Bilateral facial palsy with paresthesias, variant of Guillain-Barré syndrome following COVID-19 vaccine: A case series of 9 patients

Abstract

Several cases of Guillain-Barré Syndrome (GBS) associated with COVID-19 vaccination have been reported, including the rare subtype known as Bilateral Facial Palsy with paresthesias (BFP). To date, it is not known whether a causal relationship may exist between the two. We report 9 cases of BFP in patients vaccinated against COVID-19 in the previous month. Nerve conduction studies revealed demyelinating polyneuropathy in 4 patients, and 5 presented bilateral, focal facial nerve involvement, exclusively. Ganglioside antibody panel was positive in 4 patients (anti-GM1=2, anti-GD1a=1 and anti-sulfatide=1). Seven patients received intravenous immunoglobulin treatment, one plasma exchange, and one patient died from sudden cardiac arrest following arrhythmia before treatment could be administered. Rates of BFP following COVID-19 vaccination, did not differ from those reported in previous series. Epidemiological studies are essential to determine whether a causal relationship may exist between this rare form of GBS and COVID-19 vaccination.

Keywords: Bilateral Facial Palsy (BFP); COVID-19 vaccine; Facial diplegia; Guillain-Barré Syndrome (GBS).

Fig. 1

(A) T2-FLAIR weighted and (B) postcontrast T1-weighted axial images of the brain. (A) Normal appearance of brain parenchyma, ventricles and subarachnoid space, on the T2-weighted image. (B) Post-contrast T1-weighted image shows smooth contrast enhancement on both facial nerves (arrows).