Pearls & Oy-sters: Delayed Diagnosis of Acute Motor Axonal Neuropathy With Cardiac Arrest

We present the case of a 53-year-old female who presented with right lower extremity weakness with preceding systemic symptoms including fever and chest pain. She developed rapid quadriparesis over 24 hours and had ventricular fibrillation with cardiac arrest. Examination demonstrated tetraplegia, facial diplegia with spared extra-ocular movements and areflexia. Electrodiagnostic studies including nerve conduction studies and electromyography were consistent with Acute Motor Axonal Neuropathy (AMAN). This case highlights an atypical asymmetric presentation with initially preserved reflexes, rapid progression and cardiac dysfunction that can occur independent of dysautonomia. Treatment options include intravenous immunoglobulin (IVIg) or plasmapheresis as well as supportive care and long term multidisciplinary rehabilitation and communication strategies.

Guillain–Barré syndrome with bilateral facial diplegia secondary to severe acute respiratory syndrome coronavirus-2 infection: a case report

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.

Diplegia nervi facialis paraesthesiával – ritka Guillain–Barré-szindróma-variáns, SARS-CoV-2-infekciót követően

Összefoglaló. A COVID–19 világméretű járvány kapcsán már jól ismertek az általános akut tünetek, mint a láz, a száraz köhögés, a nehézlégzés, a tüdőgyulladás, a hasi panaszok, a hasmenés, az ízérzés- és szaglásvesztés. Talán kevésbé ismertek a betegség neurológiai szövődményei: az encephalitis, a fejfájás és szédülés, az ischaemiás stroke, az akut haemorrhagiás nekrotizáló encephalopathia, de agitáltság és exekutív funkciózavar is kialakulhat. Hosszabb távon az úgynevezett poszt-COVID-szindróma jelenhet meg, perzisztáló testi panaszokkal, krónikusfáradtság-érzéssel, depresszióval, mentális problémákkal. A perifériás idegrendszeri betegségek közül a Guillain–Barré-szindróma fordul elő gyakrabban. Jelen közleményünkben egy diplegia nervi facialis, dysarthria és négy végtagot érintő szubjektív paraesthesiák miatt hospitalizált 41 éves férfi betegünk esetét ismertetjük, akinek felső légúti tünetekkel és lázzal járó SARS-CoV-2-infekciót 10–14 nappal követően jelentek meg neurológiai tünetei. Elektrofiziológiai és liquor laboratóriumi vizsgálat során alátámasztott módon, ritka Guillain–Barré-szindróma-variáns – bifacialis paresis paraesthesiával – igazolódott. Fontos, hogy a vírus idegrendszeri szövődményeit is ismerjük, mert az esetszámok a jövőben várhatóan növekedni fognak. Orv Hetil. 2021; 162(45): 1803–1807. Summary. After the worldwide spread of COVID-19, common symptoms are already well known as fever, coughing, shortness of breath, pneumonia, abdominal pain and diarrhea, either loss of olfaction or sense of taste. Neurological complications are perhaps less known as headache, dizziness, agitation, executive dysfunction or, in particular cases, viral encephalitis and acute hemorrhagic necrotizing encephalitis may also occur. In COVID-19 patients, ischemic stroke or cerebral vein thrombosis are also more commonly related to the increased risk of thrombosis. In the long term, so called post-COVID syndrome can emerge in the form of fatigue, depression or many other mental disorders. The most common disease of the peripheral nervous system is Guillain–Barré syndrome. This chapter reviews a case of a 41-year-old man presented to the Department of Neurology with facial diplegia, dysarthria and intermittent paresthesia of the upper and lower extremities. 10–14 days before the onset of neurological symptoms, he has gone through COVID-19 infection that involved fever and upper respiratory tract symptoms. Electrophysiology and liquor samples showed typical signs of a rare Guillain–Barré syndrome subtype – bifacial weakness with paresthesias. We are reviewing the neurological complications of the virus due to the expected increase of case numbers. Orv Hetil. 2021; 162(45): 1803–1807.

Facial Diplegia—Complication or Manifestation of SARS-CoV-2 Infection? A Case Report and Systemic Literature Review

Since the outbreak of the new coronavirus, healthcare systems around the world have witnessed not only COVID-19 symptoms but also long-term complications of the aforementioned, including neurological problems. We report a clinical case of an adult patient with bilateral facial nerve palsy and progressive ascending paresis of the limbs after contracting the novel coronavirus (COVID-19). Additionally, the systematic review aimed to identify and summarize specific clinical features, outcomes and complications of the studies focusing on bilateral facial diplegia as a sequela of COVID-19 infection. The total number of analyzed patients was 15. Only one patient was diagnosed with isolated bilateral palsy; the rest had Guillain-Barré Syndrome (GBS). With one exception, all the presented cases had favorable outcomes, with facial palsy recovery from slight to almost complete. In patients with a confirmed COVID-19 diagnosis, bilateral facial palsy may be an isolated symptom as well as a variant of GBS. Symptoms of cranial nerve damage during a COVID-19 infection may explain the appearance of facial nerve damage. In order to clarify the spectrum of neurological manifestations and a causal relation between SARS-CoV-2, COVID-19 vaccination and neurological symptoms, direct attention towards the study of this virus is crucial. It seems reasonable to recognize human coronavirus as another potential GBS trigger.

Miller-Fisher Syndrome and Guillain-Barre Syndrome overlap syndrome in a patient post Oxford-AstraZeneca SARS-CoV-2 vaccination

We describe a patient who developed bilateral oculomotor nerve palsy, ataxia, facial diplegia and lower limb weakness 2 weeks post-Oxford-AstraZeneca SARS-CoV2 vaccination, consistent with Miller-Fisher syndrome (MFS) and Guillain-Barre syndrome (GBS) overlap syndrome. Although some features of the patient’s presentation were typical of recently reported cases of a rare GBS variant post-Oxford-AstraZeneca vaccination, including severe facial weakness and a lack of respiratory involvement, to our knowledge this is the first reported case of MFS associated with SARS-CoV2 vaccination. While postvaccination GBS remains rare, it appears to have a favourable prognosis, and recognising this entity is therefore important for patient counselling and monitoring for potential complications.

Guillain‐Barré syndrome presenting with facial diplegia following COVID‐19 vaccination in two patients

In March 2020, the WHO declared COVID‐19 to be a global pandemic and since December 2020, millions of vaccines have been administered. To date, cases of Guillain‐Barré syndrome (GBS) following a COVID vaccine (Pfizer, Johnson & Johnson, Janssen, AstraZeneca) have been reported. A 61-year-old woman developed bilateral asymmetrical lower motor neuron (LMN) facial weakness followed by limb symptoms, 10 days after receiving the first dose of AstraZeneca COVID vaccine. The second patient was a 56-year-old man who, 9 days after receiving first dose of AstraZeneca COVID vaccine, developed bilateral asymmetrical LMN facial weakness with limb symptoms. Intravenous immunoglobulin was administered with rapid recovery. These cases of GBS following the AstraZeneca COVID vaccine add to cohort of patients reported. We flag up to raise awareness of this condition post‐COVID‐19 vaccine and highlight the prominent bifacial involvement. Early diagnosis and prompt treatment with intravenous immunoglobulin led to rapid recovery.

A Novel Case of Bifacial Diplegia Variant of Guillain-Barré Syndrome Following Janssen COVID-19 Vaccination

Guillain-Barré syndrome (GBS) is an immune-mediated demyelinating disorder which attacks the peripheral nervous system. Antecedent infection or vaccine administration are known to precipitate the onset of this disorder. Its typical presentation leads to a symmetric, rapidly progressive, ascending paresis with associated sensory deficits and impaired reflexes. We present a rare case of a bi-facial diplegia variant of GBS, within four weeks of the COVID-19 vaccination. Due to its chronology, clinical manifestations, and cerebrospinal fluid (CSF) findings, we propose this case to be a rare complication of the COVID-19 vaccination.