key: cord-0877366-ysgrojdx
authors: Foresti, Camillo; Servalli, Maria Cristina; Frigeni, Barbara; Rifino, Nicola; Storti, Benedetta; Gritti, Paolo; Fabretti, Fabrizio; Grazioli, Lorenzo; Sessa, Maria
title: COVID‐19 provoking Guillain‐Barrè Syndrome: the Bergamo case series
date: 2020-09-22
journal: Eur J Neurol
DOI: 10.1111/ene.14549
sha: 3418bce9ad3aa90ce703a9d7ed49a5a6b21b1fbc
doc_id: 877366
cord_uid: ysgrojdx

At the time of writing, the number of confirmed COVID‐19 cases in Italy has dropped off to less than 150 cases per day. Now we can finally take a breath and think back on what we have experienced during the last months in our hospital Papa Giovanni XXIII in Bergamo, Lombardy, the epicentre of the Italian pandemic.

At the time of writing, the number of confirmed COVID-19 cases in Italy has dropped off to less than 150 cases per day. Now we can finally take a breath and think back on what we have experienced during the last months in our hospital Papa Giovanni XXIII in Bergamo, Lombardy, the epicentre of the Italian pandemic.

Among 1,832 COVID-19 patients hospitalized between February 23rd and May 21st, we diagnosed 17 cases of Guillian Barré Syndrome (GBS). All the patients had a Brighton criteria level of 1 or 2 (1). The median age was 53 years and 11 were men.

The majority of the patients were admitted to the intensive care unit (ICU) for severe respiratory distress, and peripheral nervous system (PNS) involvement became evident at weaning of sedation. Notwithstanding, we are confident that, in accord with Brighton Criteria, the interval between Coronavirus diagnosis and nadir of weakness was between 12 hours and 28 days. If not necessary for diagnosis, cerebrospinal fluid (CSF) analysis was avoided, as the majority of the patients were treated with low molecular weight heparin at high doses for primary prevention of SARS-CoV-2 induced thrombophilia. In the four patients who performed CSF analysis, RT-PCR assay on CSF for SARS-CoV-2 was negative.

The nerve conduction studies (NCS) demonstrated acute inflammatory demyelinating polyneuropathy (AIDP) in 16 cases, according to Hadden criteria (2). In one case with equivocal results, diagnosis was confirmed with CSF evaluation. Eight patients underwent a blink reflex test, which showed a demyelinating pattern in either the facial and/or the trigeminal nerves in all cases, suggesting a frequent cranial nerve involvement. Neuromuscular weakness is a common occurrence in the ICU, nevertheless, it is usually due to a critical illness myopathy and neuropathy (CRIMYNE), the differential diagnosis of which is based on the electrophysiological tests. Both of these diseases usually present as a symmetric flaccid limb weakness, however, they must promptly be distinguished considering the proved effectiveness of intravenous immune globulin (IVIG) or plasma exchange in GBS.

This article is protected by copyright. All rights reserved Among our cohort, 15 patients were treated with IVIG and 2 received plasma exchange. One patient died because of pulmonary complications. 16 patients were discharged to home or to a rehabilitation centre. To the best of our knowledge, this is the largest number of GBS cases reported following SARS-CoV-2 infection. Other cases were previously described, either singularly or in small groups (3) (4) (5) . Interestingly, during the same period of the previous year, only 3 cases of GBS were admitted to our hospital.

We believe it worthwhile to communicate our experience and to raise awareness to healthcare professionals dealing with COVID-19 patients regarding the frequent PNS involvement of SARS- 

Electrophysiological classification of Guillain-Barré syndrome: clinical associations and outcome. Plasma Exchange/Sandoglobulin Guillain-Barré Syndrome Trial Group

Guillain-Barré Syndrome Associated with SARSCoV-2

Guillain-Barré syndrome related to COVID-19 infection

Guillain-Barré syndrome associated with SARSCoV