Concomitant Guillain-Barré Syndrome and COVID-19: A Meta-Analysis of Cases.

Background and Objectives: Recent findings demonstrate that the transmigration of severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) to the nervous system implicates severe neurotropic pathologies, including the onset of the rare disease called Guillain-Barré syndrome (GBS) which is characterized by immune-mediated polyneuropathy. This study aimed to identify the predisposing factors and the clinical features of coronavirus disease 2019 (COVID-19)-induced GBS. Materials and Methods: We have performed an analysis of 147 cases. A systematic review of the published research work was performed per the PRISMA statement to obtain individual participant data (IPD) for the meta-analysis. The search was conducted through PubMed, using the combined search terms "Guillain-Barré syndrome" and "COVID-19". All case reports and series in the English language with accessed full text were included in the search. Results: A systematic database search led to the retrieval of 112 peer-reviewed articles published between 1 April 2020, and 8 February 2022. The articles comprised 16 case series and 96 case reports containing IPD for 147 patients. Our findings showed that 77.6% of all cases were 40 years or older. Males comprised most of the cases (65.3%; n = 96). The intensive care unit (ICU) admission was 44.9%, and the need for mechanical ventilation (MV) was 38.1%. The patients presented with hyporeflexia or areflexia (84.4%; n = 124), lower limb strength and sensation impairment (93.2%; n = 138), upper limb strength and sensation impairment (85.7; n = 126), and somatic sensation impairment (72.8%; n = 107). The patients presented with increased cerebral spinal fluid (CSF) protein levels (92%; n = 92) and the presence of CSF albuminocytological dissociation (83.5%; n = 71). The most common variant of GBS observed was acute inflammatory demyelinating polyneuropathy (AIDP). We found that predisposing factors concomitant with COVID-19 and GBS were male gender and older age. Among the cases, patient mortality was 10.9%. Conclusions: A gap of knowledge exists regarding the complete spectrum of clinical characteristics of COVID-19-related GBS. Recent findings suggest that SARS-CoV-2 triggers GBS, as it follows a similar para-infectious pattern as the other viral agents contributing to the onset of GBS.

Can Neuron Specific Enolase Be a Diagnostic Biomarker for Neuronal Injury in COVID-19?

Neuron specific enolase (NSE) is a biomarker for neuronal injury. However, increased levels in cerebrospinal fluid (CSF) and serum is associated with the clinical outcome in patients with head injury, ischemic stroke, intracerebral hemorrhage, cardiac arrest, anoxic encephalopathy, encephalitis, brain metastasis, and status epilepticus. Recently, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, which started in China, rapidly evolved into the coronavirus disease 2019 (COVID-19) pandemic. Patients with COVID-19 have a wide range of symptoms varying from mild upper respiratory symptoms to severe illness requiring mechanical ventilation. While coronaviruses primarily target the human respiratory system, neurological symptoms are also observed in some patients. These include symptoms such as loss of taste and olfaction and diseases like cerebrovascular disorders including ischemic stroke and hemorrhages, encephalopathies, Guillain-Barré syndrome and acute disseminated encephalomyelitis. Here we report an observation from a patient whose NSE levels increased approximately four-fold in CSF. This finding was accompanied by increased white blood cell count and elevated protein in CSF indicating neuroinflammation. Thus, we suggest that NSE may be used as a CSF biomarker in COVID-19 patients with encephalopathy.