Table 2.
Case reports of Guillain-Barre syndrome (GBS) variants and skeletal muscle injury related to COVID-19.
| Region | Age, Gender | Neurological symptoms on admission (day from admission) | Other symptoms (onset day prior neurologic symptoms) | Admission serum labs (or day from admission) | CSF (day from admission) | Imaging or NCS/EMG (day from admission) | Treatments received | Outcome | Ref |
|---|---|---|---|---|---|---|---|---|---|
| Miller-Fisher Syndrome | |||||||||
| Madrid, Spain | 50, M | Two-day anosmia, ageusia, right INO, right fascicular oculomotor palsy, perioral paresthesia, ataxia, & areflexia | Fever, cough, malaise, headache & lumbar pain (5 days prior) | Lymphocytopenia, ↑ CRP; positive anti-GD1b IgG antibody | ↑ Protein (80 mg/dL), 0 WBC, normal glucose, negative culture / COVID-19 rRT-PCR | Head CT scan: normal EMG/NCS: NR |
IVIG (0.4 g/kg/day for 5 days) | Favorable; recovery in 2 weeks with residual anosmia & ageusia | (Gutiérrez-Ortiz, Méndez, 2020) |
| Madrid, Spain | 39, M | Same-day ageusia, bilateral abducens palsy, & areflexia | Low-grade fever & diarrhea (3 days prior) | Leukopenia; normal LFT, RFT & cardiac enzymes | ↑ Protein (62 mg/dL), 2 WBC, normal glucose, negative culture / COVID-19 rRT-PCR | Head CT: normal. EMG/NCS: NR |
Supportive care | Favorable, complete recovery in 2 weeks | (Gutiérrez-Ortiz, Méndez, 2020) |
| Malaga, Spain | 51, F | Eleven-day radicular thoracic/lumbar back & all limbs pain; 7-day rapidly progressive lower limb weakness & binocular diplopia, left external rectus muscle & bifacial weakness, areflexia, & autonomic dysfunction (dry eyes/mouth, diarrhea, labile blood pressure) | Diarrhea, odynophagia & cough (15 days prior) | Positive SARS-CoV-2 IgG, negative COVID-19 rRT-PCR | ↑ Protein (70 mg/dL), 5 WBC, negative antiganglioside antibodies | EMG/NCS (day 4): asymmetric prolonged F wave latency for the lower limbs, low A-wave amplitude on the left leg, altered bilateral R1 responses in the Blink-Reflex, ↓ poor activity in right rectus-anterior femoral muscle & little spontaneous denervation activity in left rectus-anterior femoral (RAF) muscle on EMG, overall suggestive of demyelination in early stage. Repeat EMG/NCS (day 20): low F-wave amplitude & disintegrated morphology, similar alteration of Blink-Reflex & spontaneous denervation activity in bilateral RAF & left anterior tibialis. |
IVIG (0.4 g/kg/day for 5 days), gabapentin (total 900 mg/day) | Favorable | (Reyes-Bueno, García-Trujillo, 2020) |
| Acute Inflammatory Demyelinating Polyneuropathy (AIDP) | |||||||||
| Jingzhou, China | 61, F | One-day rapidly progressive ascending paraparesis & areflexia; evolving to tetraparesis & distal numbness (day 3) | No prior symptoms (had trip to Wuhan 7 days prior), later fever & cough (admission day 8) | Lymphocytopenia, thrombocytopenia, positive COVID-19 nasopharyngeal swab. | Day 4: ↑ protein level (124 mg/dL), 5 WBC, negative COVID-19 rRT-PCR. | EMG/NCS (day 5): prolonged left ulnar & bilateral tibial/peroneal distal motor latencies, absent ulnar/tibial/peroneal F waves, normal left median/ulnar & bilateral sural/superficial peroneal SNAPs, overall suggestive of demyelination. | IVIG (0.4 g/kg/day for 5 days); Day 8: arbidol, lopinavir & ritonavir | Favorable; complete recovery within 1 month | (Zhao, Shen, 2020a) |
| Northern Italy | 76, M | One-day lumbar pain followed & rapidly progressive paraparesis; evolving tetraplegia, areflexia, & ataxia (day 4) | Cough & anosmia (5 days prior), fever (prior IVIG) |
Lymphocytopenia, ↑ CRP, ketonuria; positive serum SARS-CoV-2 IgG (64.59 AU/mL), positive COVID-19 nasopharyngeal swab. | Day 5: normal with negative COVID-19 rRT-PCR. | Brain/Spine MRI: normal. EMG/NCS (day 2): prolonged tibial /ulnar distal motor latencies, ↓ tibial/ulnar CMAP amplitudes, slow tibial/ulnar motor conduction velocities, prolonged tibial F wave, normal sural/ulnar SNAPs, normal EMG, overall suggestive of demyelination. |
IVIG (0.4 g/kg/day for 5 days) | Incomplete recovery, upper limb improvement but unable to stand (one month later) | (Toscano et al., 2020) |
| Northern Italy | 61, M | One-day rapidly progressive paraplegia, lower limb paresthesia & areflexia; evolving to tetraplegia, bifacial weakness & dysphagia (day 3), & respiratory failure (day 4) | Cough, ageusia, & anosmia (7 days prior) | Lymphocytopenia, ↑ CRP, LDH & AST; ketonuria; negative anti-GM1, GQ1b & GD1b antibodies; positive serum SARS-CoV-2 IgG (50.92 AU/mL), negative COVID-19 nasopharyngeal swab. | Day 3: normal protein (40 mg/dL), 3 WBC, negative COVID-19 rRT-PCR and viral/bacterial panel. | EMG/NCS (day 3): prolonged tibial and normal ulnar distal motor latencies, ↓ tibial/ulnar CMAP amplitudes, slow tibial/ulnar motor conduction velocities, absent tibial F wave, ↓ ulnar SNAP amplitude with sural sparing, fibrillation potentials on EMG, overall suggestive of demyelination. | IVIG (0.4 g/kg/day for 5 days) & plasma exchange |
Poor, prolonged ICU stay (> 1 month), bacterial pneumonia during IVIG therapy delaying plasma exchange |
(Toscano, Palmerini, 2020) |
| Monza, Italy | 71, M | Three-day rapidly progressive distal paresthesia, lumbar pain, tetraparesis & areflexia | Low-grade fever (7 days prior), severe hypoxia on admission | Positive COVID-19 nasopharyngeal swab. | Admission: ↑ protein (54 mg/dL), 9 WBC, negative COVID-19 rRT-PCR. | Head CT scan: normal. EMG/NCS (on admission): absent bilateral sural SNAPs & tibial CMAP, prolonged peroneal motor distal latency, slow conduction velocity, & ↓ amplitude with temporal dispersion/conduction block, ulnar/radial CMAP temporal dispersion, slow radial CMAP conduction velocity, ↓ ulnar SNAP amplitude, normal radial SNAP, overall suggestive of demyelination. |
IVIG (0.4 g/kg/day; only received one dose), lopinavir, ritonavir, hydroxychloroquine | Death within 24 h due to progressive respiratory failure | (Alberti, Beretta, 2020) |
| Trento, Italy | 66, F | Three-day rapidly progressive paraplegia, upper limb distal & unilateral facial weakness, gait instability, & areflexia | Self-resolved mild fever & cough (10 days prior) | ↑ CRP (70.6 mg/L) & D-dimer (506 μg/L); normal CBCdiff, LFT, RFT, CK, PT, INR & LDH; positive COVID-19 nasopharyngeal swab | ↑ Protein (108 mg/dL), 0 WBC | EMG/NCS (day 7): diffuse prolonged left tibial/common peroneal & right median distal motor latencies, reduced distal CMAP amplitudes & slight slow conduction velocities, absent left tibial/common peroneal & right median F-waves, absent right median/ulnar/radial/sural SNAPs, overall suggestive of demyelination. | IVIG (0.4 g/kg/day for 5 days); lopinavir, ritonavir, hydroxychloroquine | Poor, progressive weakness, dysesthesia, intermittent confusion / psychomotor agitation, intubation due to respiratory failure, multiorgan failure, leg DVT & pneumonia | (Ottaviani et al., 2020) |
| Ravenna, Italy | 70, F | One-day progressive limbs weakness, distal limb paresthesia, gait instability, areflexia; evolving to respiratory failure & intubation (day 4) | Fever & cough (24 days prior) | Prior admission: positive COVID-19 nasopharyngeal swab. Admission: mild leukocytosis, normal D-dimer, CK, LFT, RFT, ESR, & CRP. |
Day 4: mild ↑ protein (48 mg/dL), 1 WBC; COVID-19 rRT-PCR not done. | EMG/NCS (day 4): prolonged left median/right ulnar/bilateral tibial distal latencies, absent right median CMAP, slow median/ulnar/tibial motor conduction velocities, absent median/ulnar/tibial F waves, absent left median/left ulnar/bilateral superficial peroneal SNAPs, ↓ right ulnar/sural SNAP amplitudes, neurogenic pattern on EMG, overall suggestive of demyelination | IVIG (0.4 g/kg/day for 5 days) | Poor, ICU stay & intubation due to respiratory failure | (Padroni et al., 2020) |
| Milan, Italy | 60s, M | Three-day progressive tetraparesis, distal paresthesia, areflexia; evolving to bifacial weakness, hypophonia and dysarthria (day 8) | Self-resolved fever, headache, myalgia followed by anosmia & ageusia (20 days prior) | ↑ IL-6, ferritin, LDH & fibrinogen; normal CBCdiff, CRP, CK, LFT & RFT; negative antiganglioside antibodies; negative COVID-19 nasopharyngeal swab, positive SARS-CoV-2 IgG. | Day 3: normal protein & WBC, negative COVID-19 rRT-PCR & other viral / bacterial panels. | Cervical spine MRI: normal EMG/NCS (day 5): prolonged right peroneal/median motor distal latencies, slow left tibial/bilateral peroneal/right ulnar motor conduction velocities, ↓ right median CMAP amplitude, abnormal temporal dispersion of peroneal CMAP, absent F waves, absent median/ulnar SNAPs with sural sparing, overall suggestive of demyelination. |
IVIG (0.4 g/kg/day for 5 days) | Incomplete with slow recovery | (Riva et al., 2020) |
| Zaragoza, Spain | 56, F | Acute hand paresthesia & gait instability; evolving to lumbar pain, progressive proximal paraparesis & areflexia (within 2 days of admission); following by tetraparesis, bifacial & bulbar weakness on IVIG. | Fever, cough & dyspnea (15 days prior) | Positive COVID-19 nasopharyngeal swab. | ↑ Protein (86 mg/dL), 3 WBC, negative COVID-19 rRT-PCR. | Spine MRI: brainstem and cervical meningeal enhancement. EMG/NCS (day 11): prolonged distal latencies and absent F waves, suggestive of demyelination. |
IVIG (0.4 g/kg/day for 5 days) | Initial worsening on IVIG but partial recovery in 7 days | (Sancho-Saldaña, Lambea-Gil, 2020) |
| Ciudad Real, Spain | 43, M | Acute rapidly progressive tetraparesis, distal paresthesia & areflexia; evolving to bifacial paresis & dysphagia (day 2) | Self-resolved diarrhea & cough (10 days prior) | Positive COVID-19 nasopharyngeal swab | Not done | EMG/NCS: prolonged distal motor latencies & slow sensory conduction velocities, prolonged F waves for right L5 and S1 roots, overall suggestive of demyelination | IVIG (0.4 g/kg/day for 5 days), hydroxychloroquine, lopinavir, ritonavir, amoxicillin, corticosteroids | Favorable | (Velayos Galán et al., 2020) |
| Paris, France | 64, M | Four-day rapidly progressive paraparesis, areflexia, distal hypoesthesia | Cough, dyspnea, diarrhea & fever (26 days prior) | Prior admission: positive COVID-19 nasopharyngeal swab. Admission: negative antiganglioside & anti-neuronal antibodies |
Day 6: ↑ protein (165 mg/dL), normal WBC, negative COVID-19 rRT-PCR | Head CT scan: normal. EMG/NCS (day 2): prolonged bilateral median & ulnar/left peroneal motor distal latencies, slow median/ulnar/peroneal/tibial motor conduction velocities and normal CMAP amplitudes, conduction blocks in bilateral peroneal/tibial CMAPs, absent SNAPS except for radial/ left median at palm, overall suggestive of demyelination. |
IVIG (0.4 g/kg/day for 5 days) | Favorable | (Arnaud et al., 2020) |
| La Tronche, France | 43, M | Four-day progressive ascending paraparesis, areflexia, limbs paresthesia & ataxia; evolving to right facial weakness (admission day) |
Self-resolved cough, asthenia, leg myalgia, acute anosmia, ageusia & diarrhea (21 days prior) | Normal CBCdiff & CRP; negative antiganglioside antibodies; positive COVID-19 nasopharyngeal swab | Admission: ↑ protein (94 mg/dL), 1 WBC, negative COVID-19 rRT-PCR. | Brain/spine MRI (day 3): multiple cranial neuritis (III, V, VI, VII, & VIII), radiculitis, & brachial/lumbar plexitis. EMG/NCS (day 5): bilateral peroneal conduction blocks, tibial/peroneal slow motor conduction velocities, sural sparing pattern, absent H-reflex, mildly prolonged F-waves, overall suggestive of demyelination |
IVIG (0.4 g/kg/day for 5 days) | Favorable, rapid improvement | (Bigaut, Mallaret, 2020) |
| La Tronche, France | 70, F | Three-day rapidly progressive tetraparesis, areflexia, forelimb / perioral paresthesia; evolving to respiratory failure (admission day) & left facial weakness (day 6) | Self-resolved diarrhea, mild asthenia & myalgia with continuous anosmia and ageusia (10 days prior) | Prior admission: positive COVID-19 nasopharyngeal swab. Admission: ↑ CRP (22 mg/L); negative antiganglioside antibodies |
Admission: ↑ protein (106 mg/dL), 6 WBC, negative COVID-19 rRT-PCR. | EMG/NCS (day 4): left median conduction block & temporal dispersion, prolonged median/ulnar motor distal latencies, diffuse slow, motor/sensory conduction velocities, neurogenic pattern on EMG, overall suggestive of demyelination. | IVIG (0.4 g/kg/day for 5 days) | Slow recovery | (Bigaut, Mallaret, 2020) |
| Lausanne / Geneva, Switzerland | 52, F | Acute lumbar pain, rapidly progressive proximal limb weakness, ataxia, distal paresthesia, dysgeusia & cacosmia; evolving to respiratory failure, dysautonomia & tetraplegia with areflexia (day 4) | Fever, cough, odynophagia, arthralgia & diarrhea (15 days prior) | Admission: normal CBCdiff, LFT & RFT, negative anti-GM1, GQ1b & GD1a antibodies. Day 14: positive serum SARS-CoV-2 IgM, positive COVID-19 nasopharyngeal swab (4th test) |
Day 2: ↑ protein (60 mg/dL), 3 WBC, negative COVID-19 rRT-PCR. |
Spine MRI: normal. EMG/NCS (day 4): prolonged tibial/peroneal/median/ulnar distal motor latencies & slow conduction velocities, absent F waves, no sural sparing, overall suggestive of demyelination Repeat EMG/NCS (days 7 & 14): slower conduction velocities & temporal dispersions. |
IVIG (0.4 g/kg/day for 5 days) | Favorable, initially worsening (day 4) while on IVIG, but recovery within 5 weeks | (Lascano et al., 2020) |
| Lausanne / Geneva, Switzerland | 63, F | Acute lower limb pain & weakness with normal reflexes; evolving to tetraparesis, distal paresthesia & areflexia (day 5) | Cough, shivering, odynophagia, dyspnea & chest pain (7 days prior) | Admission: negative COVID-19 nasopharyngeal swab; Day 7: positive COVID-19 nasopharyngeal swab. Mild lymphocytopenia, mild ↑ AST (65 U/L), normal RFT. |
Day 6: normal protein (40 mg/dL), 2 WBC; COVID-19 rRT-PCR not done. |
EMG/NCS (day 9): conduction block in tibial/peroneal/ulnar CMAPs, absent F waves, normal insertional/spontaneous activity on EMG, overall suggestive of demyelination. | IVIG (0.4 g/kg/day for 5 days), 5-day amoxicillin & clarithromycin (pneumonia) | Favorable, complete motor recovery residual distal paresthesia & areflexia (5 weeks) | (Lascano, Epiney, 2020) |
| Lausanne / Geneva, Switzerland | 61, F | Four-day rapidly progressive lower limb weakness, distal paresthesia, dizziness, dysphagia, bifacial weakness & areflexia; evolving to dysautonomia (one day prior admission) | Fever, cough, myalgia, headache, vasovagal syncope, diarrhea, nausea & vomiting (22 days prior) | Prior to admission: positive COVID-19 nasopharyngeal swab. Admission: lymphocytopenia, hyponatremia, normal LFT & RFT. |
Day 1: ↑ protein (140 mg/dL), 4 WBC, negative COVID-19 rRT-PCR. | Brain MRI: normal. Spine MRI: lumbosacral nerve root enhancement. EMG/NCS (day 4): prolonged peroneal/median motor distal latencies, slow tibial/peroneal/median/ulnar conduction velocities, ↓ tibial/peroneal/median CMAP amplitudes, absent F waves, overall suggestive of demyelination. |
IVIG (0.4 g/kg/day for 5 days), duloxetine | Favorable, residual allodynia & mild lower limb weakness after 5 weeks | (Lascano, Epiney, 2020) |
| Geneva, Switzerland | 70s, M | Four-day rapidly progressive paraparesis, distal allodynia & areflexia; evolving to voiding problem & constipation | myalgia, fatigue & cough (6 days prior) | Prior admission: positive COVID-19 nasopharyngeal swab. | Day 1: ↑ protein, normal WBC, negative COVID-19 rRT-PCR, negative antiganglioside antibodies. | Spine MRI: normal. EMG/NCS (day 1): sensorimotor demyelinating polyneuropathy with sural sparing pattern, absent or prolonged F waves in tested nerves. |
IVIG (0.4 g/kg/day for 5 days) | Favorable within 11 days | (Coen et al., 2020) |
| Selters, Germany | 54, F | Ten-day progressive proximal>distal paraparesis, four limbs numbness & paresthesia, gait instability, & areflexia; evolving to paraplegia & dysphagia (day 2). | No symptoms; transient anosmia/ageusia (14 days prior); exposed to a case with PCR-positive COVID-19 | Prior admission: positive COVID-19 nasopharyngeal swab (3 weeks prior), Admission: normal CRP, CBCdiff, TSH, electrolytes & vitamin B12 level; negative repeat COVID-19 nasopharyngeal swab. | ↑ Protein (140 mg/dL), normal WBC; negative serology, Lyme antibody & COVID-19 rRT-PCR | Cervical spine MRI: normal. EMG/NCS (admission day): prolonged distal motor latencies and temporal dispersion of bilateral common peroneal nerve CMAPs, normal bilateral tibial nerve F wave latencies with pathological intermediate latency responses (complex A waves), overall suggestive of demyelination. |
IVIG (0.4 g/kg/day for 5 days) | Favorable, complete recovery, unchanged repeat EMG/NCS (14 days later) | (Scheidl et al., 2020) |
| Pittsburgh, USA | 72, M | One-day rapidly progressive ascending weakness, areflexia, distal paresthesia; evolving to respiratory failure and intubation (day 3), dysautonomia with labile blood pressure & tachycardia (day 4) with tetraplegia (day 6) | Self-resolved diarrhea, anorexia & chills (7 days prior) | Admission: leukocytosis, normal LFT, RFT, CK, & Lyme antibody; negative anti-GM1, GD1b, GQ1b and acetylcholine receptor binding, voltage-gated Ca2+ channel, ANA, & ANCA antibodies; positive COVID-19 nasopharyngeal swab. Day 8: SIADH with hyponatremia Day 28: negative COVID-19 nasopharyngeal swab. |
Day 8: ↑ protein (313 mg/dL), 1 WBC, negative COVID-19 rRT-PCR & other viral / bacterial panels. | Head CT scan: normal. EMG/NCS (day 13): prolonged right ulnar & bilateral tibial/peroneal motor distal latencies with slow conduction velocities, absent F waves, ↓ right ulnar/peroneal CMAP amplitudes, absent right ulnar/bilateral sural SNAPs, normal EMG with poor effort, overall suggestive of demyelination. |
IVIG (0.4 g/kg/day for 4 days) | Poor, prolonged ICU (> 1 month) stay | (Su et al., 2020) |
| Bursa, Turkey | 53, F | 3-day history of dysarthria associated with progressive weakness and numbness of the lower extremities 3-day history of dysarthria associated with progressive weakness and numbness of the lower extremities Three-day dysarthria & progressive lower limbs weakness & numbness, & areflexia |
No symptoms prior, mild fever (day 5 after neurological symptoms) | Admission: mild neutropenia, normal electrolytes, LFT, RFT & CRP. Day 5: mild lymphocytopenia, ↑ CRP, positive COVID-19 nasopharyngeal swab. |
Day 7: normal protein (32.6 mg/dL), 0 WBC, negative COVID-19 rRT-PCR. | Thoracic/lumbar spine MRI: asymmetrical thickening and hyperintensity of post-ganglionic roots supplying the brachial and lumbar plexuses in STIR sequences. EMG/NCS: conduction blocks and temporal dispersion in right median/ulnar/peroneal CMAPs, normal right median/ulnar/peroneal F waves with decreased persistence, normal right sural/median/ulnar SNAPs, overall suggestive of demyelination. |
Plasma exchange (5 sessions every other day), hydroxychloroquine | Favorable, recovery within 2 weeks | (Oguz-Akarsu et al., 2020) |
| Acute Motor and Sensory Axonal Neuropathy (AMSAN) | |||||||||
| Northern Italy | 77, F | Same-day rapidly progressive tetraplegia, facial weakness, areflexia, upper limb paresthesia (36 h later), & respiratory failure (day 6) | Fever, cough & ageusia (7 days prior) | Lymphocytopenia, ↑ CRP & LDH, ketonuria; negative anti-GM1, GQ1b & GD1b antibodies; positive COVID-19 nasopharyngeal swab. | Day 2: normal. Day 10: ↑ protein (101 mg/dL), 4 WBC, negative COVID-19 rRT-PCR in both days. |
Brain MRI: normal. Spine MRI: caudal nerve roots enhancement. EMG/NCS (day 3): ↓ tibial/ulnar CMAP amplitudes, absent tibial/ulnar F waves, ↓ ulnar SNAP amplitude with sural sparing & fibrillation potentials on EMG, overall suggestive of AMSAN. |
2 cycles of IVIG (0.4 g/kg/day for 5 days) | Poor; persistent tetraplegia & dysphagia | (Toscano, Palmerini, 2020) |
| Northern Italy | 23, M | Two-day progressive bifacial weakness & areflexia, evolving to lower limb paresthesia, ageusia & sensory ataxia | Fever & sore throat (10 days prior) | Lymphocytopenia, ↑ CRP, ferritin, LDH & AST; positive COVID-19 nasopharyngeal swab | Day 3: ↑ protein (123 mg/dL), 0 WBC, negative COVID-19 rRT-PCR. | Brain MRI: focal contrast enhancement at the internal acoustic meatus (bilateral facial nerve). Spinal MRI: normal. EMG/NCS (day 12): ↓ tibial/facial but normal ulnar CMAP amplitudes, prolonged ulnar distal latency, absent tibial F waves, ↓ ulnar SNAP amplitude with sural sparing, & fibrillation potentials on EMG, overall suggestive of AMSAN. |
IVIG (0.4 g/kg/day for 5 days) | Favorable; residual ataxia & facial weakness | (Toscano, Palmerini, 2020) |
| Casablanca, Morocco | 70, F | Ten-day rapidly progressive tetraplegia, distal limbs paresthesia, areflexia | Self-resolved cough (3 days prior) | Lymphocytopenia, positive COVID-19 nasopharyngeal swab. | ↑ protein (100 mg/dL), normal WBC, COVID-19 rRT-PCR not done. | EMG/NCS (day 10): markedly ↓ or absent motor and sensory nerve amplitudes in all four limbs, relatively normal conduction velocities and latencies, fibrillation potentials on EMG, overall suggestive of AMSAN. | IVIG (0.4 g/kg/day for 5 days), hydroxychloroquine, azithromycin | No improvement after one week | (El Otmani et al., 2020) |
| Sari, Iran | 65, M | Five-day rapidly progressive ascending tetraparesis, bifacial weakness, areflexia, & distal limbs numbness | Fever, cough, intermittent dyspnea (14 days prior) | ↑ ESR & CRP, normal LFT, RFT & electrolytes, positive COVID-19 nasopharyngeal swab | Not done | Cervical spine MRI: only mild herniation of 2 intervertebral discs. EMG/NCS (day 9): ↓ bilateral median/ulnar/tibial CMAP amplitudes, absent bilateral peroneal CMAP, absent tibial F waves, absent bilateral median/ulnar/right sural SNAPs, ↓ recruitment on EMG, overall suggestive of AMSAN. |
IVIG (0.4 g/kg/day for 5 days) | NR | (Sedaghat and Karimi, 2020) |
| Acute Motor Axonal Neuropathy (AMAN) | |||||||||
| Northern Italy | 55, M | Two-day rapidly progressive tetraparesis, limb paresthesia, neck pain, & areflexia; evolving to bifacial weakness & respiratory failure (day 5) | Fever & cough (12 days prior) | Lymphocytopenia, ↑ CRP, LDH, AST & GGT, ketonuria; negative anti-GM1, GQ1b & GD1b antibodies; positive serum SARS-CoV-2 IgG (32.5 U/mL), positive COVID-19 nasopharyngeal swab. | Day 3: ↑ protein (193 mg/dL), 0 WBC, negative COVID-19 rRT-PCR. | Brain MRI: normal. Spinal MRI: contrast enhancement of caudal nerve roots. EMG/NCS (day 11): ↓ tibial/ulnar CMAP amplitudes, absent tibial/ulnar F waves, normal ulnar/sural SNAPs, & fibrillation potentials on EMG, overall suggestive of AMAN. |
2 cycles of IVIG (0.4 g/kg/day for 5 days) | Poor; prolonged (> 1 month) ICU stay due to neuromuscular respiratory failure & tetraplegia |
(Toscano, Palmerini, 2020) |
| Unspecified GBS variant (No EMG/NCS available) | |||||||||
| Madrid, Spain | 61, M | Same-dame right facial weakness; evolving to bifacial weakness next day | Fever & cough (10 days prior) | Prior admission: positive COVID-19 nasopharyngeal swab. | Mild ↑ protein (44 mg/dL), 0 WBC, negative COVID-19 rRT-PCR. | Head CT scan & Brain MRI: normal. | Low dose oral prednisone, hydroxychloroquine, lopinavir, ritonavir | Favorable, recovery after 2 weeks | (Juliao Caamaño and Alonso, 2020) |
| Pamplona, Spain | 76, F | Ten-day radicular lumbar pain, progressive tetraparesis, distal hypoesthesia, areflexia; evolving to bulbar weakness & respiratory failure within 4–12 h of admission | Fever & cough (8 days prior) | Prior admission: positive COVID-19 nasopharyngeal swab. Admission: mild thrombocytopenia, ↑ fibrinogen & D-dimer |
Not done | Head/cervical spine CT scan: only vertebral bodies degenerative signs. | Supportive | Death within 12 h of admission due to respiratory failure | (Marta-Enguita, Rubio-Baines, 2020) |
| Pittsburgh, USA | 54, M | Two-day rapidly progressive ascending paraparesis & numbness, lower limbs areflexia, upper limbs hyporeflexia, later urinary retention | Fever & cough (7 days prior), Clostridium difficile colitis diarrhea (2 days prior), dyspnea & intubation | Normal CBCdiff & electrolytes, positive COVID-19 nasopharyngeal swab | Not done | Thoracic/lumbar MRI: normal. | IVIG (0.4 g/kg/day for 5 days), hydroxychloroquine | Favorable, residual lower limb weakness | (Virani et al., 2020) |
| Skeletal Muscle Injury | |||||||||
| Wuhan, China | 60, M | Admission day 9: proximal lower limb weakness, myalgia & tenderness | Fever & cough (6 days prior), continued fever till admission day 6 | Admission: leukopenia, ↑ CRP (111 mg/L), ↑ LDH (280 U/L), normal CK, LFT, RFT, positive COVID-19 nasopharyngeal swab. Day 7: ↑ CRP (206 mg/L). Day 9: ↑↑ myoglobin (>12,000 μg/L), CK (11,842 U/L), LDH (2347 U/L), ALT (111 U/L) & AST (213 U/L), normal RFT & electrolytes. Day 12: negative COVID-19 nasopharyngeal swab. |
NR | NR | Admission: opinavir, moxifloxacin & interferon nebulization; Day 6: meropenem & methylprednisolone Day 9: IV fluid, plasma transfusion, IVIG & supportive care |
Favorable; recovery within few days | (Jin and Tong, 2020) |
| New York, USA | 88, M | Acute progressive proximal lower limb weakness & myalgia | Low-grade fever & tachypnea (on admission) | ↑↑ CK (13,581 U/L), ↑ LDH (364 U/L), positive COVID-19 nasopharyngeal swab; AKI (day 7) | NR | NR | IV fluid, hydroxychloroquine | Favorable; ↓ CK within 6 days (368 U/L) | (Suwanwongse and Shabarek, 2020) |
| New York, USA | 75, F | Four-day generalized weakness; evolving to lethargy, acute encephalopathy, & respiratory distress requiring ICU admission (day 3) | Concurrent ↓ appetite | Admission: ↑ CK (2767 U/L), ↑ troponin (0.663 ng/mL), normal EKG, hypernatremia (152 mM/L), AST (198 U/L), ALT (63 U/L), BUN (31 mg/dL) & creatinine (1.2 mg/dL); normal CBCdiff. Day 2: positive COVID-19 nasopharyngeal swab, ↑ LDH (497 U/L), CRP (37 mg/L), D-dimer (573 μg/L) & ferritin (2134 μg/L) |
NR | NR | Day 2: azithromycin, hydroxychloroquine, vancomycin & cefepime. Day 3: IV fluid, supportive care in ICU |
Favorable | (Chan et al., 2020) |
| New York, USA | 71, M | On admission: intermittent leg twitching with tingling/numbness at the lateral upper thigh radiating down to the posterior mid-calf. | No prior symptoms, fever on admission; Day 2: spike fever and AKI Day 3: tachypnea, tachycardia, AF with RVR, AKI & ARDS requiring intubation |
Admission: ↑ CK (1859 U/L), BUN (78 mg/dL), creatinine (3.6 mg/dL), troponin (0.249 ng/mL), LDH (538 U/L), CRP (18.8 mg/L), D-dimer (989 μg/L) & ferritin (1003 μg/L); normal CBCdiff; EKG: new AF, positive COVID-19 nasopharyngeal swab. Day 2: ↑↑ creatinine (5.6 mg/dL) |
NR | Head CT scan: old right lacunar infarct. | Admission: doxycycline, ceftriaxone, hydroxychloroquine, IV fluid; heparin and metoprolol for new AF. Day 3: hemodialysis for AKI |
Poor, prolonged ICU stay & intubated. | (Chan, Farouji, 2020) |
| New York, USA | 16, M | Four-day generalized myalgias, fatigue, & 2-day dark-colored urine; evolving to continued myalgia (day 4) | Fever, concurrent dyspnea on exertion (4 days), pharyngeal erythema & abdominal pain (on exam) | Mild leukocytosis & thrombocytopenia; ↑ AST (839 U/L) & ALT (157 U/L); normal creatinine, GGT, & electrolytes; positive COVID-19 nasopharyngeal swab, ↑↑↑ CK (427,656 U/L). Repeat CK (296,396 U/L), hyponatremia (130 mM/L), ↓ albumin (3.2 g/dL), normal creatinine & ferritin, ↑ procalcitonin (0.22 μg/L), LDH (2184 U/L), CRP (24.9 mg/L), troponin (0.58 ng/mL) & HgA1C (8.2%). |
NR | NR | IV fluid with sodium bicarbonate & KCl |
Favorable; recovery with ↓ CK (6526 U/L) and no myalgia at discharge (day 12) | (Gefen, Palumbo, 2020) |
AIDP, acute inflammatory demyelinating polyneuropathy; AKI, acute kidney injury, ALT, alanine aminotransferase; AMAN, acute motor axonal neuropathy; AMSAN, acute motor and sensory axonal neuropathy; ARDS, acute respiratory distress syndrome; AST, aspartate aminotransferase; CBCdif, complete blood counts with differential; CK, creatine kinase; CMAP, compound motor action potential; CRP, C-reactive protein; COVID-19, coronavirus disease 2019; CSF, cerebrospinal fluid; EMG/NCS, electromyography/nerve conduction study; ESR, erythrocyte sedimentation rate; F, female; IL, interleukin; INO, internuclear ophthalmoparesis; INR, international normalized ratio; IVIG, intravenous immunoglobulin; LDH, lactate dehydrogenase; LFT, liver function test; M, male; NR, not reported; PT, prothrombin time; RFT, renal function test; rRT-PCR, real-time reverse transcription polymerase chain reaction; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; SIADH, syndrome of inappropriate antidiuretic hormone secretion; SNAP, sensory nerve action potential; WBC, white blood cell.