Table 1.
Summary of clinical findings, results of diagnostic investigations, and outcome in 73 GBS cases
| Article | Country | Age | Sex | GBS clinical picture | COVID-19 clinical picture | Previous comorbidities | GBS diagnosis | Level of diagnostic certaintyb | GBS variant | |||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Days between COVID-19 symptoms and GBS onset | Onset | Disease course | Autonomic disturbances | Respiratory symptoms/failure | Time to Nadira | |||||||||
| Agosti et al. [5] | Italy | 68 | M | 5 days after | LL weakness | Bilateral facial palsy, progressive symmetric ascending flaccid tetraparesis, achilles tendon areflexia | NA | No | NA | Dry cough associated with fever, dysgeusia, and hyposmia | Dyslipidemia, benign prostatic hypertrophy, hypertension, abdominal aortic aneurysm | Clinical + CSF + electrophysiology | 1 | Pure motor |
| Alberti et al. [6] | Italy | 71 | M | 4 days after (no resolution of pneumonia) | LL paraesthesia | Ascendant weakness, flaccid tetraparesis, hypoesthesia and paraesthesia in the 4 limbs, generalized areflexia, dyspnea | None | Yes (concurrent pneumonia) | 4 days after symptoms onset (24 h after the admission) | Fever (low grade), dyspnea, pneumonia | Hypertension, treated abdominal aortic aneurysm, treated lung cancer | Clinical + CSF + electrophysiology | 1 | Classic sensorimotor |
| Arnaud et al. [7] | France | 64 | M | 23 days after | Fast progressive LL weakness | Generalized areflexia, severe flaccid proximal paraparesis, decreased proprioceptive length-dependent sensitivity and LL pinprick and light touch hypoesthesia | None | No | 4 days after symptoms onset | Fever, cough, diarrhea, dyspnea, severe interstitial pneumonia | DM type 2 | Clinical + CSF + electrophysiology | 1 | Classic sensorimotor |
| Assini et al. [8] | Italy | 55 | M | 20 days after | Bilateral eyelid ptosis, dysphagia, dysphonia | Masseter weakness, tongue protusion (bilateral hypoglossal nerve paralysis), UL and LL hyporeflexia without muscle weakness, soft palate elevation defect | None | Yes (concurrent pneumonia) | NA | Fever, anosmia, ageusia, cough, pneumonia | NA | Clinical + electrophysiology | 2 | Classic sensorimotor overlapping with Miller-Fisher |
| Assini et al. [8] | Italy | 60 | M | 20 days after | Distal tetraparesis with right foot drop, autonomic disturbances | UL and LL distal weakness, right foot drop, generalized areflexia | Gastroplegia, paralytic ileus, loss of blood pressure control | Yes (concurrent pneumonia) | NA | Fever, severe interstitial pneumonia | NA | Clinical + electrophysiology | 2 | Pure motor |
| Bigaut et al. [9] | France | 43 | M | 21 days after | UL and LL paraesthesia, distal LL weakness | Extension to midthigh and tips of the finger with ataxia, right peripheral facial nerve palsy, generalized areflexia | None | No | 2 days after symptoms onset | Cough, asthenia, myalgia in legs, followed by acute anosmia and ageusia with diarrhea, mild interstitial pneumonia | NA | Clinical + CSF + electrophysiology | 1 | Classic sensorimotor |
| Bigaut et al. [9] | France | 70 | F | 10 days after | Acute proximal tetraparesis, distal forelimb and perioral paraesthesia | Respiratory weakness, loss of ambulation | None | Yes | 3 days after symptoms onset | Anosmia, ageusia, diarrhea, asthenia, myalgia, moderate interstitial pneumonia | Obesity | Clinical + CSF + electrophysiology | 1 | Classic sensorimotor |
| Bracaglia et al. [10] | Italy | 66 | F | Unknown (due to asymptomatic infection) | Acute proximal and distal tetraparesis, lumbar pain and distal tingling sensation | Loss of ambulation, difficulty in speeching and swallowing, generalized areflexia | None | No | NA | Asymptomatic | None | Clinical + electrophysiology | 2 | Classic sensorimotor |
| Camdessanche et al. [11] | France | 64 | M | 11 days after | UL and LL paraesthesia | Ascendent weakness, flaccid tetraparesis, generalized areflexia, dysphagia | None | Yes | 3 days after symptoms onset | Fever (high grade), cough, pneumonia | None | Clinical + CSF + electrophysiology | 1 | Classic sensorimotor |
| Chan et al. [12] | Canada | 58 | M | 20 days after home isolation for suspected contact | Bilateral facial weakness, dysarthria, feet paraesthesia, LL areflexia | NA | None | No | NA | Asymptomatic, interstitial pneumonia | None | Clinical + CSF + electrophysiology | 1 |
Bilateral facial palsy with paraesthesia |
| Chan et al. [13] | USA | 68 | M | 18 days after | Gait disturbance, hands and feet paraesthesia | LL proximal weakness, absent vibratory and proprioceptive sense at the toes, UL hyporeflexia, LL areflexia, unsteady gait with inability to toe or heel walk, bilateral facial weakness, dysphagia, dysarthria, neck flexion weakness | None | No | 8 days after the onset of symptoms | Fever and upper respiratory symptoms | NA | Clinical + CSF | 2 | Classic sensorimotor |
| Chan et al. [13] | USA | 84 | M | 16 days after | Hands and feet paraesthesia, progressive gait disturbance | Bilateral facial weakness, progressive arm weakness, neuromuscular respiratory failure | Yes (not specified autonomic dysfunction) | Yes | 25 days after the onset of symptoms | Fever | NA | Clinical + CSF | 2 | Classic sensorimotor |
| Coen et al. [14] | Switzerland | 70 | M | 6 days after | Paraparesis, distal allodynia | Generalized areflexia | Difficulties in voiding and constipation | No | NA | Dry cough, myalgia, fatigue | None | Clinical + CSF + 0electrophysiology | 1 | Classic sensorimotor |
| Ebrahimzadeh et al. [15] | Iran | 46 | M | 18 days after | Pain and numbness in distal LL and UL extremities, ascending weakness in legs | Mild peripheral right facial nerve palsy, generalized areflexia | None | No | 7 days after symptoms onset | Low-grade fever, sore thorat, dry cough and mild dyspnea, bilateral interstitial pneumonia (concurrent with neurological symptoms) | None | Clinical + CSF + electrophysiology | 1 | Classic sensorimotor |
| Ebrahimzadeh et al. [15] | Iran | 65 | M | 10 days after | Progressive ascending LL and UL extremities weakness and paraesthesia | Proximal and distal UL and LL weakness, UL hyporeflexia and LL areflexia | None | No | 14 days after symptoms onset | History of COVID-19 (symptoms not specified), fine crackles in both lungs (concurrent with neurological symptoms) | Hypertension | Clinical + electrophysiology | 2 | Classic sensorimotor |
| El Otmani et al. [16] | Morocco | 70 | F | 3 days after | Weakness and paraesthesia in the 4 limbs | Tetraparesis, hypotonia, generalized areflexia, bilateral positive Lasègue sign | None | No | NA | Dry cough, pneumonia | Rheumatoid arthritis | Clinical + CSF + electrophysiology | 1 | Classic sensorimotor |
| Esteban Molina et al. [17] | Spain | 55 | F | 14 days after | Paraesthesia and weakness in the 4 limbs | Lumbar pain, dysphagia, tetraplegia, general areflexia, bilateral facial palsy, lingual and perioral paraesthesia | None | Yes | 3 days after symptoms onset (48 h after the admission) | Fever, dry cough and dyspnoea, pneumonia | Dyslipidemia | Clinical + CSF + electrophysiology | 1 | Classic sensorimotor |
| Farzi et al. [18] | Iran | 41 | M | 10 days after | Paraesthesia of the feet | Tetraparesis, areflexia at the LL and hyporeflexia at the UL, stocking-and-glove hypesthesia and reduced sense of vibration and position | None | No | 7 days after symptoms onset | Cough, dyspnea and fever | DM type II | Clinical + electrophysiology | 2 | Classic sensorimotor |
| Fernández–Domínguez et al. [19] | Spain | 74 | F | 15 days after | Gait ataxia and generalized areflexia | NA | NA | No | NA | Respiratory symptoms (not further detailed) | Hypertension and follicular lymphoma | Clinical + CSF | 2 | Miller Fisher variant |
| Finsterer et al. [20] | India | 20 | M | 5 days after | NA | NA | NA | NA | NA | NA | NA | Clinical + electrophysiology | 2 | NA |
| Frank et al. [21] | Brazil | 15 | M | > 5 days after | Paraparesis, pain in the LL | Rapidly progressive ascending tetraparesis, areflexia | NA | No | NA | Fever, intense sweating | NA | Clinical + electrophysiology | 2 | Classic sensorimotor |
| Gigli et al. [22] | Italy | 53 | M | NA | Paraesthesia, gait ataxia | NA | NA | NA | NA | Fever, diarrhea | NA | Clinical + CSF + electrophysiology | 1 | NA |
| Gutiérrez-Ortiz et al. [23] | Spain | 50 | M | 3 days after | Vertical diplopia, perioral paraesthesia, gait ataxia | Right internuclear ophthalmoparesis and right fascicular oculomotor palsy, ataxia, generalized areflexia | None | No | NA | Fever, cough, malaise, headache, low back pain, anosmia, ageusia | Bronchial asthma | Clinical + CSF | 2 | Miller Fisher variant |
| Gutiérrez-Ortiz et al. [23] | Spain | 39 | M | 3 days after | Diplopia (bilateral abducens palsy) | Generalized areflexia | None | No | NA | Diarrhea, low-grade fever | None | Clinical + CSF | 2 | Polyneuritis cranialis (GBS–Miller Fisher Interface) |
| Helbok et al. [24] | Austria | 68 | M | 14 days after | Hypoaesthesia and paraesthesia in the LL, proximal weakness, areflexia, stand ataxia | Ascending weakness, flaccid tetraparesis, generalized areflexia | NA | Yes | 2 days after symptoms onset (24 h after the admission) | Fever, dry cough, myalgia, anosmia and ageusia. | None | Clinical + CSF + electrophysiology | 1 | Classic sensorimotor |
| Hutchins et al. [25] | USA | 21 | M | 16 days after | Right-sided facial numbness and weakness | Bilateral facial palsy, severe dysarthria, bilateral LL weakness , bilateral UL paraesthesia, areflexia | NA | No | 3 days after symptoms onset | Fever, cough, dyspnoea, diarrhea, nausea, headache | Hypertension, prediabetes, and class I obesity | Clinical + CSF + electrophysiology | 1 | Bilateral facial palsy with paraesthesia |
| Juliao Caamaño et al. [26] | Spain | 61 | M | 10 days after | Facial diplegia | No progression | None | No | 1 day after symptoms onset | Fever and cough | None | Clinical + electrophysiology | 3 | Bilateral facial nerve palsy |
| Khalifa et al. [27] | Kingdom of Saudi Arabia | 11 | M | 20 days after | Gait ataxia, areflexia and paraesthesia in the LL | Gradual motor improvement, persistent hyporeflexia | NA | No | NA | Acute upper respiratory tract infection, low-grade fever, dry cough. | NA | Clinical + CSF + electrophysiology | 1 | Classic sensorimotor |
| Kilinc et al. [28] | The Netherlands | 50 | M | 24 days after | Facial diplegia, symmetrical proximal weakness, paraesthesia of distal extremities, gait ataxia, areflexia | Progression of limb weakness and inability to walk | NA | No | 11 days after symptoms onset | Dry cough | None | Clinical + electrophysiology | 2 | Classic sensorimotor |
| Lampe et al. [29] | Germany | 65 | M | 2 days after | Acute right UL and LL weakness causing recurrent falls | Right UL paresis, slight paraparesis more pronounced on the right side, generalized hyporeflexia | None | No | 3 days after symptoms onset | Fever and dry cough | None | Clinical + CSF + electrophysiology | 1 | Pure motor |
| Lantos et al. [30] | USA | 36 | M | 4 days after | Opthalmoparesisa and hypoesthesia below knee | Progressive ophthalmoparesis (including initial left III cranial nerve and eventual bilateral VI cranial nerve palsies), ataxia, and hyporeflexia | None | No | NA | Fever, chills, and myalgia | None | Clinical | 3 | Miller Fisher variant |
| Lascano et al. [31] | Switzerland | 52 | F | 15 days after (no resolution of pneumonia) | Back pain, diarrhea, rapidly progressive tetraparesis, distal paraesthesia | Worsening of proximal weakness (tetraplegia), generalized areflexia, ataxia | Constipation, abdominal pain | Yes | 4 days after symptoms onset | Dry cough, dysgeusia, cacosmia | None | Clinical + CSF + electrophysiology | 1 | Classic sensorimotor |
| Lascano et al. [31] | Switzerland | 63 | F | 7 days after (no resolution of pneumonia) | Limb weakness, pain on the left calf | Moderate tetraparesis, LL and left UL areflexia, distal hypoesthesia and paraesthesia | None | No | 5 days after symptoms onset | Dry cough, shivering, breathing difficulties, chest pain, odynophagia | DM type 2 | Clinical + electrophysiology | 2 | Classic sensorimotor |
| Lascano et al. [31] | Switzerland | 61 | F | 22 days after | LL weakness, dizziness, dysphagia | Moderate tetraparesis, bilateral facial palsy, lower limb allodynia, severe hypopallesthesia, areflexia (except for bicipital tendon reflexes) | None | Yes | 4 days after symptoms onset | Productive cough, headaches, fever, myalgia, diarrhea, nausea, vomiting, weight loss, recurrent episodes of transient loss of consciousness | None | Clinical + CSF + electrophysiology | 1 | Classic sensorimotor |
| Manganotti et al. [32] | Italy | 50 | F | 16 days after | Diplopia and facial paraesthesia | Ataxia, diplopia in vertical and lateral gaze, left upper arm dysmetria, generalized areflexia, mild lower facial defects, and mild hypoesthesia in the left mandibular and maxillary branch | None | Yes (concurrent pneumonia) | NA | Fever, cough, ageusia, bilateral pneumonia | None | Clinical + CSF | 2 | Miller Fisher variant |
| Manganotti et al. [33] | Italy | 72 | M | 18 days after | Tetraparesis UL > LL, LL paraesthesia , generalized areflexia, facial weakness on the right side | NA | NA | No | NA | Fever, dyspnea, hyposmia and ageusia | NA | Clinical + CSF + electrophysiology | 1 | Classic sensorimotor |
| Manganotti et al. [33] | Italy | 72 | M | 30 days after | Tetraparesis LL > UL, paraesthesia, global areflexia | NA | NA | No | NA | Fever, cough, dyspnea, hyposmia and ageusia | NA | Clinical + electrophysiology | 1 | Classic sensorimotor |
| Manganotti et al. [33] | Italy | 49 | F | 14 days after | Ophthalmoplegia, limb ataxia, generalized areflexia, diplopia, facial hypoesthesia, facial weakness | NA | NA | No | NA | Fever, cough, dyspnea, hyposmia and ageusia | NA | Clinical + CSF + electrophysiology | 1 | Miller Fisher variant |
| Manganotti et al. [33] | Italy | 94 | M | 33 days after | LL weakness, generalized hyporeflexia | NA | NA | No | NA | Fever, cough, gastrointestinal symptoms | NA | Clinical + electrophysiology | 2 | Classic sensorimotor |
| Manganotti et al. [33] | Italy | 76 | M | 22 days after | Quadriparesis UL > LL, generalized areflexia, facial weakness, transient diplopia | NA | NA | No | NA | Fever, cough, dysuria, hyposmia, ageusia | NA | Clinical + CSF + electrophysiology | 1 | Pure motor |
| Marta-Enguita et al. [34] | Spain | 76 | F | 8 days after | Back pain and progressive tetraparesis with distal-onset paraesthesia | Progressive with dysphagia and cranial nerves involvement, generalized areflexia | NA | Yes | 10 days after symptom onset | Cough and fever without dyspnea | None | Clinical | 3 | NA |
| Mozhdehipanah et al. [35] | Iran | 38 | M | 16 days after | Progressive LL paraesthesia, facial diplegia, lobal areflexia | Mild LL weakness , bulbar symptoms developed | Blood pressure instability, tachycardia | No | 8 days after symptoms onset | Upper respiratory infection (no further details) | NA | Clinical + CSF + electrophysiology | 1 | Bilateral facial palsy with paraesthesia |
| Mozhdehipanah et al. [35] | Iran | 14 | F | NA | Ascending quadriparesis, UL hyporeflexia, LL areflexia, distal hypoesthesia, ataxia | NA | NA | No | NA | Upper respiratory infection (no further details) | NA | Clinical + CSF | 2 | Classic sensorimotor |
| Mozhdehipanah et al. [35] | Iran | 44 | F | 26 days after | Weakness of LL | Tetraparesis, generalized areflexia, symmetrical hypoesthesia | NA | Yes | NA | Dry cough, fever, myalgia, progressive dyspnea | COPD | Clinical + CSF + electrophysiology | 1 | Classic sensorimotor |
| Mozhdehipanah et al. [35] | Iran | 66 | F | 30 days after | Progressive UL and LL weakness, generalized areflexia, symmetrical hypoesthesia | NA | No | No | NA | Fever, dry cough, severe myalgia | DM, hypertension, and rheumatoid arthritis | Clinical + CSF + electrophysiology | 1 | Classic sensorimotor |
| Naddaf et al. [36] | USA | 58 | F | 17 days after | Progressive paraparesis, imbalance, severe lower thoracic pain without radiation | Mild neck flexion weakness, mild/moderate distal UL and proximal and distal LL weakness, UL hyporeflexia, LL areflexia, moderately severe length-dependent sensory loss in the feet, ataxic gait | None | No | NA | Fever, dysgeusia without anosmia, bilateral interstitial pneumonia | None | Clinical + CSF + electrophysiology | 1 | Classic sensorimotor |
| Oguz-Akarsu et al. [37] | Turkey | 53 | F | Concurrent pneumonia | Dysarthria, progressive LL weakness and numbness | Ataxia, generalized areflexia | None | No | NA | Mild fever (37.5 °C), pneumonia | None | Clinical + electrophysiology | 2 | Classic sensorimotor |
| Ottaviani et al. [38] | Italy | 66 | F | 7 days after (concurrent pneumonia) | Flaccid paraparesis, no sensory symptoms | Progressively developed proximal weakness in all limbs, dysesthesia, and unilateral facial palsy, generalized areflexia | NA | Yes | 13 days after symptoms onset | Fever and cough, pneumonia | NA | Clinical + CSF + electrophysiology | 1 | Classic sensorimotor |
| Padroni et al. [39] | Italy | 70 | F | 23 days after | UL and LL paraesthesia, gait difficulties, asthenia | Ascendant weakness, tetraparesis, generalized areflexia | None | Yes | 6 days after symptoms onset | Fever (38.5 °C), dry cough, pneumonia | None | Clinical + CSF + Electrophysiology | 1 | Classic sensorimotor |
| Paterson et al. [40] | UK | 42 | M | 13 day after | Distal limb numbness and weakness, dysphagia | Tetraparesis, generalized areflexia, sensory loss | NA | Yes | 16 days after symptom onset | Cough, fever dyspnea, diarrhea, anosmia | None | Clinical + CSF + electrophysiology | 1 | Classic sensorimotor |
| Paterson et al. [40] | UK | 60 | M | 1 day before | Distal limb numbness and weakness | Tetraparesis, generalized areflexia, sensory loss, dysautonomia, facial and bulbar weakness | Yes | Yes | 5 days after symptom onset | Headache, ageusia, anosmia | NA | Clinical + CSF + electrophysiology | 1 | Classic sensorimotor |
| Paterson et al. [40] | UK | 38 | M | 21 day after | Distal limb numbness, weakness, clumsiness | Mild distal weakness, sensory ataxia | None | No | NA | Cough, diarrhea | NA | Clinical + CSF + electrophysiology | 1 | Classic sensorimotor |
| Paybast et al. [41] | Iran | 38 | M | 21 days after | Acute progressive ascending paraesthesia of distal LL | Quadriparesthesia, bilateral facial droop with drooling of saliva and slurred speech, generalized areflexia, swallowing inability, bilaterally absent gag reflex | Tachycardia and blood pressure instability | No | 3 days after symptoms onset | Symptoms of upper respiratory tract infection | Hypertension | Clinical + CSF + electrophysiology | 1 | Classic sensorimotor |
| Paybast et al. [41] | Iran | 14 | F | 21 days after | Progressive ascending quadriparesthesia, mild LL weakness | Mild proximal and distal LL weakness, hypoactive deep tendon reflexes in UL and absent in LL, decreased light touch, position, and vibration sensation in all distal limbs up to ankle and elbow joints, gait ataxia | None | No | 2 days after symptoms onset | Symptoms of upper respiratory tract infection | None | Clinical + CSF | 2 | Classic sensorimotor |
| Pfefferkorn et al. [42] | Germany | 51 | M | 14 days after | UL and LL weakness, acral paraesthesia | Tetraparesis, generalized areflexia, deterioration to an almost complete peripheral locked-in syndrome with tetraplegia, complete sensory loss at 4 limbs, bilateral facial and hypoglossal paresis | None | Yes | 15 days after symptoms onset | Fluctuating fever, flu-like symptoms with marked fatigue and dry cough, pneumonia | NA | Clinical + CSF + electrophysiology | 1 | Classic sensorimotor |
| Rana et al. [43] | USA | 54 | M | 14 days after | LL paresthesias of LL | Ascending tetraparesis, general areflexia, burning sensation diplopia, facial diplegia, mild ophthalmoparesis | Resting tachycardia and urinary retention | Yes | NA | Rhinorrhea, odynophagia, fever, chills, and night sweats | Hypertension, hyperlipidemia, restless leg syndrome, and chronic back pain, concurrent C. Difficile infection | Clinical + electrophysiology | 2 | Miller Fisher variant |
| Reyes-Bueno et al. [44] | Spain | 50 | F | 15 days after | Root-type pain in all four limbs, dorsal and lumbar back pain | LL Weakness, ataxia, diplopia, bilateral facial palsy, generalized areflexia | Dry mouth, diarrhea and unstable blood pressure | No | 12 days after symptoms onset | Diarrhea, odynophagia and cough | NA | Clinical + CSF + electrophysiology | 1 | Miller Fisher variant |
| Riva et al. [45] | Italy | 60+ | M | 17 days after | Progressive limb weakness and distal paresthesia at four limbs | Ascending paraparesis with involvement of the cranial nerves (facial diplegia), generalized areflexia | None | No | 10 days after symptoms onset | Fever, headache, myalgia, anosmia and ageusia | NA | Clinical + electrophysiology | 2 | Classic sensorimotor |
| Sancho-Saldaña et al. [46] | Spain | 56 | F | 15 days after | Unsteadiness and paraesthesia in both hands | Lumbar pain and ascending weakness, global areflexia, bilateral facial nerve palsy, oropharyngeal weakness and severe proximal tetraparesis | No | Yes | 3 days after symptoms onset | Fever, dry cough and dyspnea, pneumonia | NA | Clinical + CSF + electrophysiology | 1 | Classic sensorimotor |
| Scheidl et al. [47] | Germany | 54 | F | 11 days after | Proximal weakness of LL, numbness of 4 limbs | Initial worsening of the paraparesis with rapid improvement upon initiation of the treatment, areflexia | None | No | 12 days after symptoms onset | Temporary ageusia, | None | Clinical + CSF + electrophysiology | 1 | Paraparetic variant |
| Sedaghat et al. [48] | Iran | 65 | M | 14 days after | LL distal weakness | Ascending weakness, tetraparesis, facial bilateral palsy, generalized areflexia, LL distal hypoesthesia and hypopallesthesia | None | No | 4 days after symptoms onset | Fever, cough and sometimes dyspnea, pneumonia | DM type 2 | Clinical + electrophysiology | 2 | Classic sensorimotor |
| Sidig et al. [49] | Sudan | 65 | M | 5 days after | Numbness and weakness in both UL and LL | Ascending weakness, bilateral facial paraesthesia and palsy, clumsiness of UL, tetraparesis, slight palatal muscle weakness, areflexia | Urinary incontinence | Yes | NA | Low-grade fever, sore throat, dry cough, headache and generalized fatigability | DM and Hypertension | Clinical + electrophysiology | 2 | Classic sensorimotor |
| Su et al. [50] | USA | 72 | M | 6 days after | Proximal UL and LL weakness | Progression with worsening of the paresis, areflexia, hypoesthesia | Hypotension alternating with hypertension and tachycardia | Yes | 8 days after symptoms onset | Mild diarrhea, anorexia and chills without fever or respiratory symptoms | Coronary artery disease, hypertension and alcohol abuse | Clinical + CSF + electrophysiology | 1 | Classic sensorimotor |
| Tiet et al. [51] | United Kingdom | 49 | M | 21 days after | Distal LL paraesthesia | LL and UL weakness, facial diplegia, distal reduced sensation to pinprick and vibration sense, LL dysesthesia, generalized areflexia | None | No | 4 days after symptoms onset | Shortness of breath, headache and cough | Sinusitis | Clinical + CSF + electrophysiology | 1 | Classic sensorimotor |
| Toscano et al. [52] | Italy | 77 | F | 7 days after | UL and LL paraesthesia | Flaccid tetraplegia, areflexia, facial weakness, dysphagie, tongue weakness | None | Yes | NA | Fever, cough, ageusia, pneumonia | Previous ischemic stroke, diverticulosis, arterial hypertension, atrial fibrillation | Clinical + CSF + electrophysiology | 1 | Classic sensorimotor |
| Toscano et al. [52] | Italy | 23 | M | 10 days after | Facial diplegia | LL paraesthesia, generalized areflexia, sensory ataxia | None | No | 2 days after symptoms onset | Fever, pharyngitis | NA | Clinical + CSF + electrophysiology | 1 | Bilateral facial palsy with paraesthesia |
| Toscano et al. [52] | Italy | 55 | M | 10 days after | Neck pain, Paresthesias in the 4 limbs, LL weakness | Flaccid tetraparesis, areflexia, facial weakness | None | Yes | NA | Fever, cough, pneumonia | NA | Clinical + CSF + electrophysiology | 1 | Classic sensorimotor |
| Toscano et al. [52] | Italy | 76 | M | 5 days after | Lumbar pain, LL weakness | Flaccid tetraparesis, generalized areflexia, ataxia | None | No | 4 days after symptoms onset | Cough and hyposmia | NA |
Clinical + CSF+ Electrophysiology |
1 | Classic sensorimotor |
| Toscano et al. [52] | Italy | 61 | M | 7 days after | LL weakness and paraesthesia | Ascending weakness, tetraplegia, facial weakness, areflexia, dysphagia | None | Yes | NA | Cough, ageusia and anosmia, pneumonia | NA | Clinical + CSF+ electrophysiology | 1 | Classic sensorimotor |
| Velayos Galán et al. [53] | Spain | 43 | M | 10 days after | Distal weakness and numbness of the 4 limbs, gait ataxia | Progression of the weakness with bilateral facial paresis and dysphagia, generalized areflexia | NA | No | 2 days after admission | Cough, pneumonia | NA | Clinical + electrophysiology | 2 | Classic sensorimotor |
| Virani et al. [54] | USA | 54 | M | 8 days after | LL weakness, numbness | Ascending weakness, tetraparesis, areflexia | Urinary retention | Yes | Shortly after presentation in the outpatient clinic (after 2 days of symptoms onset) | Fever (102 F), dry cough, pneumonia | Clostridium difficile colitis 2 days before GBS onset | Clinical | 3 | Classic sensorimotor |
| Webb et al. [55] | United Kingdom | 57 | 6 days after | Ataxia, progressive limb weakness and foot dysaesthesia, | Tetraparesis, generalized areflexia, hypoesthesia in the 4 limbs, hypopallesthesia in LL, dysphagia | None | Yes | 3 days after symptoms onset | Mild cough and headache, myalgia and malaise, slight fever, diarrhea, pneumonia | Untreated hypertension and psoriasis | Clinical + CSF + electrophysiology | 1 | Classic sensorimotor | |
| Zhao et al. [56] | China | 61 | F | 8 days before | LL weakness | Ascending weakness, tetraparesis, areflexia, LL distal hypoesthesia | None | No | 4 days after symptoms onset | Fever (38·2 °C), dry cough pneumonia | NA | Clinical + CSF + electrophysiology | 1 | Classic sensorimotor |
| Article | COVID-19 diagnosis | Blood findings | Auto-antibodies and screening for most common GBS causes | CSF findings | Electrophysiology: Neuropathy type and GBS electrophysiologic subtype | MRI (brain and spinal) | Management and therapy | Outcome | |
|---|---|---|---|---|---|---|---|---|---|
| GBS | COVID-19 | ||||||||
| Agosti et al. [5] | RT-PCR + chest CT | Thrombocytopenia (101 × 109 /L, reference value: 125–300 × 109 /L), lymphocytopenia (0.48 × 109 /L, reference value: 1.1–3.2 × 109 /L) | Negative ANA, anti-DNA, c-ANCA, p-ANCA, negative screening for Campylobacter jejuni, Mycoplasma pneumoniae, Salmonella enterica, CMV, HSV 1 and 2, VZV, influenza virus A and B, HIV, normal B12 and serum protein electrophoresis | Increased total protein (98 mg/dl), cell count: 2/106 L |
Demyelinating AIDP |
NA | IVIG 400 mg/kg/day (5 days) | Antiviral drugs (not specifically mentioned) | Improvement, discharged home after 30 days |
| Alberti et al. [6] | RT-PCR + chest CT | NA | NA | Increased total protein (54 mg/dl), 9 cells/µl, negative SARS-CoV-2 PCR |
Demyelinating AIDP |
NA | IVIG 400 mg/kg (5 days) + mechanical invasive ventilation | Lopinavir/ritonavir, hydroxychloroquine | 24 h after admission, death because of respiratory failure |
| Arnaud et al. [7] | RT-PCR + chest CT | NA | Negative anti-ganglioside and antineural antibodies, negative Campylobacter Jejuni, HIV, syphilis, CMV, EBV serology | Increased total protein (1.65 g/L), no pleyocitosis, negative oligoclonal bands, negative SARS-CoV-2 PCR, negative EBV and CMV RT-PCR |
Demyelinating AIDP |
NA | IVIG 400 mg/kg (5 days) | Hydroxychloroquin, cefotaxime, azithromycine | Progressive improvement |
| Assini et al. [8] | RT-PCR | Lymphocytopenia, increased LDH and inflammation markers; low serum albumin (2.9 mg/dL) | NA | Normal total protein level, increased IgG/albumin ratio (233), negative SARS-CoV-2 PCR, presence of oligoclonal bands (both in serum and CSF) |
Demyelinating with sural sparing AIDP |
Brain: no pathological findings | IVIG 400 mg/kg (5 days) | Hydroxychloroquine, arbidol, ritonavir and lopinavir + mechanical invasive ventilation | 5 days after IVIG, improvement of swallowing, speech, tongue motility, eyelid ptosis and strength |
| Assini et al. [8] | RT-PCR + chest CT | Lymphocytopenia, increased LDH and GGT, leucocytosis, low serum albumin (2.6 mg/dL) | Negative anti-ganglioside antibodies | Normal total protein level, increased IgG/albumin ratio (170), negative SARS-CoV-2 PCR, presence of oligoclonal bands (both in serum and CSF) |
Motor sensory axonal, muscular neurogenic changes AMSAN |
NA | IVIG 400 mg/kg (5 days) | Hydroxychloroquine, antiretroviral therapy, tocilizumab + tracheostomy and assisted ventilation | 5 days after IVIG, improvement of vegetative symptoms, persistence of hyporeflexia and right foot drop |
| Bigaut et al. [9] | RT-PCR + chest CT | Normal blood count, negative CRP | Negative anti-ganglioside antibodies, negative HIV, Lyme and syphilis serology | Increased total protein (0.95 g/L), cell count: 1 × 106/L, negative SARS-CoV-2 PCR |
Demyelinating AIDP |
Spinal: Radiculitis and plexitis on both brachial and lumbar plexus; multiple cranial neuritis (in III, VI, VII, and VIII nerves) | IVIG 400 mg/kg (5 days) + non-invasive ventilation | NA | Progressive improvement |
| Bigaut et al. [9] | RT-PCR + chest CT | Increased CRP | Negative anti-ganglioside antibodies | Increased total protein (1.6 g/L), cell count: 6 × 106/L, negative SARS-CoV-2 PCR |
Demyelinating AIDP |
NA | IVIG 400 mg/kg (5 days) | NA | Slow progressive improvement |
| Bracaglia et al. [10] | RT-PCR (normal chest CT) | Elevated CPK (461 U/L, normal < 145), CRP 5,65 mg/dL (normal < 0.5), lymphocyto- penia (0·68 × 109/L, normal 1·10–4), mild increase of LDH (284 U/L, normal < 248), GOT and GPT (549 and 547 U/L, normal < 35), elevation of IL-6 (11 pg/mL, normal < 5.9) | Negative anti-ganglioside antibodies; negative microbiologic testing on CSF and serum for HSV1-2, EBV, VZV, CMV, HIV, Mycoplasma Pneumoniae and Borrelia. | Increased total protein (245 mg/dL) and increased cell count: 13 cells/mm3, polymorphonucleate 61.5% |
Demyelinating AIDP |
NA | IVIG 400 mg/kg (5 days) | Hydroxychloroquine, ritonavir, darunavir | Improvement of UL and LL weakness, development of facial diplegia |
| Camdessanche et al. [11] | RT-PCR + chest CT | NA | Negative anti-gangliosides antibodies; negative screening for Campylobacter jejuni, Mycoplasma pneumoniae, Salmonella enterica, CMV, EBV, HSV1-2, VZV, Influenza virus A & B, HIV, and hepatitis E | Increased total protein (1.66 g/L), normal cell count |
Demyelinating AIDP |
NA | IVIG 400 mg/kg (5 days) + mechanical invasive ventilation | Oxygen therapy, paracetamol, low molecular weight heparin, lopinavir/ritonavir 400/100 mg twice a day for 10 days | NA |
| Chan et al. [12] | RT-PCR + chest CT | Persistent thrombocytosis (maximum PC 688 ×109/L), elevated d-dimer (1.47 mg/L) | NA | Increased total protein (1.00 g/L), cell count: 4 × 106/L (normal), negative SARS-CoV-2 PCR |
Demyelinating AIDP |
Brain: bilateral intracranial facial nerve enhancement | IVIG 400 mg/kg (5 days) | Empiric azithromycin and ceftriaxone | Slight improvement of facial weakness, unchanged paraesthesia |
| Chan et al. [13] | RT-PCR | NA | Negative anti-gangliosides antibodies | Increased total protein (226 mg/dL), leucocytes: 3 cells/mm3, glucose: 56 mg/dL, negative SARS-CoV-2 PCR | NA | Lumbosacral spine: no pathological findings | 5 sessions of plasmapheresis | NA | Resolution of dysphagia, ambulation with minimal assistance 28 days after symptoms onset |
| Chan et al. [13] | RT-PCR | NA | Elevated GM2 IgG/IgM antibodies | Increased total protein (67 mg/dL), leucocytes: 1 cells/mm3, glucose 58 mg/dL, negative SARS-CoV-2 PCR | NA | NA | Mechanical invasive ventilation + 5 sessions of plasmapheresis (without benefit on ventilation) + IVIG | NA | Persistence of quadriparesis with intermittent autonomic dysfunction, slowly weaned from the ventilator |
| Coen et al. [14] | RT-PCR + serology | Normal (not specified) | Negative anti-gangliosides antibodies; negative meningitis/encephalitis panel | Albuminocytological dissociation, no intrathecal IgG synthesis, negative SARS-CoV-2 PCR |
Demyelinating with sural sparing AIDP |
Brain: NA Spinal: no pathological findings |
IVIG 400 mg/kg (5 days) | NA |
Rapid improvement. From day 11 from hospitalisation Rehabilitation |
| Ebrahimzadeh et al. [15] | RT-PCR + chest CT | Normal CRP (5 mg/L), normal serum protein immunoelectrophoresis | Negative anti-GQ1b antibodies, negative screening for Campylobacter jejuni, HIV, EBV, CMV, influenza virus (type A and B), HCV, non-reactive VDRL | Increased total protein (78 mg/dL), normal cell count (erythrocyte = 0/mm3, leukocyte = 4/mm3), normal glucose (70 mg/dL) |
Demyelinating AIDP |
Brain: no pathological findings Spinal: no pathological findings |
None | Hydroxychloroquine for 5 days | Improvement of muscle strength to near normal after 16 days |
| Ebrahimzadeh et al. [15] | RT-PCR + chest CT | Slightly elevated CRP (34 mg/L), normal serum protein immunoelectrophoresis | Negative anti-GQ1b antibodies, negative screening for Campylobacter jejuni, HIV, EBV, CMV, influenza virus (type A and B), HCV, non-reactive VDRL | NA |
Demyelinating AIDP |
NA | IVIG | NA | Improvement of muscle strength in all extremities after 14 days |
| El Otmani et al. [16] | RT-PCR + chest CT | Lymphocytopenia (520/ml) | NA |
Increased total protein (1 g/L), normal cell count, negative PCR assay for SARS-CoV-2 |
Motor sensory axonal AMSAN |
NA | IVIG 400 mg/kg/day (5 days) | Hydroxychloroquine 600 mg/day; azithromycin 500 mg at the first day, then 250 mg per day | At week 1 from admission no significant neurological improvement |
| Esteban Molina et al. [17] | RT-PCR + chest X-ray | Leucocyte 7400/mm3, lymphocyte 2400/mm3. Hb 14 g/dl. PC 408,000/mm3, d-Dimer 556 ng/ml. Ferritin 544 ng/ml, CRP 2.04 mg/dl, Fibrinogen 6.8 g/dl | Negative bacteriological and viral tests | Increased total protein (86 mg/dL), cell count: 3x106/L |
Demyelinating AIDP |
Brain: leptomeningeal enhancement in midbrain and cervical spine | IVIG 400 mg/kg/day (5 days) | Hydroxychloroquine, azithromycin, ceftriaxon | Motor improvement but persistence of paraesthesia |
| Farzi et al. [18] | RT-PCR + chest CT | Lymphopenia (WBC:5.9 × 109/L, neutrophils: 85%, lymphocyte:15%), elevated levels of CRP, ESR 69 mm/h | NA | NA |
Demyelinating AIDP |
NA | IVIG (2 g/kg over 5 days) | Lopinavir/ritonavir and hydroxychloroquine | Improvement after 3 days, favorable outcome |
| Fernández–Domínguez et al. [19] | RT-PCR | NA | Negative anti-GD1b antibodies, negative other anti-ganglioside antibodies | Increased total protein (110 mg/dL), albuminocytological dissociation |
Demyelinating NA |
Brain: no pathological findings | IVIG 20 g/day (5 days) | Hydroxychloroquine, lopinavir/ritonavir | NA |
| Finsterer et al. [20] | NA | NA | NA | NA |
Axonal AMAN |
NA | IVIG | NA | Recovery |
| Frank et al. [21] | RT-PCR, + serology (IgG and IgM) | WBC and CRP normal | Negative hepatitis B and C, HIV and VDRL tests | Two CSF analysis 2 weeks apart, both showing normal cell count and CSF biochemistry, negative SARS-CoV-2 PCR, negative PCR for HSV1, HSV2, CMV, EBV, VZV; Zika virus; Dengue virus and Chikungunya virus |
Axonal AMAN |
Brain: no pathological findings Spinal: no pathological findings |
IVIG 400 mg/kg/day (5 days) | Methylprednisolone, azithromycin, albendazole | Some improvement, weakness persisted |
| Gigli et al. [22] | Chest CT + serology (negative RT-PCR) | NA | Negative anti-ganglioside antibodies, negative PCR for influenza A and B viruses (nasal swab) | Increased total protein (192.8 mg/L), leucocytes: 2.6 cells/µL, positive Ig for SARS-CoV-2, negative SARS-CoV-2 PCR |
Demyelinating AIDP |
NA | NA | NA | NA |
| Gutiérrez-Ortiz et al. [23] | RT-PCR | Lymphocytes 1000 cells/UI, CRP 2.8 mg/dl | Positive anti-GD1b antibodies, other anti-ganglioside antibodies negative |
Increased total protein (80 mg/dl), no leucocytes, glucose 62 mg/dl, negative SARS-CoV-2 PCR |
NA | NA | IVIG 400 mg/kg (5 days) | NA | After 2 weeks from admission complete resolution except anosmia, ageusia |
| Gutiérrez-Ortiz et al. [23] | RT-PCR | Leucopenia (3100 cells/µl) | NA | Increased total protein (62 mg/dl), WBC: 2/μl (all monocytes), glucose: 50 mg/dl, negative SARS-CoV-2 PCR | NA | NA | None | Paracetamol | 2 weeks later complete neurological recovery with no ageusia, complete eye movements, and normal deep tendon reflexes |
| Helbok et al. [24] | Chest CT + serology (repeated negative RT-PCR) | WBC 8.1G/L (normal: 4.0–10.0G/L), CRP 2.3 mg/dL, (normal: 0.0–0.5 mg/dL), fibrinogen level 650 mg/dL (normal: 210–400 mg/dL), LDH 276 U/L (normal: 100–250 U/L), erythrocyte sedimentation rate 55 mm/1 h | Negative PCR for CMV, EBV, influenza virus A/B, Respiratory Syncytial Virus and IgM antibodies for Chlamydia pneumoniae and Mycoplasma pneumoniae | Increased total protein (64 mg/dl), cell count: 2 cells/mm3, serum/ CSF glucose ratio of 0.83, negative SARS-CoV-2 PCR, positive anti-SARS-CoV-2 antibodies (not determined if intrathecal synthesis or passive transfer from blood) |
Demyelinating with sural sparing AIDP |
Spinal: no pathological findings | IVIG 30 g + plasma exchange (4 cycles) + mechanical invasive ventilation | None | Improvement of muscle forces with recovery of mobility without significant help after 8 weeks |
| Hutchins et al. [25] | RT-PCR + chest CT | Lymphopenia (absolute lymphocyte count of 0.7 K/mm3) | Serum HSV IgG and IgM. Respiratory viral panel PCR negative Negative GM1, GD1b, and GQ1b IgG and IgM), aquaporin-4 receptor (IgG), HIV 1/2, HSV 1/2 (IgG and IgM), CMV (IgM), Mycoplasma pneumoniae (IgG and IgM), Borrelia burgdorferi (IgG and IgM), Bartonella species (IgG and IgM), and syphilis (Venereal Disease Research Laboratory test) | Increased total protein (49 mg/dL), normal glucose levels (65 mg/dL), no leukocytes | Mixed demyelinating and axonal EMG subtype unknown |
Brain: enhancement of the facial and abducens nerves bilaterally, as well as the right oculomotor nerve Spinal: no pathological findings |
Plasma exchange (5 cycles) | NA | Discharged to inpatient rehabilitation |
| Juliao Caamaño et al. [26] | RT-PCR | NA | NA | Normal total protein (44 mg/dL), no pleocytosis |
Absent blink-reflex EMG subtype unknown |
Brain: no pathological findings | Oral prednisolone | Hydroxychloroquine and lopinavir/ritonavir for 14 days | Minimal improvement of muscle weakness after 2 weeks |
| Khalifa et al. [27] | RT-PCR + chest X-ray + chest CT | WBC 5.5 × 103, PC 356 × 103, CRP 0.5 mg/dL (normal 0.0–0.5), serum ferritin 87.3 ng/ml (normal 12.0–150.0), elevated d-Dimer levels 0.72 mg/L (0.00–0.49) | Negative screening for: influenza A and B viruses; influenza A virus subtypes H1, H3, and H5 including subtype H5N1 of the Asian lineage; parainfluenza virus types 1, 2, 3, and 4; respiratory syncytial virus types A and B; adenovirus; metapneumovirus; rhinovirus; enterovirus; Coronavirus 229E, HKU1, NL63, and OC43 | Cell count: 5 mm3, increased total protein (316.7 mg/dL) |
Demyelinating AIDP |
Brain: no pathological findings Spinal: enhancement of the cauda equina nerve roots |
IVIG 1 g/kg (2 days) | Paracetamol, azithromycin, hydroxychloroquine | Discharge to home after 15 days with clinical and electrophysiological improvement |
| Kilinc et al. [28] | Fecal PCR + serology | NA | Negative anti-GQ1b antibodies, serologic tests on Borrelia burgdorferi, syphilis, Campylobacter jejuni, CMV, hepatitis E, Mycoplasma pneumoniae and CMV | Normal cell count, normal proteins |
Predominantly demyelinating AIDP |
Brain: no pathological findings | IVIG 2 g/kg (5 days) | None | Persistence of mild symptoms at the discharge (after 14 days) |
| Lampe et al. [29] | RT-PCR (negative chest X-ray) | Slightly increased CRP (1.92 mg/dL) | Negative anti-ganglioside antibodies; negative influenza and respiratory syncytial virus | Increased total protein (56 mg/dL), normal cell count (2 cells/μL) |
Demyelinating AIDP |
NA | IVIG 400 mg/kg (5 days) | None | Improvement of GBS symptoms with persistence of generalized areflexia except for left biceps reflex, discharge after 12 days |
| Lantos et al. [30] | RT-PCR | NA | GM1 antibodies in the equivocal range | NA | NA | Brain: enlargement, prominent enhancement with gadolinium, and T2 hyperintense signal of the left cranial nerve III | IVIG | Hydroxychloroquine | Improvement, discharge after 4 days |
| Lascano et al. [31] | RT-PCR + chest X-ray + positive IgM (IgG positivity 2 weeks later) | WBC 8900 cells/mm3; lymphocytes 1200 cells/mm3; PC 45,500 cells/mm3 | Negative anti-ganglioside antibodies | Increased total protein (60 mg/dL), leucocytes: 3 cells/μL, negative SARS-CoV-2 PCR |
Demyelinating AIDP |
Spinal: no nerve root gadolinium enhancement |
IVIG 400 mg/kg (5 days) + mechanical invasive ventilation |
Azithromycin |
Improvement of tetraparesis. Able to stand up with assistance. |
| Lascano et al. [31] | RT-PCR + chest X-ray | WBC 3300 cells/mm3; lymphocytes 800 cells/mm3; PC 119,000 cells/mm3 | NA | Normal total protein (40 mg/dl), cell count: 2 cells/μL |
Mixed demyelinating (conduction blocks) and axonal with sural sparing pattern Predominantly AIDP |
NA | IVIG 400 mg/kg (5 days) | Amoxicillin, clarithromycin | Dismissal with full motor recovery. Persistence of LL areflexia and distal paraesthesia |
| Lascano et al. [31] | RT-PCR + chest X-ray | WBC 4000 cells/mm3; lymphocytes 600 cells/mm3; PC 322,000 cells/mm3 | NA | Increased total protein (140 mg/dL), cell count: 4 cells/μL, negative SARS-CoV-2 PCR |
Demyelinating with sural sparing pattern AIDP |
Brain: no pathological findings Spinal cord: lumbosacral nerve root enhancement |
IVIG 400 mg/kg (5 days) | Amoxicillin | Improvement of tetraparesis and ability to walk with assistance. Persistence of neuropathic pain and distal paraesthesia |
| Manganotti et al. [32] | RT-PCR + chest CT | NA | Negative anti-ganglioside antibodies negative serum anti-HIV, anti-HBV, anti-HCV antibodies | Increased total protein (74.9 mg/dL), negative CSF PCR for bacteria, fungi, Mycobacterium tuberculosis, Herpes viruses, Enteroviruses, Japanese B virus and Dengue viruses | NA | Brain: no pathological findings | IVIG 400 mg/kg (5 days) | Lopinavir/ritonavir, hydroxychloroquine, antibiotic therapy, oxygen support (35%) | Resolution of all symptoms except for minor hyporeflexia at the LL |
| Manganotti et al. [33] | RT-PCR | IL-1: 0.2 pg/ml (< 0.001 pg/ml), IL-6: 113.0 pg/ml (0.8–6.4 pg/ml), IL-8: 20.0 pg/ml (6.7–16.2 pg/ml), TNF-α: 16.0 pg/ml (7.8–12.2 pg/ml) | Negative anti-ganglioside antibodies, negative HIV, HBV, HCV negative serological tests for autoimmune disorders | Increased total protein (52 mg/dl), leucocytes: 1 cell/mm3, negative SARS-CoV-2 PCR |
Demyelinating AIDP |
NA | IVIG 400 mg/kg/day (5 days) | Hydroxychloroquine, oseltamivir, darunavir, methylprednisolone and tocilizumab + mechanical invasive ventilation | Improvement of motor symptoms |
| Manganotti et al. [33] | RT-PCR | IL-1: 0.5 pg/ml (< 0.001 pg/ml), IL-6: 9.8 pg/ml (0.8–6.4 pg/ml), IL-8: 55.0 pg/ml (6.7–16.2 pg/ml), TNF- α: 16.0 pg/ml (7.8–12.2 pg/ml) | Negative anti-ganglioside antibodies, negative HIV, HBV, HCV negative serological tests for autoimmune disorders | Normal total protein (40 mg/dl), leucocytes: 1 cell/mm3, negative SARS-CoV-2 PCR | Mixed demyelinating and axonal EMG subtype unknown | Brain: no pathological findings | IVIG 400 mg/kg/day (5 days) | Hydroxychloroquine, lopinavir/ritonavir, methylprednisolone + mechanical invasive ventilation | Improvement of motor symptoms |
| Manganotti et al. [33] | RT-PCR | NA | Negative anti-ganglioside antibodies, negative HIV, HBV, HCV negative serological tests for autoimmune disordes | Increased total protein (72 mg/dL), leucocytes: 5 cell/mm3, negative SARS-CoV-2 PCR |
Mainly demyelinating Predominantly AIDP |
Brain: no pathological findings | IVIG 400 mg/kg/day (5 days) | Hydroxychloroquine, lopinavir/ritonavir, methylprednisolone | Improvement |
| Manganotti et al. [33] | RT-PCR | NA | NA | NA | Mixed demyelinating and axonal EMG subtype unknown | NA | Methylprednisolone 60 mg for 5 days | Methylprednisolone | Stationary |
| Manganotti et al. [33] | RT-PCR | IL-1: 0.2 pg/ml (< 0.001 pg/ml), IL-6: 32.7 pg/ml (0.8–6.4 pg/ml), IL-8: 17.8 pg/ml (6.7–16.2 pg/ml), TNF- α : 11.1 pg/ml (7.8–12.2 pg/ml), IL-2R: 1203.0 pg/ml (440.0–1435.0 pg/ml), IL-10: 4.6 (1.8–3.8 pg/ml) | Negative anti-ganglioside antibodies, negative HIV, HBV, HCV negative serological tests for autoimmune disordes | Increased total protein (53 mg/dL), leucocytes: 2 cell/mm3, negative SARS-CoV-2 PCR | Mixed demyelinating and axonal EMG subtype unknown | NA | IVIG 400 mg/kg/day (5 days) | Hydroxychloroquine, lopinavir/ritonavir, methylprednisolone, meropenem, linezolid, clarithromycin, fluconazole, doxycycline + mechanical invasive ventilation | Improvement |
| Marta-Enguita et al. [34] | RT-PCR + chest CT | Thrombocytopenia, d-Dimer elevation | NA | NA | NA | NA | NA | NA | Death after 10 days |
| Mozhdehipanah et al. [35] | RT-PCR (negative chest CT) | Normal WBC, CRP and ESR | NA | Increased total protein (139 mg/dL), normal cell count, negative CSF HSV serology and gram stain and culture |
Demyelinating AIDP |
NA | Plasma exchange (5 cycles) | NA | Significant improvement of muscle weakness after 3 weeks, persistence of mild bifacial paresis |
| Mozhdehipanah et al. [35] | RT-PCR | Normal WBC, CRP and ESR | NA | Albuminocytological dissociation | NA | NA | IVIG 400 mg/kg/day (5 days) | NA | Complete recovery, except for the persistence of hyporeflexia |
| Mozhdehipanah et al. [35] | RT-PCR + chest CT | Leucocytosis lymphopenia, elevated ESR and CRP | NA | Increased total protein (57 mg/dL), normal cell count and glucose (not further specified) |
Axonal AMSAN |
NA | IVIG 400 mg/kg/day (3 days) | Hydroxy chloroquine, lopinavir/ ritonavir | Death after 3 days from starting treatment with IVIG |
| Mozhdehipanah et al. [35] | RT-PCR + chest CT | Leucocytosis, lymphopenia, elevated ESR and CRP | NA | Increased total protein (89 mg/dL), normal cell count and glucose (not further specified) |
Demyelinating AIDP |
NA | IVIG 400 mg/kg/day (5 days) | Hydroxy chloroquine, lopinavir/ ritonavir | No significant clinical improvement |
| Naddaf et al. [36] | Positive SARS-CoV-2 IgG (index value: 8.2, normal < 0.8) and IgA + chest CT (negative RT-PCR) | Normal completed blood count, elevated d-dimer (690 ng/mL), ferritin (575 mcg/L), ESR (26 mm/h), alanine aminotransferase (73 U/L) | Negative anti-ganglioside antibodies negative HIV, syphilis, West Nile virus, Lyme disease testing, EBV and CMV serology consistent with remote infection, negative paraneoplastic evaluation | Increased total protein (273 mg/dL), total cells count: 2/mm3, negative CSF SARS-CoV-2 RT-PCR, negative meningitis/encephalitis panel, negative oligoclonal bands and IgG index |
Demyelinating AIDP |
Spine: smooth enhancement of the cauda equine roots | Plasma exchange (5 sessions) | Hydroxy chloroquine, zinc, methylprednisolone 40 mg bid for 5 days | Improvement of motor and gait examination. Persistence of slight ataxia without requiring gait aid |
| Oguz-Akarsu et al. [37] | RT-PCR + chest MRT + chest CT | Mild neutropenia (1.49 cells/µL) and a high monocyte percentage (19.77) | HIV test negative | Normal total protein (32.6 mg/dL) with no leucocytes |
Demyelinating with sural sparing pattern AIDP |
Cervical and lumbar and spine: asymmetrical thickening and hyperintensity of post-ganglionic roots supplying the brachial and lumbar plexuses in STIR sequences | Plasma exchange (five sessions, one every other day) | Hydroxychloroquine, azithromycin | Marked neurological improvement after 2 weeks and she was able to walk without assistance |
| Ottaviani et al. [38] | RT-PCR + chest CT | Lymphopenia, increased d-dimer, CRP and CK | Negative anti-ganglioside antibodies | Increased total protein (108 mg/dL), cell count: 0 cells/μL |
Mainly demyelinating Predominantly AIDP |
NA | IVIG 400 mg/kg (5 days) | Lopinavir/ritonavir, hydroxychloroquine | Progressive worsening with multi-organ failure |
| Padroni et al. [39] | RT-PCR + chest CT | WBC 10.41 × 109/L (neutrophils 8.15 × 109/L), normal d-dimer | Negative screening for Mycoplasma pneumonia, CMV, Legionella pneumophila, Streptococcus pneumoniae, HSV, VZV, EBV, HIV-1, Borrelia burgdorferi; auto-antibodies not performed | Increased total protein (48 mg/dl), cell count: 1 × 106/L |
Motor sensory axonal AMSAN |
NA | IVIG 400 mg/kg (5 days) + mechanical invasive ventilation | NA | At day 6 from admission: ICU with mechanical invasive ventilation |
| Paterson et al. [40] | Definite diagnosis (not specified) (normal chest CT) | Increased neutrophils and CRP | NA |
Increased total protein (0.5 g/L), leucocytes: 3 cells/μL (0–5), |
Demyelinating AIDP |
NA | IVIG + mechanical invasive ventilation | None | 17 days of hospitalisation, at discharge able to walk 5 m (across an open space) but incapable of manual work/running |
| Paterson et al. [40] | Definite diagnosis (not specified) (normal chest CT) | Increased CRP and fibrinogen | NA |
Increased total protein (0.6 g/L) leucocytes: 2 cells/μL (0-5), Glucose 3.4 (mmol/L; 2.2-4.2) |
Demyelinating AIDP |
Brain: no pathological findings | IVIG | Mechanical invasive ventilation | 46 days (ongoing) of hospitalisation, still critical and requiring ventilation |
| Paterson et al. [40] | Definite diagnosis (not specified) (normal chest CT) | Not significant findings | NA |
Increased total protein (0.9 g/L) leucocytes: < 1 cells/μL (0-5), Glucose 3.7 (mmol/L; 2.2-4.2) |
Demyelinating AIDP |
Brain: no pathological findings | IVIG | NA | 7 days (ongoing) of hospitalisation, able to walk 5 m (across an open space) but incapable of manual work/running |
| Paybast et al. [41] | RT-PCR | NA | NA | Increased total protein (139 mg/dL), normal glucose and cell count, normal CSF viral serology, negative gram stain and culture | Mixed demyelinating and axonal EMG subtype unknown | NA | 5 sessions of therapeutic plasma exchange, intravenous bolus of labetalol to control sympathetic nervous system over-reactivity | Hydroxychloroquine sulphate 200 mg two times per day for a week | Persistence of generalized hyporeflexia, decreased light touch sensation in distal limbs, mild bilateral facial paresis, sympathetic over-reactivity successfully controlled with labetalol, |
| Paybast et al. [41] | RT-PCR | NA | NA | Albuminocytological dissociation | NA | NA | IVIG 20 g (5 days) | Hydroxychloroquine sulphate 200 mg two times per day for a week | Persistence of generalized hyporeflexia and decreased light touch sensation in distal limbs |
| Pfefferkorn et al. [42] | RT-PCR + chest CT | NA | Negative anti-gangliosides antibodies |
At admission: Normal total protein, cell count: 9/µL, negative SARS-CoV-2 PCR At day 13th: increased total protein (10.231 mg/L), normal cell count |
Demyelinating AIDP |
Spinal: massive symmetrical contrast enhancement of the spinal nerve roots at all levels of the spine including the cauda equina. Anterior and posterior nerve roots were equally affected | IVIG 30 g (5 days) + mechanical invasive ventilation + plasma exchange | NA | At day 31 from admission: motor improvement with regression of facial and hypoglossal paresis but still needed mechanical ventilation |
| Rana et al. [43] | RT-PCR | NA | NA | NA |
Demyelinating with sural sparing AIDP |
Thoracic and lumbar spine: no evidence of myelopathy or radiculopathy | IVIG 400 mg/kg (5 days) | Hydroxychloroquine and azithromycin | On day 4 respiratory improvement, on day 7 rehabilitation |
| Reyes-Bueno et al. [44] | Serology (negative RT-PCR) | NA | Negative anti-ganglioside antibodies | Increased total protein (70 mg/dl), cell count: 5 cells/µl, albuminocytological dissociation |
Demyelinating with alteration of the Blink-Reflex. Further EMG: polyradiculoneuropathy with proximal and brainstem involvement AIDP |
NA | IVIG 400 mg/kg (5 days) + Gabapentin | NA | After the 18th day progressive improvement of facial and limb paresis, diplopia and pain. Consequent neurological rehabilitation |
| Riva et al. [45] | Chest CT + serology (negative RT-PCR) | No pathological findings | Negative anti-ganglioside antibodies | Normal total protein and cells; negative PCR for SARS-CoV2, EBV, CMV, VZV, HSV 1–2, HIV |
Demyelinating with sural sparing AIDP |
Brain: NA Spinal: no pathological findings |
IVIG 400 mg/kg (5 days) | None | Slowly improvement after the 10th day |
| Sancho-Saldaña et al. [46] | RT-PCR + chest X-Ray | NA | Negative anti-ganglioside antibodies | Increased total protein (0.86 g/L), cell count: 3 leucocytes |
Demyelinating AIDP |
Whole spine: brainstem and cervical meningeal enhancement | IVIG 400 mg/kg (5 days) | Hydroxychloroquine, azithromycin | Recovering by day 7 after the onset of weakness. |
| Scheidl et al. [47] | RT-PCR | No pathological findings | Negative Campylobacter Jejuni and Borrelia serology, negative ANA, anti-DNA, c-ANCA,p-ANCA | Increased total protein (140 g/L), albuminocytological dissociation |
Demyelinating AIDP |
Brain: NA Cervical spine: no pathological findings |
IVIG 400 mg/kg (5 days) | None | Complete recovery |
| Sedaghat et al. [48] | RT-PCR + chest CT | Increased WBC 14.6 × 103 (neutrophils 82.7%, lymphocytes 10.4%) and CRP | NA | NA |
Motor sensory Axonal AMSAN |
Brain: no pathological findings Spinal: two cervical intervertebral disc herniations |
IVIG 400 mg/kg (5 days) | Hydroxychloroquine, lopinavir/ritonavir, azithromycin | Not reported |
| Sidig et al. [49] | RT-PCR + chest CT | NA | NA | None |
Demyelinating AIDP |
Brain: no pathological findings | NA | NA | Death after 7 days; because of progressive respiratory failure |
| Su et al. [50] | RT-PCR + chest X-ray | WBC 12,000 cells/µl | Negative anti- ganglioside GM1, GD1b and GQ1b antibodies, acetylcholine receptor binding, voltage-gated calcium channel, antinuclear and ANCA | Increased total protein (313 mg/dL), WBC: 1 cell |
Demyelinating AIDP |
NA | IVIG 2gm/kg (for 4 days) | None | On day 28 persistence of severe weakness |
| Tiet et al. [51] | RT-PCR | Elevated lactate on venous blood gas (3.3 mmo/L), mildly elevated CRP (20 mg/L). Normal WBC, sodium, potassium and renal function. | NA | Increased total protein (> 1.25 g/L), cell count 1x106/L |
Demyelinating AIDP |
NA | IVIG 400 mg/kg/day (5 days) | None | Resolution of facial diplegia, improved upper and lower limbs weakness; able to mobilize unassisted 11 weaks after neurorehabilitation |
| Toscano et al. [52] | RT-PCR + Chest CT + serology | Lymphocytopenia, increased CRP, LDH, ketonuria | Negative anti-ganglioside antibodies |
Day 2: normal total protein, no cells, negative SARS-CoV-2 PCR Day 10: increased total protein (101) mg/dl, cell count: 4/mm3, negative SARS-CoV-2 PCR |
Axonal with sural sparing AMSAN |
Brain: no pathological findings Spinal: Enhancement of caudal nerve roots |
IVIG 400 mg/kg (2 cycles) + temporary mechanical non-invasive ventilation | Paracetamol | At week 4 persistence of severe UL weakness, dysphagia, and LL paraplegia |
| Toscano et al. [52] | RT-PCR (negative chest CT) | Lymphocytopenia; increased ferritin, CRP, LDH | NA | Increased total protein (123 mg/dl), no cells, negative SARS-CoV-2 PCR |
Motor sensory axonal with sural sparing AMSAN |
Brain: enhancement of facial nerve bilaterally Spinal: no pathological findings |
IVIG 400 mg/kg | Amoxycillin | At week 4 improvement of ataxia and mild improvement of facial weakness |
| Toscano et al. [52] | RT-PCR + chest CT | Lymphocytopenia; increased CRP, LDH, ketonuria | Negative anti-ganglioside antibodies | Increased total protein (193 mg/dl), no cells, negative SARS-CoV-2 PCR |
Motor axonal AMAN |
Brain: no pathological findings Spinal: enhancement of caudal nerve roots |
IVIG 400 mg/kg (2 cycles) + mechanical invasive ventilation | Azythromicin | ICU admission due to respiratory failure and tetraplegia. At week 4 still critical |
| Toscano et al. [52] | RT-PCR + serology (negative chest CT) | Lymphocytopenia; increased CRP, ketonuria | NA | Normal protein, no cells, negative SARS-CoV-2 PCR |
Demyelinating AIDP |
Brain: no pathological findings Spinal: no pathological findings |
IVIG 400 mg/kg | None | At week 4 mild improvement in UL but unable to stand |
| Toscano et al. [52] | Chest CT + serology (negative RT-PCR in nasopharyngeal swab and BAL) | Lymphocytopenia; increased CRP, LDH | Negative anti-ganglioside antibodies; negative screening for Campylobacter jejuni, EBV, CMV, HSV, VZV, influenza, HIV | Normal total protein (40 mg/dL), white cell count 3/mm3; negative SARS-CoV-2 PCR |
Demyelinating AIDP |
Brain: NA Spinal: no pathological findings |
IVIG 400 mg/kg + plasma exchange + mechanical invasive ventilation + enteral nutrition | None | At week 4 flaccid tetraplegia, dysphagia, ventilation dependent |
| Velayos Galán et al. [53] | RT-PCR + chest X-ray | NA | NA | NA |
Demyelinating AIDP |
NA | IVIG 400 mg/kg (5 days) | Hydroxychloroquine, lopinavir/ritonavir, amoxicillin, corticosteroids + low-flow oxygen therapy | NA |
| Virani et al. [54] | rt-pcr + chest mrt | WBC 8.6 × 103; Hb 15.4 g/dl; PC 211 × 103; procalcitonin: 0.15 ng/ml | NA | NA | NA |
Brain: NA Spinal: no pathological findings |
IVIG 400 mg/kg (5 days) + mechanical invasive ventilation (4 days) | Hydroxychloroquine 400 mg bid for first 2 doses, then 200 mg bid for 8 doses | At day 4 of IVIG: liberation from mechanical ventilation, resolution of UL symptoms, persistence of LL weakness. Sent to a rehabilitation facility |
| Webb et al. [55] | RT-PCR + chest X-ray + chest CT | Lymphopenia (0.9 × 109/L), thrombocytosis (490 × 109/L) raised CRP (25 mg/L) | Negative ANA, ANCA, anti-ganglioside antibodies, syphilis serology HIV, hepatitis B and hepatitis C | Increased total protein (0.51 g/L), normal glucose and cell count, negative SARS-CoV-2 PCR, negative viral PCR |
Demyelinating AIDP |
NA |
IVIG 400 mg/kg/day (5 days) + Mechanical invasive ventilation |
Co-amoxiclav | After 1 week in ICU: no oxygen requirement and ventilation |
| Zhao et al. [56] | RT-PCR + chest CT | WBC 0.52 × 109; PC 113 × 109/L | NA | Increased total protein (124 mg/dL), cell count 5 × 106/L |
Demyelinating AIDP |
NA | IVIG (dosing not reported) | Arbidol, lopinavir/ ritonavir | At day 30 resolution of neurological and respiratory symptoms |
AIDP, acute inflammatory demyelinating polyneuropathy; AMAN, acute motor axonal neuropathy; AMSAN, acute motor sensory axonal neuropathy; ANA, antinuclear antibodies; ANCA, anti-neutrophil cytoplasmic antibodies; BAL, bronchoalveolar lavage; CK, creatine kinase; CMV, cytomegalovirus; COPD, chronic obstructive pulmonary disease, COVID-19, coronavirus disease 2019; CRP, C-reactive protein; CSF, cerebrospinal fluid; CT, computed tomography; DM, diabetes mellitus; EBV, Epstein–Barr virus; ESR, erythrocyte sedimentation rate; F, female; GBS, Guillain–Barré syndrome; GGT, gamma-glutamyl transferase; GOT, glutamic oxaloacetic transaminase; GPT, glutamate pyruvate transaminase; Hb, haemoglobin; HIV, human immunodeficiency virus; HSV, herpex simplex virus; ICU, intensive-care unit; IL, interleukin; IVIG, intravenous immunoglobulins; IL, interleukin; LDH, lactate dehydrogenase; LL, lower limbs; M, male; MRI, magnetic resonance imaging; NA, not available; PC, platelet count; PCR, Polymerase Chain Reaction; SARS-CoV-2, severe acute respiratory syndrome coronavirus-2; TNF, tumor necrosis factor; UL, upper limbs; VDRL, Veneral Disease Research Laboratory; VZV, varicella-zoster virus; WBC, white blood cells; X-ray: radiography
aTime to Nadir refers to days elapsed between the onset of neurological symptoms and the development of the worst clinical picture when no progression was reported nadir was considered concomitant with GBS symptoms onset
bAccording to Brighton diagnostic criteria [66]