Guillain-Barré Syndrome Presenting as Facial Diplegia after COVID-19 Vaccination: A Case Report

Abstract

Background: Guillain-Barré Syndrome (GBS) is a rapidly progressive immune-mediated polyneuropathy often associated with an antecedent infectious illness or vaccination. The classic presentation of GBS is characterized by ascending limb weakness and numbness with loss of reflexes. However, atypical variants involving the face and arms or with purely sensory symptoms also exist. In up to 30% of cases, GBS progresses to respiratory failure, with patients requiring mechanical ventilation.

Case report: We report a case of atypical GBS occurring after Coronavirus disease 2019 (COVID-19) vaccination in an otherwise healthy 38-year-old man. The patient's clinical presentation was characterized by bilateral hand and foot paresthesias, dysarthria, bilateral facial weakness, and an absence of classic ascending limb weakness. Albuminocytological dissociation within the cerebrospinal fluid was suggestive of GBS. The patient received intravenous immunoglobulin therapy, with modest improvement in his symptoms at the time of his discharge from the hospital. Why Should an Emergency PhysicianBe Aware of This? Patients with GBS are at risk for life-threatening complications, including respiratory failure requiring mechanical ventilation. It is critical for emergency physicians to be aware of the manifold presentations of GBS for early recognition and treatment. This may be of particular importance in the context of a worldwide vaccination campaign in response to the COVID-19 pandemic.

Keywords: CN-VII palsy; COVID-19 vaccination; Guillain-Barré Syndrome (GBS); dysarthria; facial diplegia.

Figure 1

The brain magnetic resonance imaging (MRI) constructive interference in steady state (CISS) sequence is useful for evaluating structures surrounded by cerebrospinal fluid, such as cranial nerves. In this brain MRI with and without contrast on the day of presentation, there is (A) evidence of focal enhancement (arrows) of the bilateral internal auditory canal fundi, which carry CN-VII and CN-VIII. There is also (B) bilateral enhancement of the cisternal segments of the trigeminal nerves (CN-V; arrows), suggesting focal inflammation, which may be seen in Guillain-Barré syndrome and other inflammatory or infectious conditions.