key: cord-0865682-868o2cuy
authors: Abolmaali, Meysam; Heidari, Matineh; Zeinali, Marjan; Moghaddam, Parichehr; Ramezani Ghamsari, Mona; Jamshidi Makiani, Mahin; Mirzaasgari, Zahra
title: Guillain–Barré Syndrome as a Parainfectious manifestation of SARS-CoV-2 infection: A Case Series
date: 2020-11-14
journal: J Clin Neurosci
DOI: 10.1016/j.jocn.2020.11.013
sha: dda8187e6cc0c26728e067e838880d42991cf4ec
doc_id: 865682
cord_uid: 868o2cuy

The global SARS-CoV-2 pandemic posed an unprecedented challenge to almost all fields of medicine and Neurology is not an exception. Collecting information about its complications and related conditions will help clinicians to become more confident in managing this disease. Guillain-Barre Syndrome (GBS) is mostly described as a post-infectious phenomenon and its occurrence during acute phase of illness is of interest. GBS has recently been reported during the active phase of COVID-19 for the first time. Severity and fast progression of GBS associated with COVID-19 have also been shown in recent studies. Here we report three cases of GBS during the active phase of COVID-19 with severe symptoms and fast progression to quadriplegia and facial diplegia over 2 days, which led to death in one case due to severe autonomic dysfunction. We suggest SARS-CoV-2 might be associated with rather a severe, rapidly progressive and life-threatening phenotype of GBS.

Coronavirus disease 2019 (COVID-19) is defined as an illness caused by a novel coronavirus, which is 38 now called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; formerly called 2019-nCoV).

SARS-CoV-2 was first identified at an outbreak of respiratory illness cases in Wuhan City, Hubei suggestive of an AMSAN sub-type of GBS (Table 3) . CSF was acellular with elevated protein (65 mg/dl).

Antigangliosides antibodies were not checked. Intravenous immunoglobulin (0.4 g/kg, for 2 days) was 104 commenced for the patient.

Two days later, he was switched to plasma exchange due to a rise in serum creatinine. The patient 106 developed severe respiratory distress and became intubated 14 days after his admission. We assumed that

GBS caused ventilation problems as well as respiratory problems. The patient died on the 20 th day of 108 admission due to multi-organ failure. post-infectious one [10] . The second case of GBS associated with SARS-CoV-19 was reported from Iran.

The case was a 65-year-old man with severe progressive peripheral neuropathy leading to quadriplegia, 

Similarities might be seen in some close viral pathogens; therefore, it is necessary for clinicians to learn 155 

Initial Public Health Response 158 and Interim Clinical Guidance for the 2019 Novel Coronavirus Outbreak -United States

WHO declares global emergency as Wuhan coronavirus spreads. New 162 York Times

Guillain-Barré syndrome 165 associated with SARS-CoV-2

Subclass IgG to motor 167 gangliosides related to infection and clinical course in Guillain-Barré syndrome

Campylobacter jejuni: role of the lipo-oligosaccharide core oligosaccharide in inducing anti-ganglioside 171 antibodies

Neurological manifestations of hospitalized 173 patients with COVID-19 in Wuhan, China: a retrospective case series study

Neurological Associations of COVID-19. 175 Available at SSRN 3589350

Guillain-Barré syndrome associated with SARS-CoV-2 177 infection: causality or coincidence?

Guillain Barre syndrome associated with COVID-19 infection: A case report

Guillain-Barré syndrome 181 related to COVID-19 infection

Guillain Barré Syndrome associated 183 with SARS-CoV-2 infection. A Systematic Review

Guillain-Barré syndrome 187 associated with Zika virus infection. The lancet

Neurological complications during 191 treatment of Middle East respiratory syndrome

EDX, electrodiagnosis; DTR, deep tendon reflex; RBC, red blood cell; WBC, white blood 199 cell

AMSAN, acute motor-sensory axonal neuropathy

 We described GBS symptoms in three infected patients with COVID-19

 The severity and fast progression of GBS linked to COVID-19 seems considerable in mentioned 207 cases

 Acute motor and sensory axonal neuropathy (AMSAN) type of GBS was diagnosed according to 209 electrodiagnostic findings in all three cases

 GBS is suggested to be considered as a severe and rapid progressive profile in neurologic 211 complications of COVID-19