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Copyright of Gaceta Médica de México is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives Neurological manifestations of Severe Acute Respiratory Syndrome coronavirus-2 have been well documented in adults during and after infection with the virus as well as after vaccination. The incidence of severe neurological symptoms among children is very low. This study aimed to analyze the varied neurological manifestations after COVID-19 infection among children and give a report on a single-center experience with these severe neurological symptoms Materials & Methods Case records of patients less than 18 years admitted between July 2021 to December 2022 with neurological manifestations and COVID-19 infection or with elevated COVID-19 antibodies after exclusion of other etiological diagnosis were analyzed. Results There were 10 cases in the age range of 1-15 years. All the cases had elevated COVID-19 antibodies with history of contact 2-3 weeks prior except one who was positive for COVID-19 infection. Two cases presented with acute ascending paralysis suggestive of Guillain-Barre syndrome. Four cases presented with features of encephalopathy with clinical presentation fulfilling the criteria of Multisystem inflammatory syndrome in children. One case presented with fever and focal seizures with MRI showing sagittal sinus thrombosis, and one presented with fever and altered sensorium with MRI showing leukoencephalopathy. One child had cerebral mucormycosis without any evidence of immunosuppression. There was one child with features of encephalopathy with active COVID-19 infection. Conclusion The varied presentation highlights the central and peripheral nervous system involvement by the virus in the pediatric population. It also emphasizes the need to investigate for COVID-19 in children presenting with these complaints during the pandemic. [ABSTRACT FROM AUTHOR]

Acute inflammatory demyelinating polyneuropathy Guillain-Barre's syndrome is typically brought on by an immunological reaction following certain post-infections. GBS causes nerve damage resulting in muscle weakness, tingling sensation and paralysis due to nerve injury. (1) It can be comparable to Sarvangavata, according to Ayurveda. The fatty myelin coating that surrounds the nerve cells protects them. The neurological system requires an insulating layer to operate properly, which is created as a result. It can also be compared to medogata vata. Since myelin contains about 40% water, the dry mass is made up of 60% to 75% lipid and 15% to 25% protein. (2) Ayurveda offers Panchakarma therapy to lessen the sickness by easing the symptoms of GBS. A 55-year-old male patient was unable to sit, stand or walk due to abrupt onset of weakness in both lower limbs. The patient was also covid 19 positive, one month before the onset of these symptoms. For the same patient has been hospitalised and underwent proper covid management. Eventually complaints of weakness in the lower limbs and GBS led the patient to seek additional medical attention and receive IV Ig injections. After receiving immunoglobulin therapy there was no expected recovery. Hence the patient has been admitted to our hospital as in patient for further management. [ABSTRACT FROM AUTHOR]

Familial Mediterranean Fever (FMF) is the most common autoinflammatory disease characterized by recurrent episodes of abdominal pain, fever and serositis. It is more common in countries around the Mediterranean. Guillain Barre Syndrome (GBS) is an acute, immune-mediated polyneuropathy affecting peripheral nerves and nerve roots. Central nervous system involvement is not common in the course of FMF. Guillain Barre Syndrome developed in a patient who was followed with colchicine treatment for 1 year due to Familial Mediterranean Fever. In a literature study, no association of these two diseases was found. This case is presented to draw attention to the coexistence of immune-mediated Familial Mediterranean Fever and Guillain Barre Syndrome.

Purpose: We aimed to evaluate the clinical characteristics of Guillain Barré syndrome (GBS) patients retrospectively and identify the prognostic factors associated with worse outcome at discharge and at the end of the first month in patients with GBS. Materials and Methods: Patients who were followed up with the diagnosis of GBS were evaluated retrospectively. Demographic characteristics of the patients, cerebrospinal fluid examinations, treatment regimens, Medical Research Council (MRC) and Hughes Motor Scale (HMS) scores were recorded and HMS =3 was accepted as associated with poor prognosis in patients. SPSS version 25 program was used in the statistical analysis of the data. p<0.05 was found to be statistically significant. Results: After the exclusion criteria 82 patients were evaluated in this study. The mean age of patients was 56.88±17.14 years and 57.3% (n=47) of the patients were male. The most common neurological finding was paresis in the lower extremities (n=67, 81.7%) followed by paresis in the upper extremities (n=48, 58.5%). Presence of paresis in lower extremities, the median of the duration of hospitalization and the mean of MRC scores at admission were statistically significantly different in patients with poor prognosis at discharge and at the end of the first month. Conclusion: Since patients may have different clinical and electrophysiological characteristics between countries, we believe that there is a need for various publications from different countries to collect information related to the clinical features and prognosis of patients, and we think our study will contribute to these data. [ABSTRACT FROM AUTHOR]

Introduction. Neurological manifestations secondary to Hymenoptera stings are rare. However, the literature describes cases of severe central and peripheral nervous system damage. Suspected pathophysiological mechanisms include hypoxic-ischemic damage, demyelination, and the direct neurotoxic effect of venoms. In this context, bee stings could be a possible atypical causative factor for Guillan–Barré syndrome and chronic inflammatory demyelinating polyneuropathy. Case report. We present the case of a 32-year-old patient who declared the presence of a bee sting two weeks before the onset of neurological manifestations (flaccid quadriparesis, predominantly distal, with paresthesia at the same level) that were initially diagnosed as a Guillain Barré syndrome. Despite the treatment with immunoglobulins in the acute phase, the worsening of the motor deficit after one month required a new course of immunoglobulins, associating corticosteroids, with initially favorable evolution. However, the presence of a new relapse after eight weeks, correlated with changes such as albumin-cytological dissociation in the examination of the cerebrospinal fluid and the appearance of active denervation on the electroneuromyography study, established the final diagnosis of chronic inflammatory demyelinating polyneuropathy. Conclusions. We consider the presented case proof of the relationship between the Hymenoptera sting and various peripheral nervous system pathologies. Inflammatory and demyelinating changes common to Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy appear to be the primary pathophysiological mechanism to explain this uncommon correlation.

Background and Aim: Plasmapheresis or plasma exchange is the most effective and treatment of choice in many neurological disorders. Thus the objective was to study the efficacy of plasmapheresis, compared to other therapies in Guillain Barre Syndrome (GBS). Materials and Methods: A prospective interventional study done on 164 patients with acute neurological disorder i.e., Guillain Barre Syndrome (GBS) admitted in a tertiary hospital in South India. 22 patients were treated with IVIg, 46 with small volume plasma exchange (SmVPE) and 5 with large volume plasma exchange (LVPE). They were compared with 91 patients on supportive therapy. Outcome of treatment was assessed by Hughes disability score and mortality at the end of 2weeks, one month and 3 months. Data analysed in percentages, paired and unpaired t-test. Results: Out of 164 patients, 1.8% overall mortality was observed. Although early recovery (14days) was seen with IVIg compared to plasmapheresis (18 days), improve in muscle weakness was more by one grade early in SmVPE than IVIg. Statistically significant improvement was seen in three treatment modalities compared to control but equal efficacy observed in plasma exchange and IVIg. Conclusions: In a developing country like India where socio economic status is very low where many people who can't afford costlier treatment like IVIG and PE, they can be treated with small volume plasma exchanges which are cheaper and with fewer complications. [ABSTRACT FROM AUTHOR]

Copyright of Argentinian Journal of Respiratory & Physical Therapy (AJRPT) is the property of Asociacion Civil Cientifica de Difusion y Promocion de la Kinesiologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Gaceta Médica de México is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background & Objective: This study aimed to determine the relationship between COVID-19 infection/vaccination and Guillain-Barré syndrome (GBS) and to compare clinical characteristics and functional outcomes between COVID-19-related and non-COVID-19 GBS patients. Method: The medical files of the patients who sought treatment with the diagnosis of GBS between March 2020 and July 2022 were retrospectively analyzed. The patients were divided into groups as COVID-19-related GBS (C-GBS) and non-COVID-19 GBS (NC-GBS). Demographic and clinical characteristics, neurological examination findings, treatment protocols, and outcomes, including functional status, ambulation level, independence in daily living activities, and anxiety-depression levels of the patients with GBS, were recorded. Results: A total of 25 patients were included in the study. GBS was found to be associated with COVID-19 in 9 (36%) patients. Among them, 5 (20%) patients developed GBS after COVID-19 infection and 4 (16%) after the COVID-19 vaccine. The latency between COVID-19 infection and the onset of GBS ranged from 7 to 60 days, and the latency between vaccination and the onset of GBS ranged from 3 to 60 days. The clinical presentation and features, disease severity, and electrodiagnostic patterns of C-GBS patients were similar to NC-GBS patients. Also, there was no significant difference between patients with C-GBS and NC-GBS regarding functional status, ambulation level, functional independence in daily activities, and anxiety-depression levels. Conclusion: GBS is not uncommon in COVID-19. In this study, 20% of GBS cases admitted to our hospital during the pandemic seem to be associated with COVID-19 infection and 16% with COVID-19 vaccination. However, clinical features and functional outcomes of C-GBS and NC-GBS cases are similar. [ABSTRACT FROM AUTHOR]

Guillain Barre syndrome (GBS) as a complication of hyaluronic acid (HA) exposure is an extremely rare occurrence. We report a case of GBS, acute motor sensory axonal neuropathy (AMSAN) variant, after a HA breast enhancement procedure. A 41-year-old lady underwent a HA breast enhancement procedure from an unlicensed beautician and developed anaphylaxis followed by bilateral breast abscess and neurological deficits involving both motor and sensory components. The AMSAN variant of GBS was diagnosed from the cytoalbuminologic dissociation and nerve conduction study. Her GBS and breast abscess were managed with plasmapheresis and bilateral mastectomy. In this case, GBS was highly suspected to be caused by HA with possible impurities. To the author's knowledge, the association between HA and GBS has not been reported or known, and further studies are required to establish this association. To prevent mortality and morbidity, breast enhancement procedures should be performed by trained professionals with properly vetted products. [ABSTRACT FROM AUTHOR]

Background: Sensory nerve conduction parameters in Guillain Barre Syndrome (GBS) are underemphasized. Objective: To describe abnormalities on sensory conduction studies in a large cohort of prospectively evaluated patients of GBS and to correlate with clinico-electrophysiological features. Methods and Materials: Sensory conduction parameters of three nerves (median, ulnar, and sural) were analyzed using standard protocols in 238 patients (M: F 163:75, mean age: 35.76 ± 15.9 years). Electrophysiological subtyping was based on criteria of Hadden et al., and Rajabally et al. Results: Among patients with "typical" GBS who underwent electrophysiological testing within 30 days of symptom-onset (n = 219), 183 (83.5%) had abnormal sensory potentials (one nerve = 52, two nerves = 77, all three nerves = 54). Frequency of abnormalities in sensory potentials increased with duration of illness. Commonest abnormality was reduced amplitude or in-excitable nerves. Mean amplitude and velocity of median and ulnar nerve sensory potentials were significantly lower among those with demyelinating electrophysiology (P < 0.05). Proportion of subjects with reduced amplitude and velocity of median and ulnar nerve sensory potentials was higher among those who required mechanical ventilation (P < 0.05). Frequency of "sural sparing" ranged from 10.5% to 84.5% depending on the criteria used and almost always was significantly associated with demyelinating neuropathy. Conclusion: This prospective study provides comprehensive data on sensory conduction parameters in GBS. Abnormalities are frequent and vary with duration of illness. While median nerve is most frequently and more severely affected, involvement of sural nerve may have prognostic value. [ABSTRACT FROM AUTHOR]

Preceding infection with Campylobacter jejuni (Cj) occurs in approximately 30% of patients with Guillain–Barre syndrome (GBS), and the risk of GBS following Cj infection is increased by 77 to 100-fold. GBS is most often of the axonal subtype and is thought to be mediated by IgG antibodies to peripheral nerve gangliosides that are cross reactive with oligosaccharides in the Cj lipopolysaccharides (LPS). The antibodies are thought to be induced by molecular mimicry, where immune reactivity to a cross reactive epitope in the infectious organism and normal tissue can cause autoimmune disease. Clonally restricted IgM antibodies that react with the same oligosaccharides in gangliosides and Cj-LPS are associated with chronic neuropathies of otherwise similar phenotypes. The anti-ganglioside antibodies in GBS are of the IgG1 and IgG3 subclasses, indicating T-cell reactivity to the same antigens that could help disrupt the blood–nerve barrier. Cj infection can activate multiple innate and adoptive pro-inflammatory pathways that can overcome immune tolerance and induce autoimmunity. Elucidation of the specific immune mechanisms involved in the development of the autoantibodies and neuropathy would help our understanding of the relation between infection and autoimmunity and aid in the development of more effective preventive interventions and therapies. [ABSTRACT FROM AUTHOR]

Immunoglobulin infusion (IVIG) is one of the first line therapy in Guillain Barre Syndrome (GBS). Several medical complications are associated with GBS (pneumonia, sepsis, deep vein thrombosis, dysautonomy). Acute kidney injury (AKI) is an uncommon complication during IVIG infusion. Several risk factors were associated with AKI during IVIG. These are an older age, previous renal disease, concomitant use of nephrotoxic agents, diabetes mellitus, hypovolemia, sepsis or using of IVIG that contained in its preparation sucrose or mannitol as stabilizers to avoid precipitation and aggregation. Infusion rate and total dose play a determinant role. The most important pathophysiological mechanism of AKI are the osmotic stress applied to the epithelium of proximal tubules and glomeruli. The osmotic overload is principally generated by IVIG stabilizers (sucrose). In general, AKI is reversible but approximately 30% hemodialysis is necessary. It is essential to respect doses, infusion rates and closely monitoring renal function parameters during IVIG infusion.

Guillain Barré syndrome (GBS) and its variants, and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP and its variants, are regarded as immune mediated neuropathies. Unlike in many autoimmune disorders, GBS and CIDP are more common in males than females. Sex is not a clear predictor of outcome. Experimental autoimmune neuritis (EAN) is an animal model of these diseases, but there are no studies of the effects of sex in EAN. The pathogenesis of GBS and CIDP involves immune response to non-protein antigens, antigen presentation through non-conventional T cells and, in CIDP with nodopathy, IgG4 antibody responses to antigens. There are some reported sex differences in some of these elements of the immune system and we speculate that these sex differences could contribute to the male predominance of these diseases, and suggest that sex differences in peripheral nerves is a topic worthy of further study.

Purpose: To add to the growing literature regarding the possible link between the onset of Guillain Barre syndrome (GBS) and Bickerstaff brainstem encephalitis (BBE) and the coronavirus disease (COVID-19) vaccines. Case reports: The first patient is a 38-year-old man that presented muscle weakness and an unsteady gait for a duration of one week. Initially, he developed an unsteady gait, then gradually worsening generalized muscle fatigue and ascending weakness in all limbs. He tested positive for GM1 and GQ1D antibodies, and magnetic resonance imaging (MRI) of the lumbar spine with contrast and nerve conduction study (NCS) results were both suggestive of acute motor axonal neuropathy (AMAN). The second patient is a 54-year-old man that developed generalized fatigue and subjective fever associated with headache and blurry vision followed by bulbar dysfunction. During hospitalization, his consciousness level started to be affected and he developed ataxia with ophthalmoparesis. A diagnosis of BBE was made based on clinical, imaging, and cerebrospinal fluid (CSF) findings. Conclusion: Since temporal relationships do not signify causation, we cannot draw any conclusions regarding the association between COVID-19 vaccines and these neurological disorders. However, it is vital that new cases are reported so that the knowledge base is built upon, and to increase healthcare workers’ vigilance for early signs of GBS or BBE.

Therapeutic plasma exchange (TPE), is based on the removal of pathogenic substrates from plasma with replacement fluid. Especially in refractory cases to standart treatment protocols, TPE procedures are performed for many neurological disorders. The aim of this study was to analyse the efficacy and safety of TPE in patients with neurological disorders. This retrospective study was conducted between 2012 and 2021 in our tertiary referral hospital, Adult Hematology Clinic and Therapeutic Apheresis Unit. The study included 59 patients with a total of 267 therapeutic procedures. The response to treatment was evaluated with the Medical Research Council (MRC) scoring system. The 59 patients comprised of 30 (50.8%) males and 29 (49.2%) females with a median age of 52 [20-80] years. Of these patients 44.1% were diagnosed with Myastenia Gravis (MG), 27.3% with Guillain Barre Syndrome (GBS), and 8.5% with Multiple Sclerosis (MS). The median number of TPE sessions per patient was 5 (1-7). The overall response rate was 76.3%. Patients with Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIPD), Transverse myelitis (TM), and MG have higher rates than other disease subtypes. The MRC score was significantly higher in the group with response than the group with no symptom regression (p= 0.001). The current study highlighted that TPE is a safe and effective treatment option with mild to moderate and manageable adverse events in patients with neurological disorders. Evaluation of response with the MRC scoring system was beneficial as a reliable quantative response. [ABSTRACT FROM AUTHOR]

Background. Guillain Barre syndrome (GBS) is a rare autoimmune neurological disorder resulting in variable clinical course and outcome. Various factors such as age, symptoms and disease form that influence the outcome of GBS have been previously studied. Aim. This study aimed at identifying factors affecting the outcomes in patients with GBS. Methods. A retrospective observational study was conducted on GBS (ICD-G61.0) patients admitted to the hospital between 2014 and 2019. Patient information on demographics, medical and medication history, laboratory parameters, electrophysiological data, type of GBS and therapy received were retrieved from medical records. Univariate and multivariate analysis were conducted to identify factors associated with outcome (improved and not improved) and calculate odds ratio (OR). Results. A total of 212 GBS patients were included in the study, of which 67% were males and the mean age was 39.9±20.1 years. 168 (79%) patients showed improvement whereas the remaining 44(21%) did not show improvement. Patients with hypertension (OR=4.512; CI=1.309-15.556, p=0.017), alcoholics (OR=5.148; CI=1.234-21.472, p=0.025), sepsis (OR= 9.139; CI=1.102-75.760, p=0.040) and cardiac arrest (OR=17.495; CI=1.249-245.027, p=0.034) were associated with risk of no improvement. Whereas those treated with IVIgG plus Physiotherapy/Occupational therapy (OR=0.062; CI=0.016-0.242, p=0.001) and Plasmapheresis plus Physiotherapy/Occupational therapy (OR=0.007; CI=0.000-0.147, p=0.001) were associated with improvement. Conclusion. Understanding these factors help to further give a more directed and focused management to improve the condition in patients who are at risk of poor outcome. Further follow-up studies could be done to determine and manage the residual disabilities associated with GBS to improve patient's quality of life. [ABSTRACT FROM AUTHOR]

Guillain–Barré syndrome is an acute immune‐mediated demyelinating disease. Typical features include progressive ascending lower extremity weakness and areflexia. Several variants have been described that can make the diagnosis challenging. Here, we report a case of GBS presenting with progressive lower limb weakness and T6 sensory level. To bring attention to the wide spectrum of presentation of Guillain–Barre syndrome by presenting a rare, atypical variant with a sensory level which was successfully managed by our team so that clinicians keep this deferential in mind when they face patients with such neurological manifestation. [ABSTRACT FROM AUTHOR]

Background: Guillain Barre syndrome (GBS) is an immune-mediated peripheral neuropathy characterized by the demyelination and axonal damage of the peripheral neurons. The pathogenesis of GBS involves the breakdown of the blood-brain barrier after which pro inflammatory cytokines attack the neurons in the peripheral nervous system.Aims: This study aims to evaluate five markers, namely matrix metalloproteinase (MMP)-2 and MMP-9, vascular endothelial growth factor (VEGF)-A, basic fibroblast growth factor (bFGF), and SFLT-1, which could have a role in the inflammatory response in patients with GBS and healthy controls.Settings and Design: In this prospective study, patients diagnosed with GBS at the department of neurology, Kasturba Medical College, Manipal, Karnataka were enrolled.Methods and Material: The markers selected for this study were analyzed using the ELISA method and expressed as given in the kit provided by the company. Ethical clearance was obtained from the Institutional Ethical Committee.Statistical Analysis: Results were evaluated using SPSS version 17.0 and expressed as mean ± SD. Error bars for each were drawn.Results: The levels of all five parameters showed a significant increase in patients as compared to controls.Conclusions: Disruption of the basement membrane of endoneurium by MMP-2 and MMP-9, recruitment and migration of macrophages and other cytokines by VEGF-A, bFGF, and soluble fms-like tyrosine kinase-1 (SFLT-1) are plausible, which leads to inflammation process and thus neuronal damage leading to the development of GBS. [ABSTRACT FROM AUTHOR]

Since the first-reported case of Severe Acute Respiratory Distress Syndrome-Coronavirus 2 in December 2019, COVID-19 has caused a global pandemic associated with significant morbidity and mortality. After a year of advances in vaccine research and development, three vaccines for the prevention of COVID-19 (manufactured by Pfizer, Moderna and Johnson & Johnson’s Janssen Biotech) are approved for use in the USA. We report the first case of Guillain–Barre Syndrome after receiving the second dose of the Pfizer COVID-19 vaccine, in a 42-year-old woman presenting with progressive ascending weakness and paresthesias. Diagnostic workup demonstrated cytoalbuminologic dissociation on cerebrospinal fluid analysis with confirmatory evidence of early demyelinating electrodiagnostic features on nerve conduction study and an extensive serological workup being negative for other viral or autoimmune disease triggers. Management included administration of intravenous immunoglobulin (total of 2 gm/kg), with frequent monitoring of forced vital capacity and negative inspiratory force. A longitudinal risk profile of neurologic complications caused from COVID-19 vaccines remains limited, and prompt recognition of potential neurological complications from the COVID-19 vaccine is of interest to public health.

We report a case of a 59-year-old male who had acute, severe, rapidly progressive ascending weakness, which progressed to difficulty of breathing in a span of twelve hours. Neurophysiologic studies showed acute denervation compatible with acute motor axonal neuropathy. He was started on intravenous immunoglobulin therapy on the first day of hospitalization and completed five days of treatment but still developed decrease in sensorium and bilateral ophthalmoplegia. Imaging studies of the brain and cervical spinal cord showed findings that are non-contributory to the clinical presentation, leading to the consideration of Bickerstaff's brainstem encephalitis. Pulse therapy with high dose methylprednisolone for five days was given however, despite maximal treatment, he expired on the 12th day of illness. Post-mortem immunohistochemical studies of the pons and sural nerve showed areas of inflammation and demyelination in both areas, suggesting combined central and peripheral demyelination in a single patient. Literature review shows that our patient presents with atypical clinical and diagnostic features, different from Bickerstaff's brainstem encephalitis and combined central and peripheral demyelination, suggesting another disease entity presenting as acute fulminant neuropathy. [ABSTRACT FROM AUTHOR]

Guillain Barré Syndrome (GBS) is a clinical entity that may prove to be difficult to diagnose in children. With the emergence of the COVID-19 pandemic, it is especially important to not just recognize the classic form, but the variants and mimics as well. Four cases are described, aiming to outline the differences in presentations and the importance of appropriate diagnosis.

Immune checkpoint inhibitor-related neurotoxicity causing Guillain Barre Syndrome is relatively uncommon. We discussed an 80-year-old patient with known systemic lupus erythematosus who presented with lower extremity weakness, areflexia and then progressed to respiratory muscle and upper extremity weakness after receiving immunotherapy with checkpoint inhibitors for metastatic bladder cancer. With the increasing use of immunotherapy for the management of cancer, awareness of neurological autoimmune side effects is essential. Immune checkpoint inhibitor-mediated GBS can be severe and fatal if not diagnosed promptly. The hospitalists, neurologists, and oncologists should be aware of neurotoxicity related to immune checkpoint inhibitor therapy requiring a multidisciplinary approach to patient care. Prompt initiation of immunosuppressive therapy is required for the management of immune checkpoint inhibitor-related neurotoxicity.

OBJECTIVE: Since the outbreak of coronavirus disease in 2019 (COVID-19), multiple systemic issues, including respiratory and nervous system complications, have evolved constantly. CASE REPORT: We present a COVID-19 case of a 7-years old male child with Guillain Barré Syndrome (GBS) symptoms. The patient complained of cough, throat pain, and acute progressive symmetric ascending quadriparesis. Eventually, on day-12 of hospitalization, he was diagnosed with GBS. The patient’s condition worsened over time; thus, he was shifted to ICU, where he had an episode of cardiac arrest and was revived through CPR. The biochemical analysis of the CSF revealed albuminocytologic dissociation. The patient was considered for regular follow-up of GBS and presently has recovered from GBS/COVID-19 induced GBS. Thus, there is a possibility of SARS-CoV-2 infection-induced GBS in children. CONCLUSIONS: More studies are needed to know the neurological manifestations of SARS-CoV-2 infection in the pediatric population.

Teaching point: Guillain-Barre Syndrome is a rare cause of a walking disorder during childhood. MRI is a key role for diagnosis.

Campylobacter jejuni causes foodborne gastroenteritis and may trigger acute autoimmune sequelae including Guillain Barré Syndrome. Onset of neuromuscular paralysis is associated with exposure to C. jejuni lipooligosaccharide (LOS) classes A, B, C, D, and E that mimic and evoke antibodies against gangliosides on myelin and axons of peripheral nerves. Family members managing a Michigan dairy operation reported recurring C. jejuni gastroenteritis. Because dairy cattle are known to shed C. jejuni , we hypothesized that calves in the sick pen were the source of human infections. Fecal samples obtained from twenty-five calves, one dog, and one asymptomatic family member were cultured for Campylobacter. C. jejuni isolates were obtained from thirteen calves and the family member: C. coli from two calves, and C. hyointestinalis from two calves. Some calves had diarrhea; most were clinically normal. Typing of lipooligosaccharide biosynthetic loci showed that eight calf C. jejuni isolates fell into classes A, B, and C. Two calf isolates and the human isolate possessed LOS class E, associated mainly with enteric disease and rarely with Guillain Barré Syndrome. Multi-locus sequence typing, por A and fla A typing, and whole genome comparisons of the thirteen C. jejuni isolates indicated that the three LOS class E strains that included the human isolate were closely related, indicating zoonotic transmission. Whole-genome comparisons revealed that isolates differed in virulence gene content, particularly in loci encoding biosynthesis of surface structures. Family members experienced diarrheal illness repeatedly over 2 years, yet none experienced GBS despite exposure to calves carrying invasive C. jejuni with LOS known to elicit antiganglioside autoantibodies. [ABSTRACT FROM AUTHOR]

Purpose. The primary purpose of this study is to evaluate the demographic, clinical and laboratory findings of patients with Guillain Barré syndrome (GBS), assess the clinical course, treatment outcomes and introduce GBS subgroups in Kocaeli, Turkey. Methods. Patients admitted to Kocaeli University Neurology Clinic between 2015 and 2019 with a preliminary diagnosis of autoimmune inflammatory acute polyneuropathy were included. Demographic, clinical, laboratory data have been collected and analyzed prospectively. Prognosis was evaluated according to the sum of total scores from GBS disability scoring and Medical Research Council (MRC) scoring guidelines and the need for mechanical ventilation. For statistical analysis, IBM SPSS 20.0 (SPSS Inc., Chicago, IL, USA) was used. Results. 52 GBS patients were evaluated. Mean age at initial presentation was 50.33±17.2. 57.7% of the patients reported a recent disease, most common one being upper respiratory tract infection (URTI). Progression of the disease was reported as ascending in 39 patients (75%) and descending in 13 (25%). Muscle weakness was symmetrical in 46 patients (88.4%) and asymmetrical in 6 (11.6%). 30 out of 52 patients (57.6%) had an elevated erythrocyte sedimentation rate (ESR), 40 (76.9%) had leukocytosis, 11 (21.1%) had hyponatremia. Cerebrospinal fluid analysis of 39 patients revealed elevated protein levels in 32 of them (61.5%). 41 patients (78.8%) were treated with IVIG, 8 (15.4%) with plasmapheresis and IVIG, 2 patients (3.8%) were treated with plasmapheresis only. Conclusion. Our study revealed both consistent and contradicting findings to the literature that may lead further debate/research on the epidemiology of GBS.

A rare variant Miller Fisher Syndrome overlap with Guillain Barre Syndrome is described in an adult patient with SARS-COV-2 infection.

Campylobacter jejuni causes foodborne gastroenteritis and may trigger acute autoimmune sequelae including Guillain Barré Syndrome. Onset of neuromuscular paralysis is associated with exposure to C. jejuni lipooligosaccharide (LOS) classes A, B, C, D, and E that mimic and evoke antibodies against gangliosides on myelin and axons of peripheral nerves. Family members managing a Michigan dairy operation reported recurring C. jejuni gastroenteritis. Because dairy cattle are known to shed C. jejuni, we hypothesized that calves in the sick pen were the source of human infections. Fecal samples obtained from twenty-five calves, one dog, and one asymptomatic family member were cultured for Campylobacter. C. jejuni isolates were obtained from thirteen calves and the family member: C. coli from two calves, and C. hyointestinalis from two calves. Some calves had diarrhea; most were clinically normal. Typing of lipooligosaccharide biosynthetic loci showed that eight calf C. jejuni isolates fell into classes A, B, and C. Two calf isolates and the human isolate possessed LOS class E, associated mainly with enteric disease and rarely with Guillain Barré Syndrome. Multi-locus sequence typing, porA and flaA typing, and whole genome comparisons of the thirteen C. jejuni isolates indicated that the three LOS class E strains that included the human isolate were closely related, indicating zoonotic transmission. Whole-genome comparisons revealed that isolates differed in virulence gene content, particularly in loci encoding biosynthesis of surface structures. Family members experienced diarrheal illness repeatedly over 2 years, yet none experienced GBS despite exposure to calves carrying invasive C. jejuni with LOS known to elicit antiganglioside autoantibodies.

ABSTRACT Background: Guillian Barré syndrome (GBS) is an acute autoimmune polyradiculoneuropathy often associated with previous exposure to infectious agents. Methods: A clinical cohort of 41 patients with GBS admitted to the Base Hospital Institute of the Federal District between May 2017 and April 2019 was followed up for 1 year. Serological tests for arbovirus detection and amplification of nucleic acids using polymerase chain reaction for zika virus (ZIKV), dengue virus (DENV), and chikungunya virus (CHIKV) were performed. Results: The cohort consisted of 61% men with a median age of 40 years, and 83% had GBS-triggering events. A total of 54% had Grade 4 disability, 17% had Grade 3, 12% had Grade 2, 10% had Grade 5, and 7% had Grade 1. The classic form occurred in 83% of patients. Nerve conduction evaluations revealed acute demyelinating inflammatory polyneuropathy (51%), acute motor axonal neuropathy (17%), acute sensory-motor neuropathy (15%), and indeterminate forms (17%). Four patients were seropositive for DENV. There was no laboratory detection of ZIKV or CHIKV infection. Ninety percent of patients received human immunoglobulin. Intensive care unit admission occurred in 17.1% of the patients, and mechanical ventilation was used in 14.6%. One patient died of Bickerstaff’s encephalitis. Most patients showed an improvement in disability at 10 weeks of follow-up. Conclusions: GBS in the Federal District showed a variable clinical spectrum, and it was possible to detect recent exposure to DENV.

The involvement of cranial nerves is being increasingly recognised in COVID-19. This review aims to summarize and discuss the recent advances concerning the clinical presentation, pathophysiology, diagnosis, treatment, and outcomes of SARS-CoV-2 associated cranial nerve mononeuropathies or polyneuropathies. Therefore, a systematic review of articles from PubMed and Google Scholar was conducted. Altogether 36 articles regarding SARS-CoV-2 associated neuropathy of cranial nerves describing 56 patients were retrieved. Out of these 56 patients, cranial nerves were compromised without the involvement of peripheral nerves in 32 of the patients, while Guillain-Barre syndrome (GBS) with cranial nerve involvement was described in 24 patients. A single cranial nerve was involved either unilaterally or bilaterally in 36 patients, while in 19 patients multiple cranial nerves were involved. Bilateral involvement was more prevalent in the GBS group (n=11) as compared to the cohort with isolated cranial nerve involvement (n=5). Treatment of cranial nerve neuropathy included steroids (n=18), intravenous immunoglobulins (IVIG) (n=18), acyclovir/valacyclovir (n=3), and plasma exchange (n=1). The outcome was classified as “complete recovery” in 21 patients and as ”partial recovery” in 30 patients. One patient had a lethal outcome. In conclusion, any cranial nerve can be involved in COVID-19, but cranial nerves VII, VI, and III are the most frequently affected. The involvement of cranial nerves in COVID-19 may or may not be associated with GBS. In patients with cranial nerve involvement, COVID-19 infections are usually mild. Isolated cranial nerve palsy without GBS usually responds favorably to steroids. Cranial nerve involvement with GBS benefits from IVIG.

Lyme disease is the most common tick-borne disease in the United States. Left untreated, it can lead to neuroborreliosis. Here we describe a case of early disseminated Lyme disease-associated Guillain Barre Syndrome in a previously healthy adult that early clinical suspicion and accurate testing led to proper diagnosis and case management. It is important to be aware of Guillain Barre Syndrome as an early consequence of Lyme disease especially during tick activity season. This case report is meant to raise awareness among clinicians and calls for protective measures especially where there is significant outdoor activity.

Since the beginning of the COVID-19 pandemic, great hesitancies regarding the COVID-19 immunization have existed. The most striking adverse events reported include thrombosis with thrombocytopenia syndrome (TTS), myocarditis, and Guillain Barre Syndrome (GBS). Post-vaccination GBS is known since the time of Influenza vaccination, but several cases of GBS have also been reported in the current COVID-19 vaccination era. As a result, our patient with a history of GBS post-Influenza vaccination, went unvaccinated for SARS-CoV-2, due to fear of GBS re-activation. Consequently, he contracted COVID-19 pneumonitis complicated with deep venous thrombosis, requiring a prolonged hospitalization. Weighing the risks and benefits of vaccination to COVID-19 is difficult, especially for people with a previous history of GBS related to Influenza vaccination. We reviewed and analyzed the reported cases of GBS temporary related to COVID-19 vaccination to determine the safety of their administration in those with a history of GBS.

Accumulating evidence suggests the neurotropic characteristics of the SARS-CoV-2. Although the pathogenesis is unclear, the relationship between COVID-19 and Guillain Barre Syndrome (GBS) has been described previously. In this report, a 66-year-old male with para-infectious COVID-19-related GBS admitted with bilateral weakness in distal lower limbs was presented. Five days ago, since he had a risky contact with the COVID-19 patient, the SARS-CoV-2 PCR test was performed and resulted in positive. Favipiravir treatment was given as outpatient therapy. On the fifth day of antiviral treatment, he had applied to Emergency Department with two days of muscle weakness of lower extremities consistent with GBS; hence lumbar punction was performed. The cerebrospinal fluid examination revealed albumin-cytological dissociation. Despite the administration of immunoglobulin infusions, neurological findings worsened, dysphagia, and facial paralysis occurred. Although he was stable for COVID, he was followed up in the intensive care unit for plasmapheresis and then intubated for the respiratory involvement of GBS. Early diagnosis and treatment are critical in GBS related to COVID-19. Since para-infectious COVID-19-related GBS has poor outcomes, clinicians should be aware of this kind of complication to manage patients as it’s supposed to be. [ABSTRACT FROM AUTHOR]

BACKGROUND: Since the outbreak of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS CoV2) in December 2019, there have been some case reports of Coronavirus disease 19 (COVID 19) associated Guillain-Barré Syndrome (GBS). GBS is an inflammatory polyradiculoneuropathy associated with numerous viral and bacterial infections. Here we describe the case of an Ethiopian man with a typical clinical and electrophysiological manifestation of GBS. CASE PRESENTATION: A 70-year-old male presented with four days history of progressive and ascending bilateral limbs weakness which end up with respiratory failure. He had an antecedent headache, loss of appetite, and generalized fatigue. Electrophysiological studies showed Acute Motor and Sensory Axonal Neuropathy whereas and cerebrospinal fluid analysis revealed albuminocytologic dissociation with positive preintubation SARS CoV2 test. He was treated with supportive care and recovered successfully. CONCLUSION: This case illustrates one of the few occasions when patients with mild COVID-19 develop severe neurologic manifestations. Seemingly, early identification and management can improve clinical outcomes. We would like to emphasize the need to consider screening for SARS CoV-2 in patients presenting with GBS. [ABSTRACT FROM AUTHOR]

Background and Aims: Guillain Barré syndrome (GBS) could be triggered by an infectious disease but by vaccination as well. Thus, suffering GBS may influence patients' attitudes towards vaccination. Methods: An anonymous questionnaire consisting of the Overall Neuropathy Limitations Score (ONLS), the short form‐36 health survey (SF‐36), and questions addressing patients' attitude towards vaccination was sent to members of a German GBS support group and to patients with GBS diagnosis who were treated at Jena University Hospital. Results: Ninety‐seven questionnaires clearly stated GBS as a diagnosis and were included in the analysis. Although 19.6% of the GBS patients reported having no disability in the long‐time follow‐up, a considerable number of patients still had persistent neurological symptoms; 74.2% of the GBS patients reported being able to walk at least 10 m independently. However, 5.2% were restricted to wheelchair. The patients reached lower scores in all domains of quality of life compared to German controls. Moreover, patients showed a more critical attitude towards vaccination compared to a German representative survey. Fewer patients (58.8%) received a vaccination after suffering from GBS than before (77.3%). Every tenth patient believed that vaccination was the trigger for the GBS. 32% of the patients did not receive a vaccination in the last 5 years mainly because of the fear of adverse effects (32%) or disadvise of the general practitioners (25.8%). Discussion: Although the risk of relapse following immunization may be rather low, uncertainties and fears still impair the counseling of these patients by their medical practitioner. [ABSTRACT FROM AUTHOR]

Abstract Background and Aims Guillain Barré syndrome (GBS) could be triggered by an infectious disease but by vaccination as well. Thus, suffering GBS may influence patients' attitudes towards vaccination. Methods An anonymous questionnaire consisting of the Overall Neuropathy Limitations Score (ONLS), the short form‐36 health survey (SF‐36), and questions addressing patients' attitude towards vaccination was sent to members of a German GBS support group and to patients with GBS diagnosis who were treated at Jena University Hospital. Results Ninety‐seven questionnaires clearly stated GBS as a diagnosis and were included in the analysis. Although 19.6% of the GBS patients reported having no disability in the long‐time follow‐up, a considerable number of patients still had persistent neurological symptoms; 74.2% of the GBS patients reported being able to walk at least 10 m independently. However, 5.2% were restricted to wheelchair. The patients reached lower scores in all domains of quality of life compared to German controls. Moreover, patients showed a more critical attitude towards vaccination compared to a German representative survey. Fewer patients (58.8%) received a vaccination after suffering from GBS than before (77.3%). Every tenth patient believed that vaccination was the trigger for the GBS. 32% of the patients did not receive a vaccination in the last 5 years mainly because of the fear of adverse effects (32%) or disadvise of the general practitioners (25.8%). Discussion Although the risk of relapse following immunization may be rather low, uncertainties and fears still impair the counseling of these patients by their medical practitioner.

Since the first-reported case of Severe Acute Respiratory Distress Syndrome-Coronavirus 2 in December 2019, COVID-19 has caused a global pandemic associated with significant morbidity and mortality. After a year of advances in vaccine research and development, three vaccines for the prevention of COVID-19 (manufactured by Pfizer, Moderna and Johnson & Johnson's Janssen Biotech) are approved for use in the USA. We report the first case of Guillain–Barre Syndrome after receiving the second dose of the Pfizer COVID-19 vaccine, in a 42-year-old woman presenting with progressive ascending weakness and paresthesias. Diagnostic workup demonstrated cytoalbuminologic dissociation on cerebrospinal fluid analysis with confirmatory evidence of early demyelinating electrodiagnostic features on nerve conduction study and an extensive serological workup being negative for other viral or autoimmune disease triggers. Management included administration of intravenous immunoglobulin (total of 2 gm/kg), with frequent monitoring of forced vital capacity and negative inspiratory force. A longitudinal risk profile of neurologic complications caused from COVID-19 vaccines remains limited, and prompt recognition of potential neurological complications from the COVID-19 vaccine is of interest to public health. [ABSTRACT FROM AUTHOR]

During the second wave of Covid-19 pandemic, children presented with myriad of central nervous system manifestations and one of them was Guillain-Barré syndrome (GBS). It is caused by various viruses including recent Covid-19 infection by either direct invasion or post infectious process. Most of these cases were reported in adults and very few in children. Here, we report a case series of five children with GBS along with positive Covid-19 antibodies. All patients responded well to intravenous immunoglobulin without any residual weakness. We could probably link casual association of Covid-19 infection with GBS. [ABSTRACT FROM AUTHOR]

Background: During 2017 to 2018, 168 polio cases were found globally that caused an increase of awareness towards the emergence of poliovirus in Indonesia. AFP surveillance was the primary strategy to overcome global polio. Therefore, the understanding of the epidemiological characteristics becomes very important to improve the success of AFP surveillance systems. Purpose: This study aims to describe the epidemiological characteristics and types of diagnosis of AFP cases in Surabaya from 2014 to 2017. Method: This study was a descriptive study with a case series design. Data sources utilized was secondary data from AFP surveillance report of Surabaya City Health Office from 2014 to 2017. Results: Total AFP cases in Surabaya from 2014 to 2017 recorded 54 cases with annual AFP Non-Polio Incidence rate of approximately 3.85/100,000 children aged

Introduction: Intravenous Immunoglobulin is an approved therapy for Guillain Barre Syndrome. Our objective is to understand the management and outcome in Guillain Barre Syndrome patients treated with Immunoglobulin. Materials and Methods: All consecutive patients were retrospectively evaluated in the study were of age ≥16 years and were being admitted in the department of Neurology of Tribhuvan University Teaching Hospital, Kathmandu, Nepal from 2016 March to 2017 February. Results: A total of 46 patients were included, mean age= 36.5±16.2 years, range = 16years to 80 years. Thirty-two patients (70%) were axonal variant, acute motor axonal neuropathy is more common (18 patients). Intravenous immunoglobulin was used in 23 patients (50%), 17 of them were axonal variant and 6 were demyelinating. Guillain Barre Syndrome patients with bilateral facial weakness (70% vs 30%; p

Preceding infection with Campylobacter jejuni (Cj) occurs in approximately 30% of patients with Guillain–Barre syndrome (GBS), and the risk of GBS following Cj infection is increased by 77 to 100-fold. GBS is most often of the axonal subtype and is thought to be mediated by IgG antibodies to peripheral nerve gangliosides that are cross reactive with oligosaccharides in the Cj lipopolysaccharides (LPS). The antibodies are thought to be induced by molecular mimicry, where immune reactivity to a cross reactive epitope in the infectious organism and normal tissue can cause autoimmune disease. Clonally restricted IgM antibodies that react with the same oligosaccharides in gangliosides and Cj-LPS are associated with chronic neuropathies of otherwise similar phenotypes. The anti-ganglioside antibodies in GBS are of the IgG1 and IgG3 subclasses, indicating T-cell reactivity to the same antigens that could help disrupt the blood–nerve barrier. Cj infection can activate multiple innate and adoptive pro-inflammatory pathways that can overcome immune tolerance and induce autoimmunity. Elucidation of the specific immune mechanisms involved in the development of the autoantibodies and neuropathy would help our understanding of the relation between infection and autoimmunity and aid in the development of more effective preventive interventions and therapies.

El profesor José Rafael Estrada González (1921-1991), considerado el padre de la Neurología en Cuba, tuvo una destacada labor no solo en el desarrollo de la neurología y neurociencias afines, sino también como investigador y publicista científico. El presente trabajo tuvo como objetivo describir la obra científica publicada por Estrada González. Se revisaron 105 materiales publicados entre 1948 y 1999; entre los cuales se encuentran 99 artículos científicos (77 en revistas nacionales y 22 en internacionales), 4 libros, un Atlas y un capítulo de libro. La mayor parte de sus publicaciones fueron en el campo de la Neurología. Como investigador se destacó por los aportes realizados sobre el síndrome de Guillain Barré y la atrofia olivopontocerebelosa dominante descubierta por él en Holguín, que promovieron nuevos conocimientos en el estudio de estas enfermedades no solamente en Cuba, sino también en la comunidad científica internacional. Professor José Rafael Estrada González (1921-1991), who is considered to be the father of Neurology in Cuba, had an outstanding work not only in the development of neurology and related neurosciences, but also as a researcher and scientific publicist. The objective of this paper was to describe the scientific work published by Estrada González. One hundred six materials published between 1948 and 1999 were reviewed; among which are 100 scientific articles (77 in national journals and 23 in international ones), 4 books, an Atlas and a book chapter. Most of his publications were in the field of Neurology. As a researcher, he stood out for the contributions made on Guillain Barré Syndrome and the dominant olivopontocerebellar atrophy discovered by him in Holguín, which encouraged new knowledge in the study of these diseases not only in Cuba, but in the international scientific community, as well. [ABSTRACT FROM AUTHOR]

Immune checkpoint inhibitor-related neurotoxicity causing Guillain Barre Syndrome is relatively uncommon. We discussed an 80-year-old patient with known systemic lupus erythematosus who presented with lower extremity weakness, areflexia and then progressed to respiratory muscle and upper extremity weakness after receiving immunotherapy with checkpoint inhibitors for metastatic bladder cancer. With the increasing use of immunotherapy for the management of cancer, awareness of neurological autoimmune side effects is essential. Immune checkpoint inhibitor-mediated GBS can be severe and fatal if not diagnosed promptly. The hospitalists, neurologists, and oncologists should be aware of neurotoxicity related to immune checkpoint inhibitor therapy requiring a multidisciplinary approach to patient care. Prompt initiation of immunosuppressive therapy is required for the management of immune checkpoint inhibitor-related neurotoxicity. [ABSTRACT FROM AUTHOR]

Rationale: Guillain Barre syndrome (GBS) is an acute neurological illness leading to quadriparesis with respiratory involvement. It can be triggered by infections, vaccinations, surgery, trauma, transplantation and drugs. Anti-rabies cell culture vaccines introduced to overcome the high rate of neurological complications associated with tissue based rabies vaccine, can be very rarely associated with GBS. Patient concerns: A 50-year-old female presented with acute severe upper back pain evolving into pure motor quadriparesis following administration of human diploid cell vaccine for rabies. Diagnosis: Acute motor axonal neuropathy variant of GBS following anti-rabies human diploid cell vaccine. Interventions: Intravenous high dose steroids. Outcomes: Patient recovered completely within 1 month. Lessons: Although anti-rabies cell culture vaccines are highly immunogenic and safe, they are rarely associated with GBS. Clinicians should be aware of this link because prompt diagnosis and treatment can result in complete recovery and avoid complications.