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CASES OF THE WEEK – “Covid And Guillain Barre Syndrome” by Dr Prachet Kulkarni, Consultant Neurology, NMC Royal Hospital Sharjah

Covid And Guillain Barre Syndrome

60 year old known patient of diabetes was admitted for COVID positive state with malaise and fever and was started on treatment for the same. He developed progressive weakness of all his limbs over the next 3-4 days.

There was no history of bladder or sensory involvement. On examination, he was conscious, oriented, had bifacial weakness and weakness of all four limbs (grade 3-4), proximal muscle weakness was more than distal. However weakness was asymmetrical left more than right and lower limb weakness was more than upper limbs. All his deep tendon reflexes were lost (which could have been due to diabetes also).

In view of COVID positive status and asymmetrical weakness it was decided to first investigate with MRI of the brain(as multiple blood clots are common in COVID). The COVID treatment was continued, MRI of the brain revealed old ischemic changes, there was no evidence of fresh infarct on the MRI. He was subsequently investigated with nerve conduction study which revealed predominantly demyelinating neuropathy (predominantly motor involving all four limbs). Lumbar puncture was not done,as the above met the diagnostic criteria and its is always better to avoid an invasive procedure in COVID patients, as much as possible.

Meanwhile his weakness progressed further to grade 2. At this point he was shifted to ICU as he stood a high chance for respiratory failure ( both by COVID and GUILLAIN BARRE SYNDROME).

The nature of disease, plan of care, prognosis and treatment options were explained to the patient and his relatives and was started on intravenous immunoglobulin (IVIg). He received 2gm/kg body weight of intravenous immunoglobulin over 5 days along with supportive care.

He made a gradually and good recovery and was discharged subsequently. Two months post discharge, his motor power is almost normal ( has mild difficulty in getting up from squatting posture), has persistent burning paresthesias. He is on pregabalin and multivitamins at present.

Lessons learned.

  1. COVID patients should be assessed regularly and carefully.
  2. New symptoms should be investigated.
  3. It is imperative for medical personnel to be aware of the new diseases, treatment protocols, unusual manifestations and their management.

I thank Dr Adel Ahmed Elnaggar for referring this patient to me.