Guillain-Barre syndrome following SARS-CoV-2 vaccination: Is there a real association?

Background: Guillain-Barre Syndrome (GBS) is the most common cause of acute flaccid paralysis, with an incidence of 0.81-1.89 cases per 100,000. With the SARS-CoV-2 virus pandemic, major international vaccination campaigns continue to be carried out to minimize the total burden of the disease. This study aims to report a case series of consecutive GBS patients after SARS-CoV-2 vaccination during the massive campaign in Mexico in 2021. Method(s): A single-center, observational study of consecutive GBS subjects diagnosed by Asbury criteria from January 1 to August 31, 2021. Including GBS-related symptoms on or after six weeks of vaccination record, both first and second doses. Result(s): From a total of 53 GBS patients, eight had a history of SARS-CoV-2 vaccination, 87.5% male, the median vaccination-symptom onset and symptom-to-admission time were 15 (IQR 12.75-23.25), and 3.5 (IQR 1.5-8.25), all of them had GBS Disability Scale >=3 at admission. Acute inflammatory demyelinating polyneuropathy (AIDP) was the most common electrophysiological variant encountered in this population. All patients received treatment Intravenous Immunoglobulin (IVIG) or Plasma Exchange (PE), 62.5% recovered independent walk at three months follow up. Conclusion(s): The annual incidence of GBS cases associated with vaccination remains lower (0.81 - 1.89 cases / 100,000 persons) than non-vaccinated patients;this should encourage health authorities to continue promoting massive vaccination as benefits outweigh the risks.Copyright © 2021

Guillain-Barre syndrome associated with SARS-CoV-2 infection: A case series from 4 Colombian cities during the pandemic

SARS-CoV-2 infection has been associated with multiple neurological manifestations. One such manifestation, which has been described since the early stages of the COVID-19 pandemic and is relevant for current neurological practice, is Guillain-Barre syndrome (GBS). The literature describes neurotoxic mechanisms of the virus itself and the possible pathways by which it may affect the peripheral nerves in experimental studies;however, we still lack information on the mechanisms causing the immune response that gives rise to GBS in the context of SARS-CoV-2 infection. Colombia is one of the Latin American countries worst affected by the pandemic, with the third-highest number of cases in the region;thus, it is essential to recognise GBS, as this potential postinfectious complication may severely compromise the patient's functional status in the absence of timely diagnosis and treatment. We present a series of 12 cases of GBS associated with SARS-CoV-2 infection from hospitals in 4 different Colombian cities and describe the clinical presentation, laboratory and electrophysiological study findings, and treatment.Copyright © 2022 Sociedad Espanola de Neurologia

Recombinant protein subunit COVID-19 vaccine-induced Guillain-Barré Syndrome in an adolescent: A case report.

Guillain-Barré Syndrome (GBS), an autoimmune neurological disease of peripheral nerves, has been causally associated with COVID-19 vaccination in adults. However, no such report has been published so far in children. We describe a 13-year-old female child who presented to the emergency department with complaints of bilateral upper limb, lower limb and truncal weakness over 3 days following first dose of recombinant protein subunit COVID-19 vaccine (Corbevax). Clinical examination and nerve conduction studies showed pure motor axonal polyneuropathy with absent compound muscle action potential (CMAP) in all sampled nerves of upper and lower limbs which was consistent with the diagnosis of GBS after ruling out possible alternative aetiologies. A temporal association between first dose of protein subunit COVID-19 vaccine administered a day prior and symptom onset was noted. The causality assessment using the World Health Organization (WHO) tool for adverse event following immunization (AEFI) assessment indicated vaccine product-related reaction categorized as A1. The patient's clinical condition improved after seven sessions of plasmapheresis. The purpose of this report is to create awareness among health care professionals about COVID-19 vaccine-induced GBS in children as early diagnosis and management can be critical in avoiding complications and improving patient outcomes.

TH-261. A case of GBS-like polyneuropathy with unusual progression (Case Report)

Nodal and paranodal antibody-associated neuropathies have been recently classified as auto-immune nodopathies. Their clinical presentation can be easily mistaken for acute or chronic idiopathic demyelinating polyneuropathy (AIDP/CIDP). We present a case of pan-neurofascin antibody associated paranodal neuropathy with serial electrodiagnostic findings. A 61-year-old man presented with acute onset generalized weakness and tiredness one day after the Covid-19 booster vaccination. He had progressive sensory disturbance and weakness in his upper limbs spreading to the lower limbs. He was treated with IVIg for Guillain-Barre syndrome (GBS) and discharged with some improvement. Five days later, he developed rapidly progressive predominantly motor symptoms becoming quadriplegic and bedbound within 9 days with no cranial or respiratory involvement. He was found to have paranodal antibodies (neurofascin-155), consistent with a pan-neurofascin antibody positive neuropathy. Although the patient responded poorly to conventional immunomodulatory therapies, he showed a rapid remarkable recovery with rituximab. He was able to walk independently again within 3 weeks after the second dose of rituximab. Electrodiagnostic studies showed only subtle proximal demyelinating features with the initial presentation. The repeat study after his relapse showed a significant deterioration with features of a generalized, non-length-dependent, primarily demyelinating, sensorimotor polyneuropathy with conduction block, but the sural nerve biopsy showed axonal neuropathy. Electrodiagnostic findings nearly normalized two months after rituximab treatment with the resolution of the all the demyelinating features. This case presentation highlights the importance of considering nodal/paranodal neuropathy as a differential for AIDP/CIDP in an early stage of the disease, especially in patients with atypical presentation. In addition, it supports the currently available evidence that more targeted treatment such as rituximab can have an excellent outcome. Copyright © 2022

Atypical myelin oligodendrocyte glycoprotein antibody-associated optic neuritis and acute demyelinating polyneuropathy after SARS-CoV-2 infection: Case report and literature review.

Post-infectious immune-mediated neurological complications of Sars-Cov-2 have been increasingly recognized since the novel pandemic emerged. We describe the case of a 74 years-old patient who developed a Myelin Oligodendrocyte Glycoprotein (MOG) antibody-associated unilateral retrobulbar optic neuritis a few weeks after paucisymptomatic COVID-19 disease and, subsequently, after the resolution of the optic neuritis, an acute inflammatory demyelinating polyneuropathy. So far, no cases of these two neurological manifestations have been reported in the same patient. We herein report a case characterized by both manifestations and review the accumulating literature regarding MOG antibody-associated disease following SarsCov-2 infection.

COVID-19 Antibody Induced Polyarthropathy

Case Diagnosis: COVID-19 antibody induced polyarthropathy Case Description or Program Description: A 71-year-old female with no medical history developed unrelenting and progressive polyarthropathy. An extensive medical workup including comprehensive rheumatologic labs, electrodiagnostic studies, and orthopedic imaging were all negative apart from a positive COVID- 19 antibody test. Furthermore, the timing of her positive COVID-19 antibody test, rather than any COVID-19 PCR test, coincided precisely with the onset of her symptoms. She completed regimens of oral steroids, NSAIDS, SSRI's, and opioids without any relief. Physical therapy provided mild relief with active movement, apart from pain upon initiation of passive movement and active exercises. Setting(s): Outpatient clinic Assessment/Results: The inter-specialty and interprofessional consensus for this patient's seronegative polyarthropathy non-responsive to medications, negative for all rheumatologic labs and orthopedic imaging, and only mildly responsive to active exercise was that the COVID-19 antibodies themselves were the likely etiologic source. Discussion (relevance): Human coronaviruses have well-documented rheumatologic and nociceptive sequelae. Viral RNA has been identified to spark novel inflammatory conditions or exacerbate preexisting autoimmune conditions. During previous outbreaks of the closely related MERS-CoV infection as well as other viruses, rheumatologic and neurologic conditions such as Systemic Lupus Erythematosus, Rheumatoid Arthritis, Guillain-Barre Syndrome, and Acute Inflammatory Demyelinating Polyneuropathy have been documented in the presence of resultant antibodies rather than viral RNA or antigens. As we progress from the current pandemic, a growing body of literature is highlighting the significant and potentially severe nociceptive effects that COVID-19 antibodies can have on patients. Conclusion(s): A physiatric approach is vital to these rising cases of polyarticular pain as many patients are not finding relief with established medications and approaches. As physiatrists, becoming familiar with the increasing prevalence of seronegative polyarthropathies in the setting of only a positive COVID antibody test is imperative to delivering timely and effective patient care.

COVID-induced Severe Global Axonal Neuropathy and Association with Anti-ganglioside Antibodies: A Case Report

Case Diagnosis: Severe global axonal neuropathy Case Description or Program Description: A 36-year-old healthy male presented with fever and body aches, found to be COVID positive. During hospitalization, he became hypoxic and obtunded, requiring emergent intubation. Physical exam notable for flaccid paralysis of extremities with diffuse atrophy. Patient opened his eyes without following commands. He was treated with a prolonged course of steroids, Remdesivir and antibiotics for COVID-19 pneumonia. Due to diffuse weakness, Nerve Conduction Studies (NCS)/ Electromyography (EMG) performed showed acute motor and sensory axonal neuropathy (AMSAN), a severe subtype of acute inflammatory demyelinating polyneuropathy (AIDP). Subsequently, the patient received 5 days of IVIG and 7 sessions of plasmapheresis but failed extubation. Setting(s): University hospital Assessment/Results: On NCS, the patient had absent sensory and motor responses to direct stimulation in the extremities. The sensory study included radial, ulnar, median and sural nerves. The motor studies included musculocutaneous, median, ulnar, peroneal and tibial nerves. EMG of selected extremities revealed fibrillations in all major muscle groups. Muscle recruitment was not assessed due to mental status. Neurological work-up including CTH and MRI spine was negative for a central process. LP was inconclusive. Additional studies notable for anti-ganglioside GQD1 antibody positive. Discussion (relevance): There continues to be neuromuscular compromise precipitated by COVID-19. The patient presented with global weakness of the entire musculature including the muscles of respiration. As evidenced by anti-GQ D1 IgG antibody and NCS/EMG, the patient presented with acute motor and sensory axonal neuropathy (AMSAN), which is the most severe form of AIDP. Conclusion(s): Within the literature, anti-ganglioside antibodies occur within 25% of AIDP and 50% of patients with the axonal variant of AIDP. There has been previous investigation regarding the relationship of Anti-ganglioside GM antibodies in GBS and the relationship with Campylobacter Jejuni infection. It is important to identify that this same relationship may be present with COVID-19, necessitating further research.

Clinical and Prognostic Characteristics of Guillain-Barre Syndrome Associated With COVID-19, Is This Coincidental?

Introduction: During Covid-19 pandemic periods, various studies have been revealed the coexistence of these two diseases, raising the question of whether SARS-CoV-2 has a role in triggering GBS or it's just co-incidentally. So far, 255 cases of this concurrence have been reported. In this study, we publish 45 patients' demographic, clinical, electro diagnostic study, response to treatment and prognostic features association of Covid- 19 and GBS during the 5 corona's epidemiologic peaks in Isfahan province. Methods: This cross-sectional, multi-central study was performed during covid-19 pandemic since 2020 February until 2021 October. In this period 5 epidemiologic peaks of corona virus occurred in Isfahan (one of providence of Islamic republic of Iran) and total of 417166 people became infected. 45 patient with definitive Covid-19 (based on positive nasopharynx Reverse transcription polymerase chain reaction (RT-PCR) or highly suggestion of Highresolution computed tomography (HRCT) for covid- 19) were referred to one of the 2 referral hospitals (Alzahra and Kashani hospital). All patients whom suspected of peripheral nerve symptoms referred to the neuromuscular fellowship for further examination and performing EDx. Demographic, clinical, therapeutic and prognostic features were collected according to Hospital records. Results & discussion: 45 patients (60% male, 40% female) were surveyed. The mean age was 54.66±10.021 (max: 84, min:14, range:80). The most EDx pattern was AIDP (57.8%, n=26).42.2%(n=19) of patients had axonal pattern. 8 of them were Acute motor axonal neuropathy(AMAN) and 11 patients were Acute motor-sensory axonal neuropathy(AMSAN). The most (91%) GBS phenotype was classic pattern which defined as acute-sub acute flaccid length dependent paralysis. 2 patients had pure para paretic pattern and 2 had miller-fisher pattern. The most common symptom of covid-19 was fever (89.7%), Other symptoms included dyspnea (48.7%), cough (46.2%), myalgia (28.2%), headache (28.2%), diarrhea (28.2%) and the less common was anosmia (12.8%). No significant difference was found between any of the covid-19 symptoms with EDx patterns. 7 patients had a history of GBS which were more than 1 year before the onset of new symptoms. 13.6% of patients had no any symptoms of covid-19 on the day of the onset of neurological symptoms, either the symptoms of covid-19 developed after the neurological symptoms or covid-19 was discovered accidentally. Mean distance between onset of covid-19 and neurological symptoms was 18.05±8.88 which was significantly lower in the axonal injury groups (12.00±800 pvalue: 0.013). Also There was also signifi cant difference between frequency of para/post infectious patient in axonal and demyelinating subtypes (p value: 0.045). So that Para infection was more associated with axonal injuries. Among other prognostic findings, include respiratory equipment (33% no equipment, 44% none-invasive and 22.2% mechanical ventilation), required to ICU admission (46.7%), length of ICU admission (16.66 ±12.03), length of intubation (12.10±6.24) , length of hospitalization( 23.66±14.13) and mortality(8.9%) no Significant differences were detected among each subgroups of EDx patterns and also between axonal/ demyelinating injuries. There was also significant difference among erythrocyte sedimentation rate and C-reactive protein among axonal patterns that means axonal patterns (AMAN and AMSAN) had more level of ESR and CRP at the first neurological symptom's day.

Sequelae of COVID-19 Pneumonia: Our Experience in High Dependence Unit

Background: SARS COVID-19 infection has brought about myriad presentations that could be disease-related, or iatrogenic. Aim: To study the occurrence of complications or sequel arising after COVID-19 infection. Materials and methods: Study period: 15th August to 16th October 2020. Inclusion criteria: All adult patients shifted from COVID isolation units and who are critically ill. Exclusion criteria: Pediatric patients <14 years. Patients with negative RTPCR at the time of admission. COVID-19 negative pneumonia. Observation: Respiratory and neurological sequelae are most commonly observed. Pulmonary fibrosis presented as most respiratory sequelae with an incidence of 7.05% (pneumothorax in patients with spontaneous respiration or invasive ventilation. Pneumomediastinum and subcutaneous emphysema are more found in invasive mechanical ventilation patients. Among neurological complications, delirium was seen in as many as 7.05% of patients. AIDP/GBS (2.35%) are not uncommon among neurological sequelae. Bleeding complication observed in 3.37% of the ICU population which includes intracranial hemorrhage, haematuria, intra-abdominal haematoma. Thromboembolic complication observed in 1.17% ICU population deep vein thrombosis being most common. Results: Pulmonary fibrosis is the most common sequelae in COVID-19 disease. This is the most common cause leading to pneumothorax or pneumomediastinum or surgical emphysema. Neurology symptoms are the most common symptom. Delirium being the most common form of presentation. COVID-19 being a prothrombotic disease we also observed some thromboembolic disease most common being DVT (deep vein thrombosis). Conclusion: COVID-19 involves almost each and every system of the body. This subsequently gives rise to some sequelae or complication directly from viral etiology or related to complication. The exact reasons are yet to be found out.

Síndrome de Guillain Barré asociado a infección por SARS-CoV-2: Reporte de caso en México

In December 2019, the first cases of COVID-19 were reported in Wuhan, China. Up to now, it has affected over 60 million people worldwide. COVID-19 is a multi-systemic disease;in addition to respiratory manifestations, various neurological complications have been identified, including encephalitis, stroke, and Guillain-Barré syndrome. Guillain-Barré syndrome is a condition of immune-mediated polyneuropathies frequently associated with infections. We present the case of a 41-year-old man that, after a 5-day history of non-productive cough, headache, muscle pain, joint pain, anosmia, ageusia, and non-quantified temperature rise;developed loss of tendon flexes and lower limbs weakness that progressed to walking disability, upper limbs weakness, and bilateral facial paresis. An oropharyngeal swab polymerase chain reaction confirmed SARS-CoV-2 infection, and the cerebrospinal analysis reported albuminocytologic dissociation. Nerve conduction studies showed acute inflammatory demyelinating polyradiculoneuropathy (AIDP). He received a 5-day course of intravenous immune globulin. There have been numerous reports of Guillain-Barré syndrome associated with SARS-CoV-2 infection worldwide;however, few cases have been reported in Latin America.

Neurological Complications of COVID-19: Guillain-Barre Syndrome Following Pfizer COVID-19 Vaccine

Objective: The first case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was reported in Wuhan, China, in December 2019. In December 2020, the FDA approved two vaccines for the prevention of COVID-19 infection. In the clinical trials of the vaccine, multiple side effects have been reported ranging from mild symptoms including injection site pain, myalgia, fatigue, and fever to more serious side effects including anaphylactic shock. However, Guillain-Barre Syndrome (GBS) after receiving COVID-19 vaccine was not been reported till (February 2, 2021) to the best of our knowledge. We reported the first case of GBS after receiving the first dose of Pfizer COVID-19 vaccine. Background: An 82-year-old highly functional female presented to the emergency department with generalized body aches, paresthesia, and difficulty walking. She received first dose of the Pfizer COVID vaccine two weeks prior to presentation. Physical examination demonstrated 5/5 strength in bilateral upper extremities in proximal and distal muscles, 4/5 in hip flexors and decrease sensation to light touch and pinprick in bilateral lower extremities up to the knees. Areflexia in both upper and lower extremities. Cerebrospinal fluid analysis showed albuminocytologic dissociation (protein of 88 and WBC of 4) suggestive of Acute Inflammatory Demyelinating Polyradiculoneuropathy (AIDP). MRI lumbar spine demonstrated the enhancement of cauda equina nerve roots consistent with the diagnosis of GBS. The patient completed five days of IVIG with significant improvement and was discharged to acute rehabilitation facility. Design/Methods: NA Results: NA Conclusions: In this pandemic and with ongoing worldwide mass vaccination campaign, it is critically important for clinicians to rapidly recognize neurological complications associated with COVID-19 vaccination. We would like to highlight that the risk of neurological complications or any other adverse effect associated with COVID-19 vaccination is low and the benefits of the vaccination outweigh any potential risks or side effects, both at the individual and society levels.

Acute Inflammatory Demyelinating Polyneuropathy as the first presenting feature of COVID 19 infection

Objective: To describe a case of a 58-year-old patient who presented to the hospital with Acute Inflammatory demyelinating Polyneuropathy (AIDP) as the first symptom of SARS COVID-19 infection without other classic manifestations of COVID-19 infection. Background: COVID-19 associated Guillain Barre syndrome is now widely reported. In our literature review, the majority of GBS patients had preceding respiratory symptoms of COVID19 but our patient had no other systemic involvement, and his symptoms started noticeably within a short duration of exposure. Design/Methods: Case report. Results: 58-year-old male patient presented to the hospital with bilateral lower extremity weakness, facial diplegia and dysphagia. Patient was tested positive for COVID-19 infection three days prior to the symptom onset due to a work-related exposure. He denied having any flu-like symptoms except generalized weakness. Patient reported progressive lower leg weakness started three days back with associated numbness and radicular pain up to T4 level. On examination, the patient had facial diplegia, areflexia and bilateral lower limb ataxia with the strength of about 3/5. CSF analysis showed albuminocytological dissociation. MRI brain and spine showed faint enhancement of lower lumbar roots. GQ1b antibody was positive on Ganglioside panel. With the clinical criteria and laboratory evidence, patient was diagnosed with AIDP. Patient was started on IVIG but due to lack of improvement after four doses patient was switched to therapeutic plasma exchange. He underwent a total of 7 sessions of plasmapheresis with improvement of motor and sensory symptoms. Conclusions: Although most cases were symptomatic for COVID-19, patients without respiratory or systemic symptoms raises a significant healthcare concern, namely the importance of SARS COVID-19 testing in all patients with suspected GBS during this global pandemic. Early diagnosis of COVID-19 associated GBS is also essential for rapid case isolation.

A rare case of bilateral Bell' s Palsy in the setting of SARS-CoV-2

Objective: To describe a rare case of an AIDP variant with bilateral bell's palsy in the setting of SARS-CoV-2. Background: Bilateral facial paralysis is a rare clinical presentation, usually in the setting of underlying systemic disease. Bilateral Bell 's palsy is defined as facial paresis or paralysis involving both sides of the face with an onset that is either simultaneous or within 30 days of each other and represents less than 2% of all facial palsies. AIDP is a potential cause of bilateral facial palsy, and is prevalent in 24-60% of cases. We report a case of a 62-year-old female who presented with bilateral Bell's palsy with bilateral lower extremity weakness and recently positive for SARS-CoV-2. Patient had appropriate findings to suggest a form of acute inflammatory demyelinating polyneuropathy (AIDP), however hyperreflexia on the exam creates a case of a plausible variant such as Acute Motor Axonal Neuropathy (AMAN). Design/Methods: Case report and literature review. Literature review spanning 2009-2021 was conducted via Pubmed. Search terms were “COVID-19”, “bilateral Bell's Palsy”, “facial diplegia”, “Guillain Barré Syndrome”, “AIDP”, “hyperreflexia” Results: Literature review found 9 nerve conduction studies confirming AIDP cases with bilateral Bell's palsy and SARS-CoV-2. 17 non-SARS-CoV-2 cases were found to have AIDP with hyperreflexia, however nerve conduction studies found an axonal neuropathy, suggesting the diagnosis of AMAN. Since this patient presented with hyperreflexia, AMAN, which is a rare AIDP subtype, could have been a likely diagnosis. Conclusions: SARS-CoV-2 infection has been associated with several neurological manifestations. AIDP, in particular, has increased in incidence with the rise in SARS-CoV-2 infections via unclear immune mediated mechanisms. The patient's bilateral Bell's palsy indicates a rare AIDP variant. Interestingly, this patient had upper motor neuron signs, but with nerve conduction studies consistent with distal demyelinating neuropathy without denervation/motor axonal loss.

Acute and Chronic Demyelinating Neuropathies following COVID-19 Vaccination: A Report of Four Cases

Objective: To report demyelinating neuropathies following COVID-19 vaccination. Background: Suspected COVID-19 vaccine-associated Guillain-Barre syndrome and other demyelinating conditions affecting the peripheral nervous system have been reported. The pathophysiologic basis of these associations, and that of vaccination-associated demyelinating neuropathies in general, has not been established. Design/Methods: Case report Results: Four cases of acute and chronic demyelinating neuropathies following COVID-19 vaccination were seen at the University of Nebraska Medical Center from May to September 2021. All were males, ages 26-83 years old. Two received the Pfizer-BioNTech vaccine, one Moderna, and one Johnson&Johnson. Onset ranged from 2-21 days after the final dose of vaccination. The time from symptom onset to neurological evaluation ranged from 3 weeks to 4 months, during which symptoms progressed. All cases presented with progressive numbness, weakness, and areflexia in all limbs;two had difficulty walking. Severe facial diplegia was seen in two cases and other bulbar symptoms in one other case. Three cases had electrophysiologic studies confirming demyelination while one case had findings of subacute polyradiculopathies. Cerebrospinal fluid protein was elevated in two cases and normal in the others. No cases had other co-morbidities or histories suggesting an alternate diagnosis. The diagnosis was acute inflammatory demyelinating polyneuropathy (AIDP) in one case, chronic demyelinating polyradiculoneuropathy (CIDP) in two, and subacute polyradiculopathies in one. The cases with AIDP and CIDP received treatment with intravenous immunoglobulin due to significant motor disability, while the case with subacute polyradiculopathies had spontaneous recovery within 8 weeks. Of the treated cases, two had significant improvement by outpatient follow-up at 2-4 weeks post-treatment and one has yet to follow up. Conclusions: Continued identification and reporting of demyelinating neuropathies following COVID-19 vaccination is essential to determine whether a causative association is present. Prompt evaluation for alternative etiologies is vital and early treatment is recommended.

Neurologic Sequela of COVID-19.Guillain Barré Syndrome Following Johnson and Johnson COVID-19 Vaccination;A Case report

Objective: Outbreak of novel coronavirus-19 (COVID-19) began in December 2019 in Wuhan, China and became global pandemic by March 2020. Federal Drug administration (FDA) has approved three vaccines for prevention of COVID-19 infection. Multiple neurological complications have been reported following vaccine administration. In July 2021 FDA issued warning about increased risk of Guillain Barre Syndrome (GBS) following Johnson and Johnson (J&J) vaccine and since then cases have been reported during clinical trials. Here we report a real life case of GBS after receiving single dose of J&J vaccine. Background: A 53 year old female presented to emergency department with progressive bilateral symmetric proximal more than distal upper and lower extremity weakness, with bilateral ascending paresthesia's, 14 days after receiving the J&J COVID-19 vaccination. Exam consistent with motor strength 4/5 in hip flexors/extensors bilaterally, 4/5 knee extensors/flexors, 4/5 plantar flexion, 4/5 dorsiflexion bilaterally, 4/5 shoulder abductors/adductors, 4/5 elbow extensor/flexors, 2+ patellar reflex, 1+ Achilles tendon reflex bilaterally and decrease sensation to light touch and pinprick in lower extremities till mid-thigh bilaterally. MRI of the Lumbar Spine with and without contrast revealed subtle enhancement of the cauda equina nerve roots suggestive of Acute Inflammatory Demyelinating Polyradiculoneuropathy. CSF analysis consistent with mildly elevated protein 48, nucleated cell count of 0, glucose of 52. Negative GM1 and Gq1b antibodies. Due to the high suspicion for Guillain-Barre syndrome the patient was started on IVIG. After 5 days of treatment the patient had significant improvement and was discharged to rehab facility. Design/Methods: NA Results: NA Conclusions: As we continue mass vaccinations for COVID-19 prevention, clinicians should be able to recognize potential complications and side effects associated with COVID-19 vaccination and must educate and reassure their patients regarding the safety and rationale of COVID-19 vaccination because the benefits of vaccination outweigh the risks of COVID-19 infection and associated morbidity and mortality.

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.

ACUTE ONSET of CHRONIC INFLAMMATORY DEMYELINATING POLYNEUROPATHY in COMBINATION with COVID-19

Acute onset of chronic inflammatory demyelinating polyneuropathy (A-CIDP) presents significant difficulties in differential diagnosis with acute inflammatory demyelinating polyneuropathy (AIDP). The article presents review of literature about differential diagnosis between A-CIDP and AIDP and a clinical case of A-CIDP at 26-year-old man. The disease started after vaccination against influenza and an episode of enteritis, the clinical picture matched Guillain-Barré syndrome criteria, according to electromyography data: demyelinating lesion of the left facial nerve, motor and sensory fibers of the median and ulnar nerves on both sides, demyelinating lesions of motor fibers of the tibial nerve and peroneal nerve on both sides. Chronic inflammatory demyelinating polyneuropathy was diagnosed. Lack of effect from plasma exchange was the reason for changing the treatment to pulse therapy with prednisolone (with a subsequent transition to a 1 mg/kg dose and further reduction until canceled within 16 weeks). Response to prednisolone - rapid recovery of motor functions, which worsened significantly due to a new coronavirus infection during treatment in the neurology department. Further continuation of prednisolone therapy made it possible to restore motor functions completely, except mild prosopoparesis. At the same time, deep reflexes were absent;no significant EMG dynamics was observed. Considering the effect of glucocorticosteroids and lack of positive dynamics on the second electromyography, the patient was diagnosed as A-CIDP. © 2021 Volgograd State University. All rights reserved.