ICU and intubated. He remained afebrile and followed commands. Oxygen saturation was normal on ventilator settings positive end-expiratory pressure 5 cm H2O and fraction of inspired oxygen 30%. Chest X-ray was stable. Sputum culture grew Stenotrophomonas maltophilia. |
Chest X-ray showed mild bibasilar atelectasis vs. patchy consolidations. Computed tomography of the head was normal. Incompatible implant precluded MRI. On day 10, his oropharyngeal secretions increased, and chest X-ray showed new right lower lobe consolidation. |
IVIg |
RT-PCR and the neurological examination disclosed moderate (Medical Research Council grade 4/5). |
Lantos et al.2020. Lantos JE, Strauss SB, Lin E. COVID-19-associated Miller Fisher syndrome: MRI findings. AJNR Am J Neuroradiol. 2020;41(7):1184-6. . https://doi.org/10.3174/ajnr.A6609 https://doi.org/10.3174/ajnr.A6609...
|
Male |
36 |
NA |
Presenting with left eye drooping, blurry vision, and reduced sensation and paresthesia in both legs for 2 days. He was in his usual state of health until 4 days before presentation, when he developed viral symptoms in a COVID-19-endemic region, reporting subjective fevers, chills, and myalgia. |
Physical examination was notable for a partial left third nerve palsy and decreased sensation below the knees to all modalities. Nonetheless, the patient's hospital course was characterized by progressive ophthalmoparesis (including initial left CN III and eventual bilateral CN VI palsies), ataxia, and hyporeflexia, and the clinical picture was thought to be consistent with MFS from COVID-19 infection. |
Brain MRI: prominent enhancement with gadolinium, and T2 hyperintense signal of the left CN III. No other CN demonstrated abnormal signal. No cerebellar lesions were seen to explain the patient's ataxia. |
IVIg; hydroxychloroquine. |
RT-PCR and RMI. |
Camdessanche et al.2121. Camdessanche JP, Morel J, Pozzetto B, Paul S, Tholance Y, Botelho-Nevers E. COVID-19 may induce Guillain-Barré syndrome. Rev Neurol (Paris). 2020;176(6):516-8. https://doi.org/10.1016/j.neurol.2020.04.003 https://doi.org/10.1016/j.neurol.2020.04...
|
Male |
64 |
NA |
The patient fell and hurt his left shoulder leading to a tear of the rotator cuff. Eleven days after the symptom onset, the patient complained of paresthesia in feet and hands. In three days, he installed a flaccid severe tetraparesia. The patient complained of swallowing disturbance with a risk of suffocation. |
Clinical presentation was moderate with high grade fever for three days requiring oxygen 2–3 L/min through nasal cannula for five days. The patient was admitted in ICU and mechanically ventilated because of respiratory insufficiency. |
Thoracic CT scan showed only 10–25% of ground glass opacities. |
Paracetamol, preventing thromboembolism by low molecular weight heparin and LPV/RTV 400/100 mg twice a day for ten days. IVIg (0.4g/kg per day during 5 days). |
EMG |
Arnaud et al.2222. Arnaud S, Budowski C, Tin S, Degos B. Post SARS-CoV-2 Guillain-Barré syndrome. Clin Neurophysiol. 2020;131(7):1652-4. https://doi.org/10.1016/j.clinph.2020.05.003 https://doi.org/10.1016/j.clinph.2020.05...
|
Male |
64 |
Diabetes mellitus type 2 |
Cough, dyspnea, diarrhea, and fever. Fast progressive lower-limb weakness; The neurological examination showed generalized areflexia, severe flaccid paraparesis, mainly affecting proximal muscles, and a decreased proprioceptive length-dependent sensitivity involving the four limbs. We also found hypoesthesia to light touch and pinprick in lower extremities rather. |
Respiratory rate was 30 breaths/min and oxygen saturation was 93% on ambient air. Lung auscultation revealed diffuse crackles. |
A chest CT showed bilateral, diffuse and subpleural ground-glass opacities with a crazy-paving appearance, and a band of air space consolidation. |
Cefotaxime, Azithromycin; IVIg and Hydroxychloroquine. |
RT-PCR and EMG. |
Bigaut et al.2323. Bigaut K, Mallaret M, Baloglu S, Nemoz B, Morand P, Baicry F, et al. Guillain-Barré syndrome related to SARS-CoV-2 infection. Neurol Neuroimmunol Neuroinflamm. 2020;7(5):e785. https://doi.org/10.1212/NXI.0000000000000785 https://doi.org/10.1212/NXI.000000000000...
|
P1 – Male |
43 |
NA |
Presented with cough, asthenia, and myalgia in legs, followed by acute anosmia and ageusia with diarrhea the next day. Symptoms resolved spontaneously after 2 weeks. Twenty-one days after the beginning of respiratory symptoms, he presented with a rapidly progressive manner paraesthesia, hypoesthesia, and distal weakness in the lower limbs. In the following 2 days, these symptoms extended to the midthigh and tip of the fingers associated with ataxia, and he was hospitalized at day 4 due to a right peripheral facial palsy. |
His BT was 36.9°C and oxygen saturation was 99%. |
CT of the chest showed ground-glass opacities; MRI at day 7 showed multiple cranial neuritis (in nerves III, V, VI, VII, and VIII), radiculitis, and plexitis on both the brachial and lumbar plexus. |
IVIg. |
RT-PCR and the neurological examination disclosed moderate (Medical Research Council grade 4/5). |
P2 – Female |
70 |
Obesity |
Anosmia and ageusia, followed by diarrhea for 2 days. She complained of mild asthenia and myalgia without fever. Seven days later, she presented with acute proximal tetraparesis and distal forelimb, perioral dyspnea, and loss of ambulation. |
Rapidly transferred to an ICU for noninvasive ventilation for acute respiratory failure with hypercapnia. She was discharged from the ICU 9 days later, without requiring invasive mechanical ventilation. Her clinical condition improved slowly with physiotherapy, needing a transfer in a rehabilitation center. |
CT of the chest showed moderate ground-glass opacities in both lungs. |
IVIg. |
RT-PCR and the neurological examination disclosed moderate (Medical Research Council grade 4/5). |
El Otmani et al.2424. El Otmani H, El Moutawakil B, Rafai MA, El Benna N, El Kettani C, Soussi M, et al. Covid-19 and Guillain-Barré syndrome: more than a coincidence! Rev Neurol (Paris). 2020;176(6):518-9. https://doi.org/10.1016/j.neurol.2020.04.007 https://doi.org/10.1016/j.neurol.2020.04...
|
Female |
70 |
Rheumatoid arthritis |
Presented with a rapidly, bilateral weakness and tingling sensation in all four extremities resulting in a total functional disability within 48 hours. The patient denied any sphincter disturbances, dyspnea or swallowing difficulties. Neurological examination showed quadriplegia, hypotonia, areflexia, and bilateral positive Lase'gue sign. CN were intact. Three days prior to the ongoing symptoms' onset, the patient presented an episode of dry cough without dyspnea or fever, spontaneously resolving within 48 hours. |
Temperature, lung, and cardiac auscultation were also normal. |
Chest CT (day 10) revealed ground-glass opacities in the left lung. |
IVIg (2 g/kg for 5 days) and a combination of Hydroxychloroquine (600 mg per day) and Azithromycine. |
RT-PCR |
Juliao Caamaño et al.2525. Juliao Caamaño DS, Alonso Beato R. Facial diplegia, a possible atypical variant of Guillain-Barré syndrome as a rare neurological complication of SARS-CoV-2. J Clin Neurosci. 2020;77:230-2. https://doi.org/10.1016/j.jocn.2020.05.016 https://doi.org/10.1016/j.jocn.2020.05.0...
|
Male |
61 |
NA |
Fever and coughing without dyspnea on day 1 of the illness; right peripheral facial nerve palsy. |
NA |
Brain CT and MRI were performed without any acute pathological findings. |
Hydroxychloroquine and LPV/RTV; oral prednisone. |
X-ray and RT-PCR. |
Galán et al.2626. Galán AV, Del Saz Saucedo P, Postigo FP, Paniagua EB. Guillain-Barré Syndrome associated with SARS-CoV-2 infection. Neurologia. 2020;35(4):268-9. https://doi.org/10.1016/j.nrl.2020.04.007 https://doi.org/10.1016/j.nrl.2020.04.00...
|
Male |
43 |
NA |
Consultation for symmetric and global weakness of the 4 extremities of progressive intensity with impossibility for walking, as well as alteration in the sensitivity of the 4 members at the distal level. Three days before, there was a self-limited diarrhea episode, followed by symptoms of infection of the upper respiratory tract, bilateral facial paresis, and dysphagia. |
NA |
In the X-ray of thorax there are alterations suggestive of Early pneumonia by COVID-19. |
IVIg; sulfate hydroxychloroquine, antiretro virals (LPV and RTV), antibiotic (amoxicillin), corticosteroids and oxygen therapy low flow. |
RT-PCR; EMG and the neurological examination disclosed moderate (Medical Research Council grade 4/5). |
Marta-Enguita et al.2727. Marta-Enguita J, Rubio-Baines I, Gastón-Zubimendi I. Fatal Guillain-Barre syndrome after infection with SARS-CoV-2. Neurologia. 2020;35(4):268-9. https://doi.org/10.1016/j.nrl.2020.04.007 https://doi.org/10.1016/j.nrl.2020.04.00...
|
Female |
76 |
NA |
Evolution of low back pain radiating to the posterior aspect of both legs and progressive tetraparesis with paresthesias of distal onset. The pain was bilateral, with right predominance and greater night intensity. He associated progressive weakness predominantly proximal in the lower extremities, and 2 days before our evaluation, he presented weakness in the upper extremities, with functional limitation. Eight days before the onset of the symptoms, he had started with a cough and fever without dyspnea, with 72 hours of evolution; He associated global areflexia and hypoesthesia in both legs. |
The patient was admitted and at 4 h presented dysphagia for liquids and progressively for solids, with a nasal voice and difficulty swallowing her own saliva, with progressive onset of a picture of ventilatory failure. She presents progressive deterioration, requiring oxygen therapy (FiO2 60%), with maintained SatO2 levels of around 91%, which do not show a problem of alveolar capillary junction or gas exchange. Finally, she dies at 12 h. |
Normal cranial CT and cervical spine were performed, showing degenerative signs at the level of the vertebral bodies, without invasion of the spinal canal. On chest CT, a pattern compatible with the level of pulmonary impairment due to SARS-CoV-2 infection was observed. |
NSAID, pyrazolones, and transdermal morphics. amoxicillin-clavulanic acid, and azithromycin. |
RT-PCR |
Molina et al.2828. Molina AE, Martínez MM, Chueca PS, López AC, Val IS, Sanjuan-Villarreal TA. Guillain-Barré syndrome associated with SARS-CoV-2 infection. Med Intensiva. 2020;44(8):513-4. https://doi.org/10.1016/j.medin.2020.04.015 https://doi.org/10.1016/j.medin.2020.04....
|
Female |
55 |
Dyslipemia and active smoking. |
Fever, unproductive cough and dyspnea after 15 days of evolution. In the past 24 hours, she reported paresthesias in the hands and feet, as well as weakness in the lower extremities. Severe low back pain radiating to both legs with progressive weakness in the 4 extremities associated with dysphagia. At 48 hours, the patient presented worsening of neurological symptoms, with areflexic tetraparesis. Along with this, liquid dysphagia, bilateral facial diplegia, weakness in closing the eyelids, lingual and perioral paresthesias. No meningeal signs. |
At initial examination, the patient is conscious and oriented. Blood pressure 155/102 mmHg, heart rate 103 beats per minute, temperature 36.6 °C, oxygen saturation 93% basal (SatO2). Eupneic with 20 breaths per minute. Bibasal crackles on pulmonary auscultation. Strength and sensitivity preserved in the 4 limbs. Rest of physical examination without significant changes. Adequate ventilatory mechanics and SatO2 without the need for respiratory support. In this context, it was decided to transfer to the ICU. |
Chest radiography revealed consolidation in the left lower lobe; Using MRI, a slight leptomeningeal improvement is observed in the brain stem and cervical cord. |
hydroxychloroquine, ceftriaxone and azithromycin; IVIg. |
RT-PCR and the neurological examination disclosed moderate (Medical Research Council grade 4/5). |
Sancho-Saldaña et al.2929. Sancho-Saldaña A, Lambea-Gil A, Liesa JLC, Caballo MRB, Garay MH, Celada DR, et al. Guillain-Barré syndrome associated with leptomeningeal enhancement following SARS-CoV-2 infection. Clin Med (Lond). 2020;20(4):e93-4. https://doi.org/10.7861/clinmed.2020-0213 https://doi.org/10.7861/clinmed.2020-021...
|
Female |
56 |
NA |
Recent unsteadiness and paraesthesia in both hands. Fifteen days earlier, she had reported fever, dry cough, and shortness of breath that was controlled with symptomatic treatment. she developed lumbar pain and progressive proximal lower limb weakness, bilateral facial nerve palsy, oropharyngeal weakness, and severe proximal tetraparesis with cervical flexion. |
She was transferred to the ICU for 5 days due to the risk of respiratory insufficiency and began rehabilitation, not needing mechanical ventilation. She started recovering by day 7 after the onset of weakness. |
Her chest X-ray showed a lobar consolidation. |
hydroxychloroquine and azithromycin; IVIg. |
RT-PCR and the neurological examination disclosed moderate (Medical Research Council grade 4/5). |
Reyes-Bueno et al.3030. Reyes-Bueno JA, García-Trujillo L, Urbaneja P, Ciano-Petersen NL, Postigo-Pozo MJ, Martínez-Tomás C, et al. Miller-Fisher syndrome after SARS-CoV-2 infection. Eur J Neurol. 2020;27(9):1759-61. https://doi.org/10.1111/ene.14383 https://doi.org/10.1111/ene.14383...
|
Female |
51 |
NA |
Diarrhea, odynophagia, and cough. The condition lasted approximately 10 days, after which she kept feeling discomfort in the throat. She did not refer ageusia or anosmia. |
From March 30th, she started having intense root-type pain in all four limbs, especially in the legs as well as dorsal and lumbar back pain. On April 4th she started with weakness in her lower limbs, which progressed to the point of preventing her from walking in a few days, associated with double binocular vision. The neurological exploration showed paresis of the left external rectus muscle with horizontal diplopia when looking to the left, discrete predominantly inferior bilateral facial paresis, symmetrical paraparesis with 3+/5 weakness in psoas, hamstrings, gluteus, and quadriceps, 3/5 in gastrocnemius, 2/5 in posterior tibial and peroneal; and global areflexia. She also presented symptoms of autonomic dysfunction such as dry mouth, diarrhea, and unstable blood pressure. |
NA |
IVIg. |
RT-PCR and ELISA technique; the neurological examination disclosed moderate (Medical Research Council grade 4/5). |
Chan et al.3131. Chan JL, Ebadi H, Sarna JR. Guillain-Barré syndrome with facial diplegia related to SARS-CoV-2 infection. Can J Neurol Sci. 2020;47(6):852-4. https://doi.org/10.1017/cjn.2020.106 https://doi.org/10.1017/cjn.2020.106...
|
Male |
58 |
NA |
Presented with acute-onset bilateral facial weakness, dysarthria, and paresthesia in his feet. He denied any other neurological symptoms, including anosmia and ageusia. He denied fever, fatigue, cough, shortness of breath, or any other symptoms on review of systems. Neurological examination demonstrated complete facial diplegia and areflexia in the lower extremities. he had slight movements of his facial muscles and the distal paresthesias of his lower extremities were unchanged. |
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. Auscultation of the lungs revealed diffuse crackles bilaterally. |
Chest x-ray demonstrated diffuse heterogeneous infiltration in both lungs. CT and CTA of the head and neck did not demonstrate any intracranial or vascular abnormalities but demonstrated ground-glass opacities in both lung apices. |
Empiric ceftriaxone and azithromycin; IVIg. |
RT-PCR and EMG; |
Coen et al.3232. Coen M, Jeanson G, Culebras Almeida LA, Hübers A, Stierlin F, Najjar I, et al. Guillain-Barré syndrome as a complication of SARS-CoV-2 infection. Brain Behav Immun. 2020;87:111-2. https://doi.org/10.1016/j.bbi.2020.04.074 https://doi.org/10.1016/j.bbi.2020.04.07...
|
Male |
70 |
NA |
Paraparesis, distal allodynia, difficulties in voiding and constipation. Ten days before he developed myalgia, fatigue, and a dry cough. |
Physical examination revealed fine crackles in the left base, bilateral lower limb flaccid paresis, absent deep tendon reflexes of the upper and lower limb and idiomuscular response to percussion of the muscle tibialis anterior, indifferent plantar reflexes. There was no sensory deficit. FilmArray Meningitis/Encephalitis (ME) Panel testing (BioFire Diagnostics, Salt Lake City, UT) and SARS-CoV-2 RT-PCR were negative. showed decreased persistence or absent F-waves in tested nerves. |
Chest X-ray was normal. Contrast-enhanced MRI excluded myelopathy. Nerve conduction study showed sensorimotor demyelinating polyneuropathy with “sural sparing pattern”; F wave study showed decreased persistence or absent F-waves in tested nerves. |
IVIg. |
RT-PCR and ELISA technique. |
Lascano et al.3333. Lascano AM, Epiney JB, Coen M, Serratrice J, Bernard-Valnet R, Lalive PH, et al. SARS-CoV-2 and Guillain-Barré syndrome: AIDP variant with a favourable outcome. Eur J Neurol. 2020;27(9):1751-3. https://doi.org/10.1111/ene.14368 https://doi.org/10.1111/ene.14368...
|
P1 – Female |
52 |
NA |
Dry cough, fever, odynophagia, arthralgia, diarrhoea. Back pain, limb weakness, ataxia, distal paresthesia, dysgeusia, cacosmia. Developed respiratory failure, dysautonomia, and tetraplegia with areflexia. |
Improvement of tetraparesis. Able to stand up with assistance. GBS disability clinical score 4/6. Spinal cord: no nerve root gadolinium enhancement. |
NA |
IVIg |
RT-PCR and Antibodies for SARS-CoV-2 IgM/IgG. |
P2 – Female |
63 |
Diabetes mellitus type 2 |
Dry cough, shivering, odynophagia, breathing difficulties, chest pain. Lower limb pain, mild weakness and normal deep tendon reflexes. Developed tetraparesis, distal paresthesia and areflexia. |
Dismissal with full motor recovery. Persistence of lower limb areflexia and distal paresthesia. GBS disability clinical score 1/6. |
NA |
IVIg |
RT-PCR |
P3 – Female |
61 |
NA |
Productive cough, fever, myalgia, vasovagal syncope, diarrhoea, nausea and vomiting. Lower limb weakness and distal paresthesia, dizziness, dysphagia, dysautonomia, areflexia. Presented worsening of bulbar symptoms and bilateral facial palsy. |
Improvement of tetraparesis and ability to walk with assistance. Persistence of neuropathic pain and distal paresthesia. GBS disability clinical score 3/6. Spinal cord: lumbosacral nerve root enhancement. Normal brain imaging. |
NA |
IVIg |
RT-PCR |
Helbok et al.3434. Helbok R, Beer R, Löscher W, Boesch S, Reindl M, Hornung R, et al. Guillain-Barré syndrome in a patient with antibodies against SARS-COV-2. Eur J Neurol. 2020;27(9):1754-6. https://doi.org/10.1111/ene.14388 https://doi.org/10.1111/ene.14388...
|
Male |
68 |
NA |
Cough, headache, fatigue, myalgia and fever up to 39°C followed by anosmia and ageusia. but still complained of severe fatigue and developed symmetric distal tingling in both feet followed by ascending dysesthesias up to the knees and proximal weakness. |
His respiratory condition worsened, and the patient required oxygen supplementation (3L/min) followed by pressure support non-invasive ventilation after 36 h. The next day he presented inability to walk. On examination, the patient was alert and fully oriented, afebrile with normal vital signs (oxygen saturation 98% on room air, blood pressure 143/90mmHg, heat rate 85 bpm). Due to muscle weakness accompanied by respiratory failure the patient underwent elective intubation in a fully conscious state. |
Chest Computed tomography was performed and revealed residual ground-glass opacities in both lower lungs |
IVIg and plasma exchange |
RT-PCR and Antibodies for SARS-CoV-2 IgM/IgG; the neurological examination disclosed moderate (Medical Research Council grade 4/5). |
Kilinc et al.3535. Kilinc D, van de Pasch S, Doets AY, Jacobs BC, van Vliet J, Garssen MPJ. Guillain-Barré syndrome after SARS-CoV-2 infection. Eur J Neurol. 2020;27(9):1757-8. https://doi.org/10.1111/ene.14398 https://doi.org/10.1111/ene.14398...
|
Male |
50 |
NA |
Four days of progressive bilateral facial weakness, paresthesia of distal extremities and an unsteady gait. Four weeks earlier he had experienced an episode of dry cough lasting several days without fever or other symptoms of infection. Neurologic examination showed facial diplegia, normal eye movements, mild symmetric proximal muscle weakness and impaired propriocepsis in the legs. Patient had an ataxic gait and tendon reflexes were absent. |
Routine blood examination showed no abnormalities. Routine analysis of CSF showed a normal cell count and total protein level. |
|
|
RT-PCR and Antibodies for SARS-CoV-2 IgM/IgG; EMG. |
Oguz-Akarsu et al.3636. Oguz-Akarsu E, Ozpar R, Mirzayev H, Acet-Ozturk NA, Hakyemez B, Ediger D, et al. Guillain-Barré syndrome in a patient with minimal symptoms of COVID-19 infection. Muscle Nerve. 2020;62(3):E54-7. https://doi.org/10.1002/mus.26992 https://doi.org/10.1002/mus.26992...
|
Female |
53 |
NA |
History of dysarthria associated with progressive weakness and numbness of the lower extremities. She had a mild fever (37.5°C) but no cough, dyspnea, anosmia or ageusia. |
NA |
Focal intensities suspicious for COVID-19 pneumonia were incidentally identified in peripheral areas of lungs on STIR sequence of the brachial plexus MRI; Chest computed tomography showed bilateral peripheral ground-glass opacities and consolidations on both lungs. |
Plasma exchange; hydroxychloroquine and azithromycin. |
RT-PCR |
Scheidl et al.3737. Scheidl E, Canseco DD, Hadji-Naumov A, Bereznai B. Guillain-Barré syndrome during SARS-CoV-2 pandemic: a case report and review of recent literature. J Peripher Nerv Syst. 2020;25(2):204-7. https://doi.org/10.1111/jns.12382. https://doi.org/10.1111/jns.12382....
|
Female |
54 |
NA |
Areflexia, numbness, and tingling of all extremities were also found, with initial maintained gain ability. She did not experience fever, respiratory or gastrointestinal symptoms, but reported about a transient loss of smell and taste 2 weeks before the GBS symptoms occurred. |
The first electrophysiological evaluation (at admission) showed significantly prolonged distal motor latencies and temporal dispersion of the CMAP of the common peroneal nerve bilaterally. |
MRI of the cervical spine and the chest x-ray examination did not show pathological findings. Electrophysiological studies were performed using a Nicolet Viking EMG device. |
IVIg |
RT-PCR and EMG. |