Article written by Dr. Cristina Herțea – neurology specialist

 

Guillan-Barre syndrome associated with SARS-COV2 infection

 

From February 28 to March 21, in 3 hospitals in northern Italy were reported 5 patients who showed specific symptoms for polyradiculoneuritis and then confirmed with this neurological condition in the context of infection with the new type of coronavirus. Out of these patients, 4 had a positive test for pharyngeal exudate at the onset of the neurological condition, and one had a negative bronchoalveolar lavage exudate at the onset of symptoms, but later had a positive serological test for coronavirus.

The first symptoms for Guillan Barre syndrome were lower limb weakness and obvious paresthesia in 4 patients and facial diplegia, followed by ataxia and paresthesia present in one patient. The clinical picture progressed to tetraplegia / tetraparesis within 36 hours to 4 days in 4 patients, 3 patients requiring ventilatory support. The time interval from the onset of typical respiratory symptoms for COVID 19 to the onset of neurological manifestations was 5 to 10 days.

The analysis of cerebrospinal fluid did not detect the presence of typical changes for polyradiculoneuritis and PCR evaluation of SARS-COV2 virus in CSF was negative. Electromyographic examination was compatible with the diagnosis of polyradiculoneuritis – the axonal variant was obvious in 3 patients and demyelinating in 2. The examination of MRI (magnetic resonance imaging) with contrast administration showed the pathological contrast of the nerve roots at the caudal level lumbosacral) in 2 patients, facial nerve in 1 patient. 2 patients did not show pathological contrast at the administration of contrast medium.

All patients were treated with intravenous immunoglobulins, 2 patients received 2 intravenous immunoglobulin coures and one was treated with plasmapheresis.

After 4 weeks of treatment, the evolution was variable, 2 patients still needed ventilatory support, 2 patients were enrolled in the motor recovery program due to tetraparesis, and one patient was discharged and was independent being able to walk without help.

The interval of 5/10 days between the onset of infection and the first symptoms compatible with Guillan-Barre syndrome is similar to the interval observed in other infections. Although many infectious agents have been associated with Guillan-Barre syndrome, there is a tropism for infectious agents such as Campylobacter Jejuni, Epstein-Barr virus, CMV and Zika virus. There have been reports of an association between Guillain-Barre syndrome and coronavirus.

Due to the small number of patients enrolled in these observational studies, it is not possible to determine exactly whether the presence of severe neurological deficits and axonal involvement are typical features of COVID-associated Guillain-Barre syndrome 19. It is not possible to assess precisely the cause. which required ventilatory support in the context of respiratory failure (neuromuscular deficit in the context of associated neurological disease or lung damage in the context of background disease – requires correlation with lung imaging).

Guillain – Barre syndrome associated with COVID 19 should be differentiated from neuropathy / myopathy associated with the critical disease which has a tendency to appear later in the course of the disease.

 

Sources:

– article published in The New England Journal of Medicine – taken from EAN pages.

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