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Aim of the study: The association of GBS and meningitis in a pediatric population is infrequent. Given the limited number of reported cases from pediatric patients and considering that treatment guidelines are predominantly based on data gathered from adult patients; this is an opportunity to pay attention to different perspectives.Materials and methods: We present a case of a pediatric patient with a positive SARS-CoV2 test and acute meningitis followed by Campylobacter jejuni associated Guillain-Barré Syndrome.Results: To our knowledge, this is the first case of a pediatric patient presenting with the combination Guillain-Barré Syndrome following acute meningitis in the setting of a SARS-CoV2 infection.Conclusions: This case highlights the importance of recognizing vague and non-specific symptoms in pediatric patients, such as gait unsteadiness. Improving awareness of uncommon associations improves treatment and patient outcomes. [ABSTRACT FROM AUTHOR]

Introduction: The wrist is the only segment where both sensory and motor conduction of the same nerve can be studied through routine nerve conduction studies. This study aims to evaluate how two diseases with different pathophysiologies, carpal tunnel syndrome (CTS) and acute inflammatory demyelinating polyradiculoneuropathy (AIDP), differ in terms of median nerve conduction at the wrist. Materials and Methods: Patients hospitalized and diagnosed as having Guillain–Barré syndrome between 2013 and 2021 were screened from the hospital database. Electrodiagnostic subtype classification was performed according to the Rajabally criteria, retrospectively. Patients with AIDP along with age-matched patients with CTS were re-evaluated. Only the data of patients with prolonged median motor distal latency (≥4.0 ms) were included and analyzed. Results: The motor distal latencies recorded in patients with AIDP were significantly more prolonged and the compound muscle action potential amplitudes were significantly lower than those with CTS (P ≤ 0.001). Among the recordable sensory responses, hands with AIDP revealed significantly lower sensory nerve action potential amplitudes than hands with CTS (P ≤ 0.001) although their peak latencies were shorter (P ≤ 0.001) and conduction velocities were faster (P ≤ 0.001). The motor distal latency of the median nerve in patients with AIDP was not correlated with the sensory peak latency, unlike in patients with CTS. Conclusion: Median nerve sensory response, if present, tends to conduct faster in AIDP compared with CTS although the motor distal latency is profoundly prolonged.

Background: Guillain-Barré syndrome (GBS) is an immune- mediated polyradiculoneuropathy, generally post-infectious, and is the leading cause of acute flaccid paralysis worldwide. Objective: To describe the epidemiological, clinical and behavioral characteristics of Guillain-Barré syndrome. Material and methods: An observational, cross-sectional and descriptive study was carried out. The records of all patients with GBS from 2012-2022 were reviewed, and information on epidemiological and clinical variables was obtained. The incidence was calculated for each of the study years and the trend for the study period using the Pearson correlation coefficient, considering p ≤ 0.05 statistically significant. Results: A total of 477 cases were obtained, 67% were men, among the comorbidities, drug addictions were present in 31% of the cases. Most cases were preceded by a gastrointestinal infectious condition. The most common phenotype was acute motor axonal neuropathy. 29% showed up in summer. A statistically significant tendency to increase was observed (p ≤ 0.05) and a mortality of 2.5% with predominance in the axonal variety. Conclusions: The results of this study cover a relatively long period compared to other reviews, the findings agree with previous studies. GBS showed a statistically significant tendency to increase. [ABSTRACT FROM AUTHOR]

Oropouche virus is the aetiological agent of Oropouche fever. At present, this is currently considered one of the most important vector-borne diseases in Latin America. On 27 May 2024, the Ministry of Public Health of Cuba reported the first ever outbreak of Oropouche fever. In this report, we describe three human cases of Oropouche virus infection with symptoms and signs of neurological disease and clinical diagnosis of Guillain-Barré Syndrome. This study offers insights regarding that Oropouche virus is a causal agent of neurological disorders and it could be involved in the etiology of the Guillain-Barré Syndrome. [ABSTRACT FROM AUTHOR]

Guillain–Barré syndrome (GBS) is one of the most common causes of acute flaccid paralysis. In typical GBS, there are no central nervous system (CNS) features. GBS with prominent CNS involvement can be seen in uncommon variants of GBS (such as Miller Fisher Syndrome and Bickerstaff brainstem encephalitis [BBE]) or rarely, when it coexists with other conditions such as acute disseminated encephalomyelitis (ADEM). We report a case of a 35-year-old male who presented with fever followed by ascending lower motor neuron type paraparesis suggestive of GBS which progressed rapidly to involve the respiratory muscles necessitating invasive mechanical ventilation. The patient had many atypical features, namely, persistent fever, early bladder and bowel involvement, facial twitching, ophthalmoplegia with ptosis, and a comatose state. Based on these clinical features and the investigations done, a diagnosis of GBS with BBE with a possibility of ADEM was made. The patient was managed intensively, but there was no improvement in the neurological manifestations and the patient succumbed to the illness due to ventilator-associated complications. [ABSTRACT FROM AUTHOR]

Background and Objectives: Guillain-Barré syndrome (GBS) is the most frequent cause of acute flaccid paresis in children. The aim of this study was to describe the clinical and electrophysiological findings and outcomes of children with GBS diagnosed in our unit. Moreover, the literature on pediatric GBS cases from the past 5 years was reviewed. In this retrospective study, we reported data on 12 patients (9 male and 3 female patients; mean age: 5 y, 4 mo; range: 9 mo–11 y) clinically diagnosed at the Child Neurology Unit of the AUSL-IRCCS of Reggio Emilia, Italy, between 2000 and 2017 and a brief analysis/comparison with data from the literature. Materials and Methods: Data were collected from medical charts. Results: In our cohort, male patients were more frequent than female ones (9 vs. 3), and upper respiratory tract infection (n = 8, 66.7%) was the most frequent triggering factor. The main clinical symptoms on admission were distal lower limbs' weakness with gait difficulties (83.3%), pain (50%), upper limbs' weakness (50%), and dysphagia for liquids (25%). Peripheral neurophysiological studies revealed acute inflammatory demyelinating polyradiculoneuropathy (AIDP) in 66.6% of the children, acute motor and sensory axonal neuropathy (AMSAN) in 25%, and acute motor axonal neuropathy (AMAN) in 8.3%. Ten individuals (83.3%) received timely treatment with intravenous immunoglobulins (IVIG), and, out of these ten patients, 58% received concomitant treatment with IV methylprednisolone because of a progressive disease course. Complete remission was observed in the majority of individuals (91.6%) within 6 months of symptom onset. Conclusions: Different subtypes of GBS can affect children; however, the outcome is usually positive. Early treatment appears to be important for a favorable outcome. [ABSTRACT FROM AUTHOR]

Background: The current study reported a case with a history of neuroradiculitis. Within 2 months of the COVID‐19 vaccine, critical Guillain‐Barre Syndrome (GBS) appeared after acute diarrhea, progressive myasthenia, and sudden respiratory and cardiac symptoms. Methods: The syndrome was addressed with measures, such as endotracheal intubation and cardiopulmonary resuscitation vasoactive drugs. Next, we conducted six cycles of human immunoglobulin treatment (dose of 400 mg/kg·d intravenously for 5 days consecutively) and three times plasma exchange (PE, 30 ml/kg), followed by methylprednisolone sodium succinate. Rehabilitation training was carried out continuously. Results: The consciousness of the patient returned to normal, wherein he carried out normal communication. The muscle strength recovered gradually but still could not stand independently. Presently, he is recovering at home. Conclusions: For patients with previous radiculitis, COVID‐19 vaccination may increase the susceptibility to GBS. Thus, it is recommended to extend the vaccination interval for these patients and ensure that any potential increased risk is continually assessed. [ABSTRACT FROM AUTHOR]

Background and Objectives: Guillain-Barré syndrome (GBS) is the most frequent cause of acute flaccid paresis in children. The aim of this study was to describe the clinical and electrophysiological findings and outcomes of children with GBS diagnosed in our unit. Moreover, the literature on pediatric GBS cases from the past 5 years was reviewed. In this retrospective study, we reported data on 12 patients (9 male and 3 female patients; mean age: 5 y, 4 mo; range: 9 mo–11 y) clinically diagnosed at the Child Neurology Unit of the AUSL-IRCCS of Reggio Emilia, Italy, between 2000 and 2017 and a brief analysis/comparison with data from the literature. Materials and Methods: Data were collected from medical charts. Results: In our cohort, male patients were more frequent than female ones (9 vs. 3), and upper respiratory tract infection (n = 8, 66.7%) was the most frequent triggering factor. The main clinical symptoms on admission were distal lower limbs’ weakness with gait difficulties (83.3%), pain (50%), upper limbs’ weakness (50%), and dysphagia for liquids (25%). Peripheral neurophysiological studies revealed acute inflammatory demyelinating polyradiculoneuropathy (AIDP) in 66.6% of the children, acute motor and sensory axonal neuropathy (AMSAN) in 25%, and acute motor axonal neuropathy (AMAN) in 8.3%. Ten individuals (83.3%) received timely treatment with intravenous immunoglobulins (IVIG), and, out of these ten patients, 58% received concomitant treatment with IV methylprednisolone because of a progressive disease course. Complete remission was observed in the majority of individuals (91.6%) within 6 months of symptom onset. Conclusions: Different subtypes of GBS can affect children; however, the outcome is usually positive. Early treatment appears to be important for a favorable outcome.

This research is mostly about Guillain-Barre syndrome (GBS), a complicated neurological condition with many subtypes that make diagnosis and treatment hard, even though medical care is always getting better. The main goal of this study is to build and test an expert system that can correctly diagnose these subtypes, with a focus on early detection and personalized treatments. The evaluation of the system was carried out using a dataset composed of 20 cases (12 positive and 8 negative). A confusion matrix was used to evaluate key metrics such as precision, sensitivity, and specificity. The findings demonstrate precision and sensitivity of 83% and specificity of 75%. These findings unambiguously demonstrate the efficacy of the system in correctly identifying positive Guillain-Barre cases while substantially reducing false negatives. In conclusion, this expert system offers a potentially useful tool to improve the accuracy of the diagnosis and treatment of Guillain-Barre patients. However, to take advantage of its full potential in clinical practice, it should be used as diagnostic support and not replace the medical staff, and it should be updated periodically to reflect new findings in medicine. [ABSTRACT FROM AUTHOR]

Background: Neuropathic tremor occurs with damage to the peripheral nervous system. Guillain-Barré syndrome (GBS) causes acute paralysis following nerve inflammation sometimes resulting in long-term disability. It is unclear how frequent and severe tremor is following GBS. Objectives: We aimed to assess the frequency and features of tremor following GBS. Methods: We enrolled 18 patients with GBS treated in a secondary care center within a 4-year period. Evaluations were done with the Fahn-Tolosa-Marin tremor rating scale (FTM-TRS). We compared these features with a cohort of consecutive patients with untreated essential tremor (ET). Results: There were 13 males and 5 females with a mean age at evaluation (S.D.) of 41.5 ± 14.0 years and at GBS onset of 40.2 ± 13.7. No patient had history of tremor before GBS. Upper limb tremor was identified in 16 (89%) cases, 35.5% of patients had FTM-TRS score ≥10 points. Tremor was mostly kinetic, jerky with low amplitude with a total score of 10.94 ± 11.84 in the FTM-TRS. Compared with patients with ET, those with GBS-tremor were younger and had lower scores in all subscales of the FTM-TRS (P value < 0.05 for all comparisons). In a multivariate linear regression analysis "days of hospitalization" had a positive association with the total FTM-TRS score (P = 0.001). Conclusions: Tremor was common following GBS. This tremor is mild compared with patients with ET, but adds functional impact. [ABSTRACT FROM AUTHOR]

Cholecystocutaneous fistula is a rare surgical entity caused by an abnormal connection between the gallbladder epithelium and the skin. These complex cases have historically required an open surgical approach and are difficult to manage. We present a rare case of a 65-year-old male patient, with chronic lithiasic cholecystitis and cholecystocutaneous fistula. The patient underwent a laparoscopic subtotal cholecystectomy, dissection of the fistula tract, and removal of the impacted stones from the abdominal wall. With appropriate expertize, a completely laparoscopic approach is acceptable and the technical challenges can be predicted and overcome through careful pre-operative planning. [ABSTRACT FROM AUTHOR]

Background: Recreational use of nitrous oxide (N2O) has dramatically increased in recent years, resulting in numerous cases of acute sensorimotor tetraparesis secondary to nitrous oxide‐induced neuropathy (N2On). Challenging clinical features can mimic Guillain‐Barré syndrome (GBS), the main differential diagnosis upon admission. The most sensitive biomarkers for distinguishing between these two conditions remain to be determined. Methods: Fifty‐eight N2On patients from three referral centers were retrospectively included over a 2‐year period and compared to GBS patients hospitalized during the same timeframe (47 patients). Collected demographic, clinical, biological, and electrophysiological data were compared between the two groups. Results: The typical N2On clinical pattern included distal sensorimotor deficit in lower limbs with absent reflexes, proprioceptive ataxia, and no cranial involvement (56.7% of our cohort). Misleading GBS‐like presentations were found in 14 N2On patients (24.1%), and 13 patients (22.4%) did not report N2O use during initial interview. Only half the N2On patients presented with reduced vitamin B12 serum levels upon admission. A slightly increased cut‐off (<200 pmol/L) demonstrated 85.1% sensitivity and 84.5% specificity in distinguishing N2On from GBS. Only 6.9% of N2On patients met the criteria for primary demyelination (p < 0.01), with only one presenting conduction blocks. A diagnostic algorithm combining these two biomarkers successfully classified all GBS‐like N2On patients. Conclusions: Vitamin B12 serum level < 200 pmol/L cut‐off and conduction blocks in initial electrophysiological study are the two most sensitive biomarkers for rapidly distinguishing N2On from GBS patients. These two parameters are particularly useful in clinically atypical N2On with GBS‐like presentation. [ABSTRACT FROM AUTHOR]

COVID-19 infection has had a profound impact on society. During the initial phase of the pandemic, there were several suggestions that COVID-19 may lead to acute and protracted neurologic sequelae. For example, peripheral neuropathies exhibited distinctive features as compared to those observed in critical care illness. The peripheral nervous system, lacking the protection afforded by the blood--brain barrier, has been a particular site of sequelae and complications subsequent to COVID-19 infection, including Guillain-Barre syndrome, myasthenia gravis, and small fiber neuropathy. We will discuss these disorders in terms of their clinical manifestations, diagnosis, and treatment as well as the pathophysiology in relation to COVID-19. [ABSTRACT FROM AUTHOR]

Guillain-Barré syndrome (GBS) is a rare rapid onset autoimmune peripheral polyneuropathy, most commonly characterized by inflammatory demyelination of peripheral nerves. Patients with GBS are considered higher risk for anesthetic-induced neurotoxicity caused by demyelination. In the present report, a case is described of a 56-year-old man with GBS who experienced mental and lingual nerve paresthesia following infiltration anesthesia for dental implant placement in the posterior mandible. The pareshesia lasted 5 months postoperatively and subsided spontaneously without any intervention. The patient was successfully restored with fixed partial dental prosthesis without any other complication. This is considered the first report of such complication in patient with GBS after local anesthesia in the oral and maxillofacial region. Possible pathogenic mechanism of the complication and clinical implications are discussed. [ABSTRACT FROM AUTHOR]

SARS-CoV-2 infection has been associated with multiple neurological manifestations. One such manifestation, which has been described since the early stages of the COVID-19 pandemic and is relevant for current neurological practice, is Guillain-Barré syndrome (GBS). The literature describes neurotoxic mechanisms of the virus itself and the possible pathways by which it may affect the peripheral nerves in experimental studies; however, we still lack information on the mechanisms causing the immune response that gives rise to GBS in the context of SARS-CoV-2 infection. Colombia is one of the Latin American countries worst affected by the pandemic, with the third-highest number of cases in the region; thus, it is essential to recognise GBS, as this potential postinfectious complication may severely compromise the patient's functional status in the absence of timely diagnosis and treatment. We present a series of 12 cases of GBS associated with SARS-CoV-2 infection from hospitals in 4 different Colombian cities and describe the clinical presentation, laboratory and electrophysiological study findings, and treatment. Resumen: En el año 2020 se declaro la pandemia ocasionada por la infección por el virus SARSCoV-2, virus de la familia del coronavirus, adoptándose el nombre de COVID-19 a la enfermedad 1. En Bogotá, Colombia, se confirmó el primer caso de COVID-19 el 6 de marzo de 2020 (2). Los principales síntomas reportados en la infección por SARSCoV-2 son fiebre (43.8% en la admisión y 88.7% durante la hospitalización) y tos (67.8%) (3). Otros síntomas encontrados son fatiga (38.1%), producción de esputo (33.7%) y cefalea (13.6%). Los principales signos neurológicos reportados en los pacientes con infección severa por SARS-Cov-2 son agitación (69%), compromiso en tracto corticoespinal (67%) y delirium (65%) (4). Las principales complicaciones neurológicas descritas asociadas a Covid 19 son: anosmia, disgeusia, encefalopatia, Síndrome de Guillain Barre, complicaciones cerebrovasculares y daño en musculo esquelético (5–8).En el presente articulo se presenta una serie de casos de pacientes con síndrome de Guillain-Barré asociado a infección por SARS-CoV-2. Se recolectaron casos de diferentes instituciones medicas de Colombia.

COVID-19 infection has had a profound impact on society. During the initial phase of the pandemic, there were several suggestions that COVID-19 may lead to acute and protracted neurologic sequelae. For example, peripheral neuropathies exhibited distinctive features as compared to those observed in critical care illness. The peripheral nervous system, lacking the protection afforded by the blood–brain barrier, has been a particular site of sequelae and complications subsequent to COVID-19 infection, including Guillain-Barre syndrome, myasthenia gravis, and small fiber neuropathy. We will discuss these disorders in terms of their clinical manifestations, diagnosis, and treatment as well as the pathophysiology in relation to COVID-19.

COVID-19 vaccination is a life-saving intervention. However, it does not come up without a risk of rare adverse events, which frequency varies between vaccines developed using different technological platforms. The increased risk of Guillain-Barré syndrome (GBS) has been reported for selected adenoviral vector vaccines but not for other vaccine types, including more widely used mRNA preparations. Therefore, it is unlikely that GBS results from the cross-reactivity of antibodies against the SARS-CoV-2 spike protein generated after the COVID-19 vaccination. This paper outlines two hypotheses according to which increased risk of GBS following adenoviral vaccination is due to (1) generation of anti-vector antibodies that may cross-react with proteins involved in biological processes related to myelin and axons, or (2) neuroinvasion of selected adenovirus vectors to the peripheral nervous system, infection of neurons and subsequent inflammation and neuropathies. The rationale behind these hypotheses is outlined, advocating further epidemiological and experimental research to verify them. This is particularly important given the ongoing interest in using adenoviruses in developing vaccines against various infectious diseases and cancer immunotherapeutics. [ABSTRACT FROM AUTHOR]

Neuromuscular diseases are relatively rare, but it is important for both anaesthetists and intensivists to have a working knowledge of the common diseases as they may complicate general anaesthesia and result in neurogenic respiratory failure. The most common neurological condition seen in the intensive care unit is that of critical illness neuropathy; this subject is covered elsewhere in the journal. The diseases most commonly encountered in general anaesthetic practice include motor neurone disease, Guillain–Barre syndrome, botulism, myasthenia gravis and the muscular dystrophies. [ABSTRACT FROM AUTHOR]

Introduction: Mechanical methods aimed at the filtration of the cerebrospinal fluid (CSF) are a group of therapies that have been proposed to treat neurological conditions where pathogens are present in the CSF. Even though the industry of medical devices has not been very active in this field, there is a lack of systematization of the different systems and procedures that can be applied. Areas covered: First, we systematize the classification and definitions of procedures and systems for mechanical filtration of the CSF. Then, we made a literature review in search of clinical or preclinical studies where any system of mechanical CSF clearance was proposed or applied. Expert opinion: We found mechanical filtration of the CSF has been explored in subarachnoid hemorrhage, CNS infections (bacterial, viral, and fungal), meningeal carcinomatosis, multiple sclerosis, autoimmune encephalitis, and polyradiculomyelitis. Brain aging and neurodegenerative diseases are additional potential conditions of interest. While there is some preliminary positive evidence for many of these conditions, more advanced systems, detailed descriptions of procedures, and rigorous validations are needed to make these therapies a reality in the next decades. [ABSTRACT FROM AUTHOR]

With the outbreak of coronavirus disease 2019 (COVID-19), the whole world was impacted by a pandemic. With the passage of time and knowledge about the dynamics and viral propagation of this disease, the short-, medium- and long-term repercussions are still being discovered. During this period, it has been learned that various manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can affect the nervous system. In recent months, a variety of studies and case reports have proposed an association between COVID-19 and Guillain–Barré syndrome (GBS). The present work aims to systematically review the publications available to date to verify the relationship between these two pathologies and the characteristics of post-COVID GBS. There were 156 studies included in this work, resulting in a total of 436 patients. The findings show a mean age of the patients of 61,38 years and a male majority. The GBS symptoms began on average 19 days after the onset of COVID-19 infection. Regarding GBS, the main manifestations found included generalized weakness, reflex reduction, facial paresis/paralysis and hypoesthesia. As expected, the most common result in cerebrospinal fluid (CSF) analysis was albuminocytological dissociation. A pattern of blood analysis findings common to all patients was not observed due to non-standardization of case reports. Regarding electrodiagnostic studies, acute inflammatory demyelinating polyneuropathy (AIDP) appeared as the most common subtype of GBS in this study. There have been reports, to a lesser extent, of acute motor axonal neuropathy (AMAN), acute sensorimotor axonal neuropathy (AMSAN), the pharyngeal-cervical-brachial variant (PCB), and Miller-Fisher syndrome (MFS). The GBS treatment used was mainly intravenous immunoglobulin (IVIG) and plasma exchange (PLEX). Therefore, the present study reports a high prevalence of hospitalization and intensive care units ICU admissions, conjecturing a relationship between the development of GBS and the severity of COVID-19. Despite the severity, most patients showed improvement in GBS symptoms after treatment, and their residual symptoms did not include motor involvement. Therefore, the development of GBS seems to be related to COVID-19 infection, as reported by the present systematic review.

GuiIlain-Barre syndrome is an idiopathic acute or subacute inflammatory demyelinating polyneuropathy with ascending and often bilaterally symmetrical paralysis. The diagnosis is made on the basis of clinical presentation which is mostly acute flaccid paralysis, and electrochemical analysis. We present a case of electrical burn injury followed by GB Syndrome like features. Patient received the standard treatment of GB Syndrome that is I/V immunoglobulins and physiotherapy besides ventilatory support and supportive treatment of electrolyte and fluid management. He was discharged satisfactorily after two months of management in the hospital. [ABSTRACT FROM AUTHOR]

Background: Guillain-Barre syndrome (GBS) is a post-infectious immune-mediated peripheral neuropathy, progressing bilaterally and often symmetrically and affecting sensory and motor function. Most cases completely recover, but around 20% of cases may lead to complications, incomplete recovery, or even death. Objectives: This study aims to assess the prognosis of GBS in pediatric patients and possible associated conditions regarding recovery or prognosis. Methods: We investigated 71 cases of GBS admitted to Mofid Pediatric Hospital from March 2014 to March 2017. Demographic, clinical, and laboratory data were retrospectively recorded and analyzed. Two follow-up visits were performed after 1 to 3 and 5 to 8 years from onset, according to the GBS Disability Scale, and recovery of motor function was assessed during patients' visits to the clinic. Results: We found 35 male and 36 female subjects with an average age of 6.17 ± 3.82 (range 0.9 up to 15 years old); cases were mostly presented with myalgia and weakness (78.9%) followed by headache, found in 5 patients (7%). Around 84.5% of patients had an upper respiratory infection as their antecedent infection. Fifteen cases of autonomic dysfunction were observed, and 15 patients had cranial nerve involvement. Most cases had the acute inflammatory demyelinating polyradiculoneuropathy (AIDP) form of GBS on electrophysiologic tests. Analysis showed onlyaxonal involvement was significantly correlated with poor prognosis (P-value<0.05), and other variables were not significantly correlated. Conclusions: Compared to the current literature, we found fewer autonomic dysfunctions, cranial neuropathies, and a smaller percentage of AIDPs in our data. Altogether, the axonal form of GBS is reported as a predictor of an unfavorable prognosis in GBS patients. [ABSTRACT FROM AUTHOR]

Various Neurological Manifestation associated with severe acute respiratory syndrome (SARS-CoV-2) has been recorded ranging from mild to severe symptoms and syndromes. An intense review of all the current published literature was conducted and found that headache, psychomotor agitation, taste and smell abnormalities, generalized muscle weakness, and Myalgia were the common neurological manifestation of SARS CoV-2. However, Seizures, stroke, flaccid paralysis, and Guillain-Barre syndrome were some of the rarely found cases among COVID 19 patients. the SARS CoV-2 virus has been found in over a hundred countries across the world. In March 2020, the World Health Organization declared a pandemic after receiving reports of more than 700,000 deaths worldwide (WHO). While first believed to be limited in its effects, the virus soon progressed to other organs, including the central nervous system (CNS), leading to symptoms such as paralysis and death. For a long time, it was thought that viral entrance into host cells through the receptor ACE2 was the key determinant of the S protein of CoV-2 linked to the SARS membrane. [ABSTRACT FROM AUTHOR]

Introduction/Aims: Studies conducted during the coronavirus disease 2019 (COVID-19) pandemic have reported varied data regarding the incidence of Guillain–Barre syndrome (GBS). The present study investigated demographic and clinical features, management, and outcomes of patients with GBS during a specified period of the COVID-19 pandemic, and compared these features to those of GBS in the previous year. Methods: A multicenter, ambispective cohort study including 26 centers across India was conducted. Data from a pre-COVID-19 period (March 1 to August 31, 2019) were collected retrospectively and collected ambispectively for a specified COVID-19 period (March 1 to August 31, 2020). The study was registered with the Clinical Trial Registry India (CTRI/2020/11/029143). Results: Data from 555 patients were included for analysis: pre-COVID-19 (n = 334) and COVID-19 (n = 221). Males were more commonly affected during both periods (male:female, 2:1). Gastroenteritis was the most frequent antecedent event in 2019 (17.4%), whereas fever was the most common event in 2020 (10.7%). Paraparesis (21.3% versus [vs.] 9.3%, P = 0.001) and sensory involvement (51.1% vs. 41.3%; P = 0.023) were more common during COVID-19 in 2020, whereas back pain (26.3% vs. 18.4%; P = 0.032) and bowel symptoms (20.7% vs. 13.7%; P = 0.024) were more frequent in the pre-COVID period. There was no difference in clinical outcomes between the two groups in terms of GBS disability score at discharge and 3 months after discharge. Independent predictors of disability in the pre-COVID period included areflexia/hyporeflexia, the requirementfor intubation, and time to bulbar weakness; in the COVID-19 period, independent predictors included time from onset to admission, intubation, and intubation requirement. The mortality rate was 2.3% during the entire study period (13/555 cases). Discussion: Results of this study revealed an overall reduction in the frequency of GBS during the pandemic. The lockdown likely reduced the risk for antecedent infections due to social distancing and improved hygiene, which may have resulted in the reduction of the frequency of GBS.

Background: Guillain-Barre syndrome (GBS) is an acute or subacute inflammatory autoimmune postinfectious polyradiculoneuropathy, usually triggered by antecedent infections during the preceding six weeks suggesting a humoral immune-pathogenic mechanism. Inflammation raises the erythrocyte sedimentation rate (ESR), which can be used to monitor the inflammatory process. Objective: This study aimed to find out if there is correlation between the ESR as a marker of the inflammatory process and the Erasmus GBS outcome score. Methods: Patients were diagnosed with GBS based Asbury and Cornblath diagnostic criteria. Assessment of GBS disability score and the Erasmus GBS outcome score (EGOS) were performed. Results: Among 37 patients with GBS; the GBS disability score was 3 in 13 patients (35.2%), and 4 in 24 patients (64.5%). None of our patients showed other grades of the GBS score. As regard the EGOS 4 patients (10.8%) scored 3, 3 (8.1%) scored 3.5, 11 (29.7%) scored 4, 6 (16.2%) scored 4.5, 10 (27.1%) scored 5, 2 (5.4%) scored 5.5, and only one patient (2.7%) scored 6. Assessed first hour ESR mean value was 42.97 ± 18.01, with minimum value of 16, maximum 110. Positive correlation between the ESR and the EGOS was detected with r value of 0.7328. Conclusion: ESR may serve as a simple prognostic biomarker of clinical severity as higher ESR levels were associated with increase severity of GBS. [ABSTRACT FROM AUTHOR]

Brucellosis is a multisystemic disease that can present with multiple signs and symptoms. Rarely, brucellosis can manifest as neurobrucellosis, with central or peripheral nervous system involvement. Guillain‐Barré syndrome (GBS) is a post‐infectious autoimmune disease that progresses rapidly, causing ascending muscle weakness, and is accompanied by areflexia/hyporeflexia. Regarding GBS etiology, it is thought to be an autoimmune disease, triggered by a previous bacterial or viral infection. There are a few Brucella‐associated GBS case reports in the literature and in our opinion, only one of them is a pediatric patient. Herein we reported a case of GBS associated with neurobrucellosis, who was successfully treated with therapeutic plasmapheresis (TP) due to poor response to IVIG treatment. [ABSTRACT FROM AUTHOR]

Background: Acute flaccid paralysis (AFP) is a syndrome that occurs with the sudden onset of paralysis in any part of the body of infants and children under 15 years old. This study investigated the epidemiology and causes of AFP in patients under 15 years of age admitted to hospitals in Hormozgan province during 2011-2018. Materials and Methods: After receiving the code of ethics, the information of the studied patients was collected by referring to the health center of Hormozgan province and reviewing their records. The corresponding data were gathered using a checklist that included the causes of paralysis, age, gender, place of residence, and involved organs and then analyzed with SPSS software. Results: Out of 121 patients, 58.7% were males. In addition, 69.4% and 21.5% of these patients were in the age groups of 0-5 and 5-10 years, and the remaining cases were in the age group of 10-15 years. In terms of accommodation, 19.8% and 14.9% of patients lived in Bandar Abbas and Minab, respectively. The highest incidence of the disease was 19% and 18.2% in 2013 and 2015, respectively. The most affected organ was 57% of both feet. The most common cause of AFP in this study was Guillain-Barre syndrome (37.2%), followed by transient synovitis (17.4%). Conclusion: Considering the high annual incidence of this disease compared to the standard of the World Health Organization, it is recommended to launch training and vaccination campaigns to reduce the incidence and eradicate this disease.

Objective COVID-19 has been associated with neurological complications such as Guillain-Barre syndrome (GBS). Several cases have been reported but without functional outcome data after intensive rehabilitation and medium-term follow-up. Methods In this observational study, patients were admitted in 2019 and 2020 to inpatient rehabilitation for GBS and were examined using the Barthel index, GBS-Disability Scale, and Medical Research Scale-sum score at admission, discharge, and at least 6 months after onset of symptoms. All the participants received personalized, goal-oriented inpatient rehabilitative treatment for the recovery of self-sufficiency in everyday life. Results Eleven people with GBS—3 cases related to COVID-19—were admitted in 2019 and 2020 to inpatient rehabilitation. Eight patients with GBS not related to COVID-19 experienced a high complication rate during inpatient rehabilitation, with 2 deaths due to sepsis. In this cohort, a higher prevalence than expected of acute motor axonal neuropathy was also detected. The COVID-19–related GBS group did not have any complications. After a mean of 10.11 months (SD = 4.46 months), 55.55% of patients regained autonomous walking. Conclusion COVID-19–related GBS appeared to have a better clinical outcome than GBS that was not COVID-19 related. A higher than usual prevalence of acute motor axonal neuropathy form was encountered. More follow-up studies are needed to understand whether the recovery of GBS related to COVID-19 might be different from that of GBS unrelated to COVID-19. Impact No data are currently available on the follow-up of GBS in the COVID-19 era and on the functional outcome of those patients. This study provides important information indicating that GBS related to COVID-19 might have a better clinical outcome than GBS unrelated to COVID-19. [ABSTRACT FROM AUTHOR]

The Zika virus outbreak has captivated the attention of the global audience and information has spread rapidly and wildly through the internet and other media channels. This virus was first identified in 1947, when it was isolated from a sentinel rhesus monkey placed by British scientists working at the Yellow Fever Research Laboratory located in the Zika forest area of Uganda, hence its name, and is transmitted primarily by the mosquito vector, Aedes aegypti. The fact that the rhesus macaque is an Asian species being placed in an African forest brings to mind the possibility of rapid adaptation of the virus from an African to Asian species, an issue that has not been considered. Whether such adaptation has played any role in acquiring pathogenicity due to cross species transmission remains to be identified. The first human infection was described in Nigeria in 1954, with only scattered reports of about a dozen human infections identified over a 50-year period. It was not until 2007 that Zika virus raised its ugly head with infections noted in three-quarters of the population on the tiny island of Yap located between the Philippines and Papua New Guinea in the western Pacific Ocean, followed by a major outbreak in French Polynesia in 2013. The virus remained confined to a narrow equatorial band in Africa and Asia until 2014 when it began to spread eastward, first toward Oceania and then to South America. Since then, millions of infected individuals have been identified in Brazil, Colombia, Venezuela, including 25 additional countries in the Americas. While the symptoms associated with Zika virus infection are generally mild, consisting of fever, maculopapular rash, arthralgia and conjunctivitis, there have been reports of more severe reactions that are associated with neurological complications. In pregnant women, fetal neurological complications include brain damage and microcephaly, while in adults there have been several cases of virus-associated Guillain-Barre syndrome. The virus was until recently believed to only be transmitted via mosquitoes. But when the Zika virus was isolated from the semen specimens from a patient in Texas, this provided the basis for the recent report of possible sexual transmission of the Zika virus. Due to the neurological complications, various vectors for infection as well as the rapid spread throughout the globe, it has prompted the World Health Organization to issue a global health emergency. Various governmental organizations have recommended that pregnant women do not travel to countries where the virus is epidemic, and within the countries affected by the virus, recommendations were provided for women of childbearing age to delay pregnancy. The overall public health impact of these above findings highlights the need for a rapid but specific diagnostic test for blood banks worldwide to identify those infected and for the counseling of women who are pregnant or contemplating pregnancy. As of this date, there are neither commercially licensed diagnostic tests nor a vaccine. Because cross-reactivity of the Zika virus with dengue and Chikungunya virus is common, it may pose difficulty in being able to quickly develop such tests and vaccines. So far the most effective public health measures include controlling the mosquito populations via insecticides and preventing humans from direct exposure to mosquitoes.

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Introduction: Numerous cases have been reported of patients with symptoms of Guillain-Barré syndrome associated with COVID-19, but much information is still lacking on this association and its implications. The objective of this review is to analyse the available evidence on this topic in the adult population. Material and methods: A systematic review was conducted of studies published on scientific databases: PubMed, Cochrane, Science Direct, MEDLINE, and WHO COVID-19 database. Results: We identified 45 studies, which were analysed and completed using the Covidence platform; the final analysis included 24 articles, with a total of 30 patients. Conclusions: We found a strong association between both conditions; furthermore, the studies analysed highlight differences in the presentation of the disease, with greater severity of symptoms in Guillain-Barre syndrome associated with COVID-19. Resumen: Introducción: Se han reportado distintos casos de pacientes con cuadro de síndrome de Guillain-Barré asociado a COVID-19, pero falta mucha información aún sobre esta asociación y sus implicancias, el objetivo de esta revisión es analizar la evidencia disponible en esta temática en la población adulta. Material y Métodos: Se realizó una revisión sistemática de estudios publicados en buscadores científicos: PubMed, Cochrane, Science direct, Medline, OMS COVID-19. Resultados: Se identificaron 45 estudios, los cuales se analizaron y completaron utilizando la plataforma Covidence, incluyendo para el análisis final 24 artículos y sumando un total de 30 pacientes. Conclusiones: Se demuestra una asociación fuerte entre ambas patologías, además los estudios analizados recalcan diferencias en la presentación de la enfermedad con mayor gravedad en los cuadros de Síndrome de Guillain-Barre asociados a COVID-19.

Introduction: Although Guillain-Barré syndrome is rare, a marked increase in incidence was observed during the 2016 Zika outbreak in the Americas, with no direct causal relationship being apparent in all cases. Methods: Cases of febrile exanthematous disease and acute flaccid paralysis were reviewed during the period from 1 August to 15 December, 2016; clinical and biochemical assessment was performed for each case to identify Zika-related Guillain-Barré syndrome. Results: During the study period, we identified 8 patients (6 men and 2 women) with Zika-related Guillain-Barré syndrome, with the most affected age group being 50-59 years. The highest incidence was in the month of September, with 7 cases. The most frequent symptoms were rash and conjunctivitis, followed by fever. The most common presentation was symmetrical ascending paralysis, present in 7 cases. Cranial nerve VII was the most frequently involved nerve. Only 2 patients presented albuminocytologic dissociation. RT-PCR returned negative results for Zika virus in all patients. All patients received intravenous immunoglobulin and all had a good prognosis. None warranted mechanical ventilation. No deaths were recorded. The cumulative incidence rate was 3.9%, monthly incidence was between 0.04 and 2 cases/month. Conclusions: Cases of Guillain-Barré syndrome increased during the Zika outbreak, with an increase in incidence and number of cases per month; however, a direct causal relationship between the 2 conditions could not be demonstrated. Resumen: Introducción: El síndrome de Guillain-Barré es poco frecuente, sin embargo, durante la oleada de zika en América se vio un marcado incremento en la incidencia del síndrome, sin poder denotarse una relación causal directa en todos los casos. Métodos: Se revisaron los casos de enfermedad febril exantemática y parálisis flácida aguda durante el periodo del 1 de agosto a 15 de diciembre del 2016, realizando caracterización clínica y bioquímica de cada caso para ser incluidos como síndrome de Guillain-Barré asociado a zika. Resultados: Durante el periodo comentado, se encontró una cohorte de 8 pacientes, 6 hombres y 2 mujeres, grupo etario más afectado: 50-59 años. La mayor incidencia fue en el mes de septiembre, con 7 casos. Los síntomas más frecuentes fueron exantema y conjuntivitis, seguidos de fiebre. La presentación más común fue parálisis simétrica ascendente con 7 casos. La afectación de pares craneales más frecuente fue la del vii par craneal. Solo 2 pacientes presentaron disociación albumino-citológica. Todos presentaron PCR-RT negativa a zika. Todos recibieron inmunoglobulina por vía intravenosa y todos tuvieron buen pronóstico. Ninguno ameritó ventilación mecánica. No se registraron defunciones. La tasa de incidencia acumulada es del 3,9%, la incidencia de casos/mes fue de 0,04 casos/mes a 2 casos/mes. Conclusiones: Existe un incremento en los casos de Guillain-Barré durante la oleada de zika, con un incremento en la incidencia y el número de casos/mes; sin embargo, no se pudo demostrar relación causal directa entre estas 2 entidades.

Competing Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: DBS reports relationships with AMAG Pharmaceuticals, Inc., General Electric Healthcare, Private Health Management, RemedyLogic, Siemens Healthcare, USA. DRL reports relationships with Choice Spine, Depuy Synthes, HS2, LLC, ISPH II, LLC, Medtronic Sofamor Danek USA, Inc., Nuvasive, Inc., Remedy Logic, Stryker, Vestia Ventures, MiRus Investment LLC, Viseon, Inc., Woven Orthopedic Technologies. The other authors declared no potential conflicts of interest.

Evidence is accumulating that SARS-CoV-2 infections and SARS-CoV-2 vaccinations can induce Guillain-Barre syndrome (GBS). More than 400 GBS cases after SARS-CoV-2 infection respectively vaccination have been reported as per the end of 2021. GBS is usually diagnosed according to the Brighton criteria, but also the Besta criteria or Hadden criteria are applied. The diagnosis can be supported by MRI with contrast medium of the cranial or spinal nerves showing enhancing nerve roots. As GBS can be complicated by autonomic dysfunction such as pupillary abnormalities, salivatory dysfunction, reduced heart rate variability, bowel disturbance (constipation, diarrhea), urinary hesitancy, urinary retention, or impotence, it is crucial to investigate GBS patients for autonomic involvement. Before diagnosing GBS various differentials need to be excluded, including neuropathy as a side effect of the anti-SARS-CoV-2 medication, critical ill neuropathy in COVID-19 patients treated on the ICU, and compression neuropathy in COVID-19 patients requiring long-term ventilation.

Guillain-Barré syndrome (GBS) is an inflammatory polyradiculopathy with potentially severe complications. Clinical tools for risk stratification have been developed, but no definitive prognostic biomarker has been reported. Hyponatremia is frequent in GBS patients, but the impact of serum sodium levels on clinical outcomes is still ill-defined. In this retrospective cohort study, we included all adult patients diagnosed with GBS spectrum disorders at our center from January 2010 to July 2020. Disability at discharge was assessed with the GBS Disability Score (GDS), and all clinical and laboratory data was retrieved from medical charts. Thirty (58.8%) of the 51 subjects included in the study were discharged with severe residual disability (GDS ≥ 3). After accounting for relevant confounders, the odds of experiencing severe disability decreased by 27% (p = 0.027) for each unitary increase in serum sodium concentration. Thirteen (25.5%) patients were diagnosed with mild to moderate hyponatremia; the use of intravenous immune globulin (IVIG) independently increased the odds of developing hyponatremia. In conclusion, we found a significant, independent association between baseline serum sodium levels and severe disability at discharge in GBS patients. In our cohort, hyponatremia was more frequently observed after treatment with IVIG, suggesting dilutional pseudohyponatremia as a probable cause.

In the wake of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, an increasing number of patients with neurological disorders, including Guillain-Barré syndrome (GBS), have been reported following this infection. It remains unclear, however, if these cases are coincidental or not, as most publications were case reports or small regional retrospective cohort studies. The International GBS Outcome Study is an ongoing prospective observational cohort study enrolling patients with GBS within 2 weeks from onset of weakness. Data from patients included in this study, between 30 January 2020 and 30 May 2020, were used to investigate clinical and laboratory signs of a preceding or concurrent SARS-CoV-2 infection and to describe the associated clinical phenotype and disease course. Patients were classified according to the SARS-CoV-2 case definitions of the European Centre for Disease Prevention and Control and laboratory recommendations of the World Health Organization. Forty-nine patients with GBS were included, of whom eight (16%) had a confirmed and three (6%) a probable SARS-CoV-2 infection. Nine of these 11 patients had no serological evidence of other recent preceding infections associated with GBS, whereas two had serological evidence of a recent Campylobacter jejuni infection. Patients with a confirmed or probable SARS-CoV-2 infection frequently had a sensorimotor variant 8/11 (73%) and facial palsy 7/11 (64%). The eight patients who underwent electrophysiological examination all had a demyelinating subtype, which was more prevalent than the other patients included in the same time window [14/30 (47%), P  =   0.012] as well as historical region and age-matched control subjects included in the International GBS Outcome Study before the pandemic [23/44 (52%), P  =   0.016]. The median time from the onset of infection to neurological symptoms was 16 days (interquartile range 12–22). Patients with SARS-CoV-2 infection shared uniform neurological features, similar to those previously described in other post-viral GBS patients. The frequency (22%) of a preceding SARS-CoV-2 infection in our study population was higher than estimates of the contemporaneous background prevalence of SARS-CoV-2, which may be a result of recruitment bias during the pandemic, but could also indicate that GBS may rarely follow a recent SARS-CoV-2 infection. Consistent with previous studies, we found no increase in patient recruitment during the pandemic for our ongoing International GBS Outcome Study compared to previous years, making a strong relationship of GBS with SARS-CoV-2 unlikely. A case-control study is required to determine if there is a causative link or not. [ABSTRACT FROM AUTHOR]

Guillain-Barré syndrome (GBS) is an inflammatory polyradiculopathy with potentially severe complications. Clinical tools for risk stratification have been developed, but no definitive prognostic biomarker has been reported. Hyponatremia is frequent in GBS patients, but the impact of serum sodium levels on clinical outcomes is still ill-defined. In this retrospective cohort study, we included all adult patients diagnosed with GBS spectrum disorders at our center from January 2010 to July 2020. Disability at discharge was assessed with the GBS Disability Score (GDS), and all clinical and laboratory data was retrieved from medical charts. Thirty (58.8%) of the 51 subjects included in the study were discharged with severe residual disability (GDS ≥ 3). After accounting for relevant confounders, the odds of experiencing severe disability decreased by 27% (p = 0.027) for each unitary increase in serum sodium concentration. Thirteen (25.5%) patients were diagnosed with mild to moderate hyponatremia; the use of intravenous immune globulin (IVIG) independently increased the odds of developing hyponatremia. In conclusion, we found a significant, independent association between baseline serum sodium levels and severe disability at discharge in GBS patients. In our cohort, hyponatremia was more frequently observed after treatment with IVIG, suggesting dilutional pseudohyponatremia as a probable cause. [ABSTRACT FROM AUTHOR]

We report the case of a 15-year-old male patient presenting frontal headaches with retro-orbital pain accompanied by fever evolving to weakness and pain of the lower limbs, which ascended to upper limbs. A COVID-19 rapid test (IgG and IgM) and nasopharyngeal swab polymerase chain reaction (PCR) was positive for SARS-CoV-2. The blood tests, cerebral spinal fluid (CSF) analysis and CSF aerobic culture revealed no abnormalities. PCR testing of the CSF was negative for the most prevalent etiologies as well as for SARS-CoV-2. Electroneurography study was compatible with the acute motor axonal neuropathy variant of Guillain-Barré syndrome. No cases involving young patients have been presented to date. Therefore, this is the first reported pediatric case of SARS-CoV-2 infection associated with GBS. Evidence reveals that SARS-CoV-2 infection is not limited to the respiratory tract. Neurotropism could explain this important neurologic manifestation of COVID-19 in children. [ABSTRACT FROM AUTHOR]

Acute pandysautonomia is a rare disorder characterized by autonomic failure affecting sympathetic, parasympathetic, and enteric functions. We present a case of acute inflammatory demyelinating polyneuropathy (AIDP) with severe pandysautonomia in a young, otherwise healthy, female who presented with gastrointestinal symptoms and sensory demyelinating polyneuropathy, which progressively worsened and subsequently developed bladder dysfunction and orthostatic hypotension. We discuss the challenges with diagnostic workup as well as the challenges we encountered as part of the management. [ABSTRACT FROM AUTHOR]

Background: To date, Mexico has more than 1,280,000 confirmed cases and more than 116,000 deaths due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Limited information is available regarding Latin American patients with Guillain-Barré syndrome (GBS) and SARS-CoV-2. Objective: The objective is to describe the presentation, diagnosis, and outcome of patients with GBS associated with SARS-CoV-2 infection. Methods: We describe four cases of GBS associated with SARS-CoV-2 infection in Mexico. Results: Neurological symptoms initiated 2-17 days after the respiratory symptoms. The age group in or patients ranged from 26 to 41 years. Two patients presented with progressive, acute, and symmetric weakness and two with bilateral facial palsy. Patients with GBS diagnosis associated with SARS-CoV-2 infection have been reported to have a good outcome after IGIV or plasma exchange therapy. Conclusion: It is important to consider GBS as a potential manifestation of SARS-CoV-2 infection and recall that the diagnosis is based mainly on clinical evaluation. Laboratory and CSF analysis, as well as neurophysiologic studies, should be considered as a complement for diagnosis. [ABSTRACT FROM AUTHOR]

Background: The role of diverse antibodies in mediating peripheral nerve injury in Guillain-Barré syndrome (GBS) is becoming clearer, but positivity for multiple antibodies in one case is uncommon. To our knowledge, this is the first case involving GBS with positive anti-sulfatide, anti-GT1a, and anti-GT1b antibodies., Case Summary: A 20-year-old female patient was admitted to the hospital due to weakness of limbs for 5 d, and deterioration of the weakness and muscle aches for 1 d. The patient's limbs were weak, but the tendon reflexes in the part of the limbs were normal. There was no comorbid peripheral nociception or deep sensory dysfunction. She was diagnosed with GBS and was discharged after receiving intravenous human immunoglobulin pulse therapy., Conclusion: In this article, the clinical manifestations, neurophysiological examination, and auxiliary examination findings of a GBS patient positive for multiple antibodies were analyzed to improve the identification of the disease by clinical physicians at an early stage., Competing Interests: Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)