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  1. Article ; Online: Guillain-Barré syndrome as only manifestation of COVID-19 infection.

    d'Orsi, Giuseppe / Sica, Salvatore / Maiorano, Annamaria / Melchionda, Donato / Lalla, Alessandra / Montemurro, Laura / Sabetta, Annarita / Goffredo, Rossana / Lecce, Brunello / Fiore, Jose Ramon / Santantonio, Teresa / Avolio, Carlo

    Clinical neurology and neurosurgery

    2021  Volume 207, Page(s) 106775

    Abstract: ... link between neurological symptoms and COVID-19 infection, not only after viral prodrome and pulmonary ... Post-infectious/immune mediated effects of COVID-19 infection include descriptions of Guillain ... of viral illness. Asymptomatic cases for COVID-19 infection were rarely described. Herein, we studied a 62 ...

    Abstract Post-infectious/immune mediated effects of COVID-19 infection include descriptions of Guillain-Barré syndrome (GBS) in patients usually with respiratory failure and after 1-2 weeks from the onset of viral illness. Asymptomatic cases for COVID-19 infection were rarely described. Herein, we studied a 62-year-old patient with progressive weakness of lower extremities, rapidly evolving to a severe, flaccid tetraplegia and dysphagia. Neurological symptoms weren't preceded by fever or pulmonary symptoms. Because of laboratory test abnormalities (thrombocytopenia, lymphocytopenia, high inflammation indexes), the patient underwent to nasopharyngeal swab, resulted positive for SARS-CoV-2 on RT-PCR assay; cerebrospinal fluid (CSF) was negative for SARS-CoV-2. The clinical (severe symmetric distal upper and lower limbs weakness, grade 0/5; decreased proprioceptive sensitivity and hypoesthesia involving the four limbs; loss of deep tendon reflexes), electrophysiological (prevailing axonal polyradiculoneuritis) and CSF features (albumino-cytological dissociation) disclosed the GBS diagnosis (level 1 of diagnostic certainty according to the Brighton criteria). The patient received plasma exchange and immunoglobulin, and, at 4 weeks after treatment and physical therapy, the patient had moderate improvement (weakness at lower and upper extremities was grade 2/5 and 3/5, respectively). Neurologists and clinicians should be aware of the possible link between neurological symptoms and COVID-19 infection, not only after viral prodrome and pulmonary symptoms, but also without COVID-19 symptoms.
    MeSH term(s) COVID-19/complications ; COVID-19/diagnostic imaging ; COVID-19/therapy ; Guillain-Barre Syndrome/diagnostic imaging ; Guillain-Barre Syndrome/etiology ; Guillain-Barre Syndrome/therapy ; Humans ; Male ; Middle Aged ; Plasma Exchange/methods
    Language English
    Publishing date 2021-06-24
    Publishing country Netherlands
    Document type Case Reports ; Journal Article
    ZDB-ID 193107-6
    ISSN 1872-6968 ; 0303-8467
    ISSN (online) 1872-6968
    ISSN 0303-8467
    DOI 10.1016/j.clineuro.2021.106775
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Guillain-Barré syndrome

    Dalakas, Marinos C.

    Neurology - Neuroimmunology Neuroinflammation

    The first documented COVID-19–triggered autoimmune neurologic disease ; More to come with myositis in the offing

    2020  Volume 7, Issue 5, Page(s) e781

    Abstract: ... encephalomyelitis or myositis-even without systemic symptoms, may represent the first manifestation of COVID-19 ... for early diagnosis and therapy initiation. Although COVID-19 infection, like most other viruses, can potentially ... Objective To present the COVID-19–associated GBS, the prototypic viral-triggered autoimmune disease ...

    Abstract Objective To present the COVID-19–associated GBS, the prototypic viral-triggered autoimmune disease, in the context of other emerging COVID-19–triggered autoimmunities, and discuss potential concerns with ongoing neuroimmunotherapies. Methods Eleven GBS cases in four key COVID-19 hotspots are discussed regarding presenting symptoms, response to therapies and cross-reactivity of COVID spike proteins with nerve glycolipids. Emerging cases of COVID-19–triggered autoimmune necrotizing myositis (NAM) and encephalopathies are also reviewed in the context of viral invasion, autoimmunity and ongoing immunotherapies. Results Collective data indicate that in this pandemic any patient presenting with an acute paralytic disease-like GBS, encephalomyelitis or myositis-even without systemic symptoms, may represent the first manifestation of COVID-19. Anosmia, ageusia, other cranial neuropathies and lymphocytopenia are red flags enhancing early diagnostic suspicion. In Miller-Fisher Syndrome, ganglioside antibodies against GD1b, instead of QG1b, were found; because the COVID-19 spike protein also binds to sialic acid-containing glycoproteins for cell-entry and anti-GD1b antibodies typically cause ataxic neuropathy, cross-reactivity between COVID-19–bearing gangliosides and peripheral nerve glycolipids was addressed. Elevated Creatine Kinase (>10,000) is reported in 10% of COVID-19–infected patients; two such patients presented with painful muscle weakness responding to IVIg indicating that COVID-19–triggered NAM is an overlooked entity. Cases of acute necrotizing brainstem encephalitis, cranial neuropathies with leptomeningeal enhancement, and tumefactive postgadolinium-enhanced demyelinating lesions are now emerging with the need to explore neuroinvasion and autoimmunity. Concerns for modifications-if any-of chronic immunotherapies with steroids, mycophenolate, azathioprine, IVIg, and anti-B-cell agents were addressed; the role of complement in innate immunity to viral responses and anti-complement therapeutics (i.e. eculizumab) were reviewed. Conclusions Emerging data indicate that COVID-19 can trigger not only GBS but other autoimmune neurological diseases necessitating vigilance for early diagnosis and therapy initiation. Although COVID-19 infection, like most other viruses, can potentially worsen patients with pre-existing autoimmunity, there is no evidence that patients with autoimmune neurological diseases stable on common immunotherapies are facing increased risks of infection.
    Keywords covid19
    Language English
    Publisher Ovid Technologies (Wolters Kluwer Health)
    Publishing country us
    Document type Article ; Online
    ZDB-ID 2767740-0
    ISSN 2332-7812
    ISSN 2332-7812
    DOI 10.1212/nxi.0000000000000781
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: Guillain-Barré syndrome with bilateral facial diplegia secondary to severe acute respiratory syndrome coronavirus-2 infection: a case report.

    Ramirez, Natalia / Ujueta, David / Diaz, Luis Felipe / Folleco, Lucila Emilse / Rodríguez, Andrea / Gaona, Ivan / Nava-Mesa, Mauricio O

    Journal of medical case reports

    2021  Volume 15, Issue 1, Page(s) 558

    Abstract: ... of patients who presented Guillain-Barré syndrome related to  COVID-19 , with sensory and motor compromise ... of any neurological manifestation generated by COVID-19 and start performing more neurophysiological tests to determine ... in the extremities.: Case presentation: In this report, we describe a rare case of Guillain-Barré syndrome in a 50 ...

    Abstract Background: The new coronavirus, known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) owing to its similarity to the previous severe acute respiratory syndrome (SARS), is characterized by causing, in most patients, nonspecific symptoms similar to those of the common flu. It has been reported that many coronavirus disease 2019 (COVID-19) patients presented neurological symptoms that involve the central and peripheral nervous systems. In addition, there have been several reports of patients who presented Guillain-Barré syndrome related to  COVID-19 , with sensory and motor compromise in the extremities.
    Case presentation: In this report, we describe a rare case of Guillain-Barré syndrome in a 50-year-old Hispanic male with bilateral facial palsy as the only neurological manifestation, following SARS-CoV-2 infection. A complete neurophysiological study showed severe axonal neuropathy of the right and left facial nerves.
    Conclusion: Regardless of severity, clinicians must to be aware of any neurological manifestation generated by COVID-19 and start performing more neurophysiological tests to determine if the infection induces an axonal, myelin, or mixed involvement of the peripheral nervous system.
    MeSH term(s) COVID-19 ; Facial Nerve ; Guillain-Barre Syndrome/complications ; Guillain-Barre Syndrome/diagnosis ; Hispanic Americans ; Humans ; Male ; Middle Aged ; SARS-CoV-2
    Language English
    Publishing date 2021-11-15
    Publishing country England
    Document type Case Reports ; Journal Article
    ZDB-ID 2269805-X
    ISSN 1752-1947 ; 1752-1947
    ISSN (online) 1752-1947
    ISSN 1752-1947
    DOI 10.1186/s13256-021-03120-w
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  4. Article ; Online: Guillain-Barré syndrome: The first documented COVID-19-triggered autoimmune neurologic disease: More to come with myositis in the offing.

    Dalakas, Marinos C

    Neurology(R) neuroimmunology & neuroinflammation

    2020  Volume 7, Issue 5

    Abstract: ... Conclusions: Emerging data indicate that COVID-19 can trigger not only GBS but other autoimmune ... manifestation of COVID-19. Anosmia, ageusia, other cranial neuropathies and lymphocytopenia are red flags ... neurological diseases necessitating vigilance for early diagnosis and therapy initiation. Although COVID-19 infection ...

    Abstract Objective: To present the COVID-19-associated GBS, the prototypic viral-triggered autoimmune disease, in the context of other emerging COVID-19-triggered autoimmunities, and discuss potential concerns with ongoing neuroimmunotherapies.
    Methods: Eleven GBS cases in four key COVID-19 hotspots are discussed regarding presenting symptoms, response to therapies and cross-reactivity of COVID spike proteins with nerve glycolipids. Emerging cases of COVID-19-triggered autoimmune necrotizing myositis (NAM) and encephalopathies are also reviewed in the context of viral invasion, autoimmunity and ongoing immunotherapies.
    Results: Collective data indicate that in this pandemic any patient presenting with an acute paralytic disease-like GBS, encephalomyelitis or myositis-even without systemic symptoms, may represent the first manifestation of COVID-19. Anosmia, ageusia, other cranial neuropathies and lymphocytopenia are red flags enhancing early diagnostic suspicion. In Miller-Fisher Syndrome, ganglioside antibodies against GD1b, instead of QG1b, were found; because the COVID-19 spike protein also binds to sialic acid-containing glycoproteins for cell-entry and anti-GD1b antibodies typically cause ataxic neuropathy, cross-reactivity between COVID-19-bearing gangliosides and peripheral nerve glycolipids was addressed. Elevated Creatine Kinase (>10,000) is reported in 10% of COVID-19-infected patients; two such patients presented with painful muscle weakness responding to IVIg indicating that COVID-19-triggered NAM is an overlooked entity. Cases of acute necrotizing brainstem encephalitis, cranial neuropathies with leptomeningeal enhancement, and tumefactive postgadolinium-enhanced demyelinating lesions are now emerging with the need to explore neuroinvasion and autoimmunity. Concerns for modifications-if any-of chronic immunotherapies with steroids, mycophenolate, azathioprine, IVIg, and anti-B-cell agents were addressed; the role of complement in innate immunity to viral responses and anti-complement therapeutics (i.e. eculizumab) were reviewed.
    Conclusions: Emerging data indicate that COVID-19 can trigger not only GBS but other autoimmune neurological diseases necessitating vigilance for early diagnosis and therapy initiation. Although COVID-19 infection, like most other viruses, can potentially worsen patients with pre-existing autoimmunity, there is no evidence that patients with autoimmune neurological diseases stable on common immunotherapies are facing increased risks of infection.
    MeSH term(s) Aged ; Aged, 80 and over ; Autoimmune Diseases of the Nervous System/diagnosis ; Autoimmune Diseases of the Nervous System/etiology ; Autoimmune Diseases of the Nervous System/immunology ; Betacoronavirus/immunology ; COVID-19 ; Coronavirus Infections/complications ; Coronavirus Infections/diagnosis ; Coronavirus Infections/immunology ; Female ; Guillain-Barre Syndrome/diagnosis ; Guillain-Barre Syndrome/etiology ; Guillain-Barre Syndrome/immunology ; Humans ; Male ; Myositis/diagnosis ; Myositis/etiology ; Myositis/immunology ; Pandemics ; Pneumonia, Viral/complications ; Pneumonia, Viral/diagnosis ; Pneumonia, Viral/immunology ; SARS-CoV-2
    Keywords covid19
    Language English
    Publishing date 2020-06-09
    Publishing country United States
    Document type Case Reports ; Journal Article ; Review
    ZDB-ID 2767740-0
    ISSN 2332-7812 ; 2332-7812
    ISSN (online) 2332-7812
    ISSN 2332-7812
    DOI 10.1212/NXI.0000000000000781
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Guillain–Barré syndrome with bilateral facial diplegia secondary to severe acute respiratory syndrome coronavirus-2 infection

    Natalia Ramirez / David Ujueta / Luis Felipe Diaz / Lucila Emilse Folleco / Andrea Rodríguez / Ivan Gaona / Mauricio O. Nava-Mesa

    Journal of Medical Case Reports, Vol 15, Iss 1, Pp 1-

    a case report

    2021  Volume 6

    Abstract: ... of patients who presented Guillain–Barré syndrome related to COVID-19 , with sensory and motor compromise ... of any neurological manifestation generated by COVID-19 and start performing more neurophysiological tests to determine ... in the extremities. Case presentation In this report, we describe a rare case of Guillain–Barré syndrome in a 50-year ...

    Abstract Abstract Background The new coronavirus, known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) owing to its similarity to the previous severe acute respiratory syndrome (SARS), is characterized by causing, in most patients, nonspecific symptoms similar to those of the common flu. It has been reported that many coronavirus disease 2019 (COVID-19) patients presented neurological symptoms that involve the central and peripheral nervous systems. In addition, there have been several reports of patients who presented Guillain–Barré syndrome related to COVID-19 , with sensory and motor compromise in the extremities. Case presentation In this report, we describe a rare case of Guillain–Barré syndrome in a 50-year-old Hispanic male with bilateral facial palsy as the only neurological manifestation, following SARS-CoV-2 infection. A complete neurophysiological study showed severe axonal neuropathy of the right and left facial nerves. Conclusion Regardless of severity, clinicians must to be aware of any neurological manifestation generated by COVID-19 and start performing more neurophysiological tests to determine if the infection induces an axonal, myelin, or mixed involvement of the peripheral nervous system.
    Keywords COVID-19 ; SARS-CoV-2 ; Guillain–Barré syndrome ; Facial diplegia ; Medicine ; R
    Subject code 616
    Language English
    Publishing date 2021-11-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  6. Article: Guillain-Barré syndrome: The first documented COVID-19-triggered autoimmune neurologic disease: More to come with myositis in the offing

    Dalakas, Marinos C

    Abstract: ... Emerging data indicate that COVID-19 can trigger not only GBS but other autoimmune neurological diseases ... manifestation of COVID-19. Anosmia, ageusia, other cranial neuropathies and lymphocytopenia are red flags ... necessitating vigilance for early diagnosis and therapy initiation. Although COVID-19 infection, like most ...

    Abstract OBJECTIVE: To present the COVID-19-associated GBS, the prototypic viral-triggered autoimmune disease, in the context of other emerging COVID-19-triggered autoimmunities, and discuss potential concerns with ongoing neuroimmunotherapies. METHODS: Eleven GBS cases in four key COVID-19 hotspots are discussed regarding presenting symptoms, response to therapies and cross-reactivity of COVID spike proteins with nerve glycolipids. Emerging cases of COVID-19-triggered autoimmune necrotizing myositis (NAM) and encephalopathies are also reviewed in the context of viral invasion, autoimmunity and ongoing immunotherapies. RESULTS: Collective data indicate that in this pandemic any patient presenting with an acute paralytic disease-like GBS, encephalomyelitis or myositis-even without systemic symptoms, may represent the first manifestation of COVID-19. Anosmia, ageusia, other cranial neuropathies and lymphocytopenia are red flags enhancing early diagnostic suspicion. In Miller-Fisher Syndrome, ganglioside antibodies against GD1b, instead of QG1b, were found; because the COVID-19 spike protein also binds to sialic acid-containing glycoproteins for cell-entry and anti-GD1b antibodies typically cause ataxic neuropathy, cross-reactivity between COVID-19-bearing gangliosides and peripheral nerve glycolipids was addressed. Elevated Creatine Kinase (>10,000) is reported in 10% of COVID-19-infected patients; two such patients presented with painful muscle weakness responding to IVIg indicating that COVID-19-triggered NAM is an overlooked entity. Cases of acute necrotizing brainstem encephalitis, cranial neuropathies with leptomeningeal enhancement, and tumefactive postgadolinium-enhanced demyelinating lesions are now emerging with the need to explore neuroinvasion and autoimmunity. Concerns for modifications-if any-of chronic immunotherapies with steroids, mycophenolate, azathioprine, IVIg, and anti-B-cell agents were addressed; the role of complement in innate immunity to viral responses and anti-complement therapeutics (i.e. eculizumab) were reviewed. CONCLUSIONS: Emerging data indicate that COVID-19 can trigger not only GBS but other autoimmune neurological diseases necessitating vigilance for early diagnosis and therapy initiation. Although COVID-19 infection, like most other viruses, can potentially worsen patients with pre-existing autoimmunity, there is no evidence that patients with autoimmune neurological diseases stable on common immunotherapies are facing increased risks of infection.
    Keywords covid19
    Publisher WHO
    Document type Article
    Note WHO #Covidence: #592228
    Database COVID19

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