Table 3.
Clinical, laboratory, treatment, and outcome of COVID-19-related GBS and Miller-Fisher syndrome
| References | Age/sex | Preceding illness | Time to GBS | Symptoms/signs | Lab tests | Nerve conduction test | Treatment/outcome |
|---|---|---|---|---|---|---|---|
| Alberti et al./July 2020 [32] | 71/M | Fever | NA | Paraesthesias in all 4 limbs, areflexic flaccid quadriparesis, dyspnoea | Oropharyngeal swab for RT-PCR SARS-CoV-2-positive, CSF-albumin-cells diss., CT chest—B/L ground-glass opacities | AIDP | Mechanical ventilation, HCQ, lopinavir, ritonavir, IVIG/died |
| Farzi et al./June 2020 [33] | 41/M | Fever, cough, dyspnea | 17 days | Parasthesia, quadreparesis | B/L ground-glass opacities in lungs | AIDP | IVIG/improved |
| Hutchins KL et al./June 2020 [34] | 21/M | Fever, cough, dyspnea, headache, nasal congestion | 16 days | Bifacial weakness, facial parasthesia, grade 4/5 power in limbs | Bilateral lung infiltrates, Gadolinium enhancement of bilateral 6th, 7th, and right 3rd cranial nerves | Mixed type sensory motor polyneuropathy | 5-cycle plasma exchange/improved |
| Webb et al./June 2020 [35] | 57/M | Cough, headache, myalgia, malaise | 7 days | Sensory motor flaccid quadriparesis, areflexia | Left lower lobe consolidation, lymphopenia, raised CRP | Demyelinating neuropathy | Mechanical ventilation, IVIG/improved |
| Kilinc et al./June 2020 [36] | 50/M | Dry cough | 4 weeks | Sensory motor quadriparesis, bifacial paralysis | Cranial MRI normal, faecal PCR-positive for SARS-CoV-2 | Demyelinating neuropathy | IVIG/improved |
| Helbok et al./June 2020 [37] | 68/M | Dry cough, headache, fatigue, myalgia, fever | 14 days | Sensory motor quadriparesis | Raised serum IgG, IgM for SARS-CoV-2, raised ESR, CRP, LDH, fibrinogen, B/L ground-glass opacities in lungs | Demyelinating neuropathy | NIV, plasma exchange/improved |
| Sancho-Saldaña et al./June 2020 [38] | 56/M | Fever, dry cough, dyspnea | 15 days | Sensory motor quadriparesis, bifacial paralysis, oropharyngeal weakness | Lobar consolidation in lung, brain stem, and spinal cord leptomeningeal enhancement, CSF-albumin-cytological dissociation | Demyelinating neuropathy | IVIG/improved |
| Oguz-Akarsu et al./June 2020 [39] | 53/F | No preceding infection/vaccination | NA | Dysarthria due to jaw weakness, predominant lower limb weakness | Ground-glass opacities lung fields, hyperintensity of post-ganglionic roots of brachial lumbar plexuses | Demyelinating neuropathy | HCQ, azithromycin/improved |
| Lascano et al./June 2020 (3 patients) [40] | NA | Typical COVID-related symptoms | 7, 15, and 22 days, respectively | Tetraparesis 2, tetraplegia 1, bifacial paralysis, and bulbar symptom 1 | Lumbar root enhancement 1, CSF-albumin-cytological dissociation 2, lymphopenia 2 | Demyelinating neuropathy 3 | IVIG 3/1 patient discharged, 1 walked with assistance, 1 bed-bound |
| Chan et al./May 2020 [41] | 8/M5 | Exposed to relative working in meat-processing plant | 20 days after exposure | Bifacial paralysis, no limb weakness | Persistent thrombocytosis, B/L ground-glass opacities in lungs, CSF-albumin-cytological dissociation | Absent blink reflex bilateral, absent F-wave in left tibial nerve | IVIG/some improvement |
| Riva et al./May 2020 [42] | In sixties | Fever, headache, myalgia, anosmia, ageusia | 20 days | Sensory motor quadriparesis, bifacial paralysis, dysarthria, dysphagia | B/L ground-glass opacities lungs, raised acute-phase reactants, SARS-CoV-2 IgG-positive | Demyelinating neuropathy | Mechanical ventilation, IVIG/slow improvement |
| Zhao et al./May 2020 [43] | 61/F | No preceding illness | Not known | Acute paraparesis, areflexic ascending quadriparesis, sensory deficit in hands and feet | CSF-albumin-cells diss. thrombocytopenia, lymphocytopenia, oropharyngeal swab for RT-PCR SARS-CoV-2-positive | AIDP | IVIG, lopinavir, ritonavir, arbidol/recovered |
| Scheidl et al./May 2020 [44] | 54/F | Hypo-osmia, dysgeusia | 14 days | Acute areflexic flaccid paraparesis, tingling sensations in all 4 limbs | Oropharyngeal swab for RT-PCR SARS-CoV-2-positive, CSF-albumin-cells diss., negative SARS-CoV-2 RT-PCR | AIDP | IVIG/recovered |
| Ottaviani et al./May 2020 [45] | 66/F | Fever, cough | 10 days | Acute areflexic paraparesis, falls, facial nerve palsy | Nasopharyngeal swab for RT-PCR SARS-CoV-2 positive, CSF-albumin-cells diss., negative SARS-CoV-2 RT-PCR, CT chest—B/L ground-glass opacities | Absent F waves, prolonged distal latencies, reduced distal CMAP amplitude, slightly reduced conduction velocities (AIDP) | Mechanical ventilation, IVIG, lopinavir, ritonavir/poor |
| Caamaño et al./May 2020 [46] | 61/M | Fever, cough | 10 days | Right facial palsy-LMN followed by left facial palsy, absent blink reflex | Nasopharyngeal swab for RT-PCR SARS-CoV-2 positive, CSF—mildly raised protein, CT chest—B/L pneumonia | Not done | HCQ, lopinavir, ritonavir, prednisolone/minimal improvement |
| Chan et al./May 2020 [47] | 68/M | Fever, URTI | 18 days | B/L hands and feet paraesthesia, ataxia, areflexic flaccid paraparesis, B/L facial palsy, dysarthria, dysphagia | Nasopharyngeal swab for RT-PCR SARS-CoV-2-positive, CSF-albumin-cells diss., negative SARS-CoV-2 RT-PCR, CT chest—B/L ground-glass opacities | Not done | Plasmapheresis/progressive improvement |
| 84/M | Fever | 23 days | B/L hands and feet paraesthesias, areflexic flaccid quadriparesis, B/L facial palsy, respiratory failure, dysautonomia | Nasopharyngeal swab for RT-PCR SARS-CoV-2-positive, elevated GM2 IgM/IgG antibodies, CSF-albumin-cells diss., negative SARS-CoV-2 RT-PCR, CT chest—B/L ground-glass opacities | Not done | Plasmapheresis, mechanical ventilation, IVIG/residual weakness | |
| Bigaut et al/Sep, May 2020 [48] | 48/M | Cough, asthenia, myalgia, anosmia, ageusia | 21 days | Flaccid paraparesis, generalized areflexia, lower limb and distal upper limb paresthesia, ataxia, facial palsy | Nasopharyngeal swab for RT-PCR SARS-CoV-2-positive, CSF-albumin-cells diss., negative SARS-CoV-2 RT-PCR, MRI-radiculitis and plexitis on both brachial and lumbar plexus; multiple cranial neuritis (in nerves III, VI, VII, and VIII) CT chest-ground-glass opacities in B/L lung fields | AIDP | IVIG/progressive improvement |
| 70/F | Anosmia, ageusia, diarrhoea, myalgia | 10 days | Flaccid tetraparesis, generalized areflexia, forelimb paresthesia, respiratory failure | Nasopharyngeal swab for RT-PCR SARS-CoV-2-positive, CSF-albumin-cells diss., negative SARS-CoV-2 RT-PCR, CT chest—B/L ground-glass opacities | AIDP | IVIG, NIV/progressive improvement | |
| Assini et al./May 2020 [49] | 55/M | Fever, cough, anosmia, ageusia, dyspnoea | 20 days | B/L ptosis, dysphagia, dysphonia, B/L masseter weakness, B/L hypoglossal nerve palsy, hyporeflexia in B/L upper and lower limbs | Oropharyngeal swab for RT-PCR SARS-CoV-2-positive, raised ferritin, LDH, lymphocytopenia, CSF-increased IgG/Alb ratio, oligoclonal bands present in CSF and serum | AIDP | Mechanical ventilation, arbidol, lopinavir, ritonavir, IVIG/improved |
| 60/M | Fever, cough, dyspnoea | 20 days | Acute areflexic paraparesis, autonomic dysfunction | Oropharyngeal swab for RT-PCR SARS-CoV-2-positive, raised ferritin, LDH, lymphocytopenia, CSF-increased IgG/Alb ratio, oligoclonal bands present in CSF and serum, CT chest—interstitial pneumonia | AMSAN | Mechanical ventilation, HCQ, tocilizumab, IVIG/improved | |
| Gigli et al./May 2020 [50] | 53/M | Fever, diarrhoea | NA | Parasthesias, ataxia | SARS-CoV-2 IgG/IgM-positive in blood and CSF, CSF-albumin-cell diss., CT chest—B/L ground-glass opacities | AIDP | NA/NA |
| Arnaud et al./May 2020 [51] | 64/M | Fever, cough, dyspnoea, diarrhoea | 21 days | Acute areflexic flaccid paraparesis, hypoesthesia | Nasopharyngeal swab for RT-PCR SARS-CoV-2-positive, CSF-albumin-cells diss., CT chest-diffuse GGO with crazy paving appearance | AIDP | Azithromycin, HCQ, IVIG/improved |
| Rana et al./May 2020 [52] | 54/M | Rhinorrhea, odynophagia, fever, chills, night sweats | 2 weeks | Quadriparesis, bifacial weakness, mild ophthalmoparesis, difficulty in urination | B/L basal lungs infiltrates/atelectasis | Demyelinating neuropathy | HCQ, azithromycin, oral vancomycin/improving |
| Su et al./May 2020 [53] | 72/M | Diarrhoea, anorexia, chills, no fever | 6 days | Ascending sensory motor quadriparesis, dysautonomia, SIADH | CSF-albumin-cytological dissociation, bibasilar atelectasis with consolidation | Demyelinating neuropathy | Mechanical ventilation, antibiotics/persistent weakness |
| Pfeferkorn et al./May 2020 [54] | 51/M | Fever, dry cough, fatigue | 14 days | Progressive areflexic flaccid quadriparesis, sensory loss in all extremities, B/L facial and hypoglossal paresis, respiratory failure | Oropharyngeal swab for RT-PCR SARS-CoV-2-positive, CSF-albumin-cells diss., CT chest—B/L interstitial infiltrates, MRI spine-contrast enhancement of the spinal nerve roots at all levels of the spine including the cauda equina | AIDP | Mechanical ventilation, IVIG, plasma exchange/poor with residual weakness |
| Sedaghat Z et al, April, 2020 [55] | 65/M | Cough, fever, dyspnoea | 14 days | Areflexic ascending quadriparesis, facial diplegia | Oropharyngeal swab RT-PCR SARS-CoV-2-positive, CT chest: consolidations, ground-glass opacities in both lungs | AMSAN | Lopinavir, ritonavir, HCQ, azithromycin, IVIG/improved |
| Toscano G et al./April 2020 [56] | 77/F | Fever, cough, ageusia | 7 days | Paresthesia hands/feet areflexic quadriparesis, facial palsy, respiratory failure | Nasopharyngeal swab for RT-PCR SARS-CoV-2 positive, lymphocytopenia, CSF-albumin-cells dissociation, antiganglioside Ab—negative, MRI spine-enhancement of caudal nerve roots, CT chest—interstitial pneumonia | AMSAN, fibrillation potentials on EMG + | 2 cycles of IVIG/poor outcome, residual weakness, and dysphagia |
| 23/M | Fever, pharyngitis | 10 days | Lower limb paresthesia, facial diplegia, areflexia, ataxia | Nasopharyngeal swab for RT-PCR SARS-CoV-2-positive, lymphocytopenia, CSF-albumin-cells diss., MRI head-enhancement facial nerves, CT chest—normal | AMSAN, fibrillation potentials on EMG | IVIG/improvement | |
| 55/M | Fever, cough | 10 days | Lower limb weakness, paresthesia, neck pain, areflexic quadriparesis, facial palsy, respiratory failure | Nasopharyngeal swab for RT-PCR SARS-CoV-2-positive, lymphocytopenia, CSF-albumin-cells dissociation, antiganglioside Ab—negative, MRI spine-enhancement of caudal nerve roots, CT chest—interstitial pneumonia | AMAN, fibrillation potentials on EMG + | 2 cycles of IVIG/poor outcome, residual weakness | |
| 76/M | Cough, hyposmia | 5 days | Lumbar pain and lower limb weakness, areflexic quadriparesis, ataxia | Nasopharyngeal swab for RT-PCR SARS-CoV-2-positive, lymphocytopenia, CSF—normal, MRI spine and head—normal, CT chest—normal | AIDP, no fibrillation potentials on EMG | IVIG/ poor, mild improvement | |
| 61/M | Cough, ageusia, anosmia | 7 days | Lower limb weakness, paresthesia, areflexic paraparesis, facial palsy, respiratory failure | Nasopharyngeal swab for RT-PCR SARS-CoV-2-negative, SARS-CoV-2 IgG-positive lymphocytopenia, CSF—normal, antiganglioside Ab—negative, MRI spine—normal, CT chest—interstitial pneumonia | AIDP, fibrillation potentials on EMG + | IVIG, plasma exchange/poor outcome, ventilator-dependent | |
| Virani et al./April 2020 [57] | 54/M | Fever, dry cough | 10 days | Numbness and weakness in B/L lower limbs, areflexic quadriparesis | Nasopharyngeal swab for RT-PCR SARS-CoV-2-positive, MRI spine—normal, CT chest—B/L basilar opacities | Not done | Mechanical ventilation, IVIG, HCQ/improved |
| Padroni et al./April 2020 [58] | 70/F | Fever, dry cough | 24 days | Hands and feet paraesthesias, gait difficulties | Nasopharyngeal swab for RT-PCR SARS-CoV-2-positive, CSF-albumin-cell diss., CT chest—B/L ground-glass opacities | AIDP | Mechanical ventilation, IVIG/poor |
| Coen et al./April 2020 [59] | 70/M | Fatigue, myalgia, dry cough | 10 days | Paraesthesias, distal allodynia, urinary retention, constipation, areflexic flaccid paraparesis | Nasopharyngeal swab for RT-PCR SARS-CoV-2 positive, CSF-albumin-cells diss., negative SARS-CoV-2 RT-PCR, CT chest—B/L ground-glass opacities | AIDP | IVIG/improved |
| El Otmani et al./April 2020 [60] | 70/F | Fever, dry cough | 3 days | Acute flaccoid areflexic quadriparesis | Oropharyngeal swab for RT-PCR SARS-CoV-2-positive, CSF-albumin-cells diss., CT chest-ground-glass opacities in the left lung | AMSAN | IVIG, HCQ, azithromycin/improved |
| Marta-Enguita et al./April 2020 [61] | 76/F | Fever, cough | 8 days | Lower backache with radiation to B/L lower limbs, progressive areflexic tetraparesis, distal-onset paraesthesia, dysphagia, respiratory failure | Oropharyngeal swab for RT-PCR SARS-CoV-2-positive, CSF-NA, CT chest—consolidation | NA | Mechanical ventilation/died |
| Miller-Fisher syndrome | |||||||
| Reyes-Bueno et al./June 2020 [62] | 51/F | Diarrhoea, odynophagia, cough | 10 days | Quadriparesis, left lateral rectus palsy, bifacial palsy, dysautonomia | CSF-albumin-cytological dissociation | Demyelinating neuropathy | IVIG/improving |
| Fernández-Domínguez et al./May 2020 [63] | 74/F | Fever, URTI | 12–15 days | Progressive gait impairment, areflexia, blurring of vision | Nasopharyngeal swab for RT-PCR SARS-CoV-2-positive, CSF-albumin-cells diss., negative SARS-CoV-2 RT-PCR | Slight F-wave delay in upper limbs | IVIG/improved |
| Lantos et al./May 2020 [64] | 36/M | Fever, chills, myalgia | 4 days | Left eyelid drooping, blurry vision, paraesthesia in both legs, left CN 3 palsy, B/L 6th CN palsy, ataxia, hyporeflexia | Nasopharyngeal swab for RT-PCR SARS-CoV-2-positive, MRI—enlargement with contrast enhancement of left occulomotor nerve | NA | IVIG, HCQ/improved |
| Gutiérrez-Ortiz et al./April 2020 [65] | 50/M | Fever, headache, cough, malaise | 5 days | Anosmia, ageusia, right internuclear ophthalmoparesis, right fascicular oculomotor palsy, ataxia, areflexia | Nasopharyngeal swab for RT-PCR SARS-CoV-2 positive, CSF-albumin-cells diss., negative SARS-CoV-2 RT-PCR | NA | IVIG/improved |
| 39/M | Fever, diarrhoea | 3 days | Ageusia, B/L abducens palsy, areflexia | Nasopharyngeal swab for RT-PCR SARS-CoV-2-positive, CSF-albumin-cells diss., negative SARS-CoV-2 RT-PCR | NA | Acetaminophen/improved | |
AIDP acute inflammatory demyelinating polyneuropathy, AMAN acute motor-axonal neuropathy, AMSAN acute motor-sensory axonal neuropathy, CSF cerebrospinal fluid, EMG electromyography, ESR erythrocyte sedimentation rate, HCQ hydroxychloroquine, IgG immunoglobulin G, IgM immunoglobulin M, IVIG intravenous immunoglobulin, NA not available, RT-PCR reverse transcriptase polymerase chain reaction, URTI upper respiratory tract infection