The challenge of diagnosing Guillain-Barre syndrome in patients with COVID-19 in the intensive care unit.

Various neurological complications have been described in COVID-19 patients, especially Guillain-Barre syndrome (GBS). The underlying mechanisms on the association between SARS-CoV-2 infection and GBS remain unclear, but several hypotheses have been proposed. It seems that post-SARS-CoV-2 GBS shares many characteristics with classic post-infectious GBS; however, it may occur in sedated and intubated patients hospitalized in the intensive care unit for SARS-CoV-2 acute respiratory distress syndrome, which presents challenges in the diagnosis and treatment of GBS. In this study, we describe three cases of post-SARS-CoV-2 GBS that were hospitalized in the intensive care unit.

Multifocal and Microvascular Involvement in Ischemic Stroke During COVID-19: A Cohort Study With Comparison With Non-COVID-19 Stroke.

Introduction: Thromboembolic events, including ischemic stroke, are major complications of coronavirus disease 2019 (COVID-19). The clinical characteristics of COVID-19-related stroke are not clearly defined, and few controlled studies assessed the underlying mechanisms of cerebrovascular complications of COVID-19. This single-center retrospective observational study compared stroke characteristics between patients with and without COVID-19. Methods: This study included all patients hospitalized between March 1, 2020, and April 30, 2020, in Colmar Hospital for ischemic stroke as confirmed by imaging. The characteristics of patients with laboratory-confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection by real-time reverse transcriptase polymerase chain reaction or serology were compared with those without SARS-CoV-2 infection. Result: Among 772 patients, nine COVID-19 patients were compared with 50 patients without COVID-19. The following inflammatory and procoagulant marker levels were significantly higher in the COVID-19 group than those in the control group: C-reactive protein, 57.3 ± 43.4 vs. 15.0 ± 30.6 mg/L, p < 0.001; fibrinogen, 5.89 ± 1.75 vs. 4.03 ± 1.26 g/L, p < 0.001; and D-dimer, 4,833.9 ± 6,549.4 vs. 1,028.6 ± 942.6 ng/ml, p < 0.001. The rates of multifocal cerebral territory involvement (4 vs. 7, p = 0.05), microvascular involvement (4 vs. 6, p = 0.04), and thrombophilia (4 vs. 4, p = 0.014) were significantly higher in the COVID-19 group than in the control group, whereas no significant intergroup differences were found in the stroke mechanisms, i.e., cardio-embolic, atherosclerotic, small vessel disease, and cryptogenic. Conclusion: COVID-19-related stroke is characterized by hypercoagulability and hyperinflammation that may favor strokes via microvascular circulation abnormalities, microthrombus formation, and multifocal lesions.

Manifestations neurologiques dans la pandémie de Covid-19

Résumé La Covid-19 peut comporter des troubles neurologiques qui se partagent en 5 grands groupes : Des encéphalopathies, souvent avec agitation, confusion, troubles psychotiques, dont la physiopathogénie est sans doute multiple (syndrome inflammatoire général lié au sepsis, hypoxie, insuffisance rénale, hypercoagulabilité, agression directe du virus). Des syndromes dysimmunitaires du système nerveux central (encéphalo-myélites aiguës disséminées, plus rarement syndrome de Miller Fisher, encéphalite aiguë nécrosante hémorragique…). Des AVC, majoritairement ischémiques, dont la Covid-19 est un facteur de risque indépendant, probablement par des phénomènes d’hypercoagulabilité. Des syndromes de Guillain-Barré. Des atteintes diverses de nerfs crâniens ou des nerfs périphériques. L’anosmie, qui est très fréquente est le plus souvent due à une atteinte de l’épithélium olfactif mais peut être due à une extension de l’agression virale au nerf et au cortex olfactifs. Des études complémentaires restent nécessaires pour mieux comprendre la physiopathogénie et donc la prévention et le traitement de ces complications neurologiques dues à la Covid-19. Summary Five major categories of Covid-19 related neurological disorders emerged : Encephalopathies, often with agitation, delirium and psychosis. Their physiopathology is probably mixed (general sepsis-induced inflammation, hypoxemia, renal failure, hypercoagulability, direct viral aggression). Dysimmune CNS disorders (acute disseminated encephalomyelitis, more rarely Miller Fisher syndrome, acute haemorrhagic necrotic encephalitis…). Ischaemic strokes associated with a prothrombotic state: Covid-19 appears to be an independant risk factor of stroke. Guillain-Barré syndrome. Various cranial nerves or peripheral nerves injuries. Anosmia, which is a key symptom, is most often the consequence of the olfactive epithelial insult, but may sometimes be due to the extension of viral aggression to the olfactive nerve and cortex. Prevention, early recognition and management of COVID-19-related neurological disorders are challenging and require a better understanding of their physiopathology.