Guillain-Barré Syndrome as a Complication of COVID-19

Abstract

Coronavirus disease 2019 (COVID-19) is associated with multiple neurological complications including Guillain-Barre syndrome (GBS). While there are reports of COVID-19 -related GBS cases, much remain unknown. We report two cases of GBS-associated COVID-19, which started about eight weeks after the initial COVID-19 infection. Such a long duration between infection and symptom onset of GBS is unusual for post-infectious GBS. Moreover, severely ill patients with COVID-19 may have prolonged hospital stay leading to critical illness myoneuropathy. Diagnosing superimposed GBS can be challenging in such cases. Clinical suspicion, nerve conduction studies with electromyography, and cerebrospinal fluid analysis can help in making the correct diagnosis. Both presented cases responded to intravenous immunoglobulin therapy.

Keywords: coronavirus disease 19; covid-19; critical illness myopathy; critical illness polyneuropathy; guillain-barré syndrome; neurology; neuromuscular disorder.

Figure 1. Nerve conduction studies (NCSs) waveforms for patient 1.

Motor responses of the left peroneal nerve (recording from extensor digitorum brevis and tibialis anterior) and tibial nerve (recording from abductor hallucis) were absent. Motor response of the left median nerve was normal. Sensory response of the left sural nerve was absent. Sensory NCS of the left radial nerve was borderline normal. [Of note, this was a bedside study].

Figure 2. Nerve conduction studies (NCSs) waveforms for patient 2.

Motor responses of the right peroneal nerve (recording from extensor digitorum brevis) and tibial nerve (recording from abductor hallucis) were absent. Motor response of the left peroneal nerve recording from tibialis anterior showed reduced response amplitude. Motor NCSs of the right median and ulnar nerves showed prolonged distal latencies and slowing of conduction velocities. Response amplitudes were reduced for right ulnar nerve. Sensory responses of the right sural, median, ulnar and radial nerves were absent.