ave been multiple reports of Guillain-Barré syndrome (GBS) associated with the COVID-19 infection (Sedaghat and Karimi, 2020, Toscano et al.,, Zhao et al., 2020). Most COVID-19-related GBS presented with acute onset of areflexic quadriparesis. However, there are some important differences to highlight (table 1 ). (Garg et al., 2018). Most patients with COVID-19-related GBS were elderly. Preceding symptoms like ageusia and hyposmia were unique for COVID-19 infection. Patients with COVID-19-related GBS had a severe disease with respiratory failure due to lobar pneumonia and interstitial pneumonitis. They showed ground-glass appearance of lungs on chest computerized tomography. Increased severity of disease is also evident from the electrophysiology study. Where demyelinating neuropathy is more common with typical GBS and GBS related to dengue and Zika virus, majority of COVID-19-related GBS patients had axonal motor (AMAN) and axonal motor-sensory polyneuropathy (AMSAN). A few of these patients showed enhancement of caudal nerve roots on Gadolinium-enhanced MRI of spine. Most COVID-19 patients received hydroxychloroquine, azithromycin, lopinavir and ritonavir in addition to intravenous immunoglobulin (IVIG). However, more than half of patients showed poor outcome in the form of long ICU stay, residual paresis and dysphagia.
Table 1 Differences in the presentation of Typical GBS, Dengue, Zika virus and COVID SARS related GBS.
Feature Typical GBS Dengue-related GBS Zika virus-related GBS COVID SARS related GBS
Geographical distributionAgeSexPreceding illnessMean time to GBSInitial symptomsDysphagiaSignsFacial diplegiaDy