ORIJINAL ARAŞTIRMA
COVID-19 Pandemisinde Artmış Akut Polinöropati Vakaları; Nörologları Neler Bekliyor?
Increased Cases of Acute Polyneuropathy in COVID-19 Pandemic; What Awaits Neurologists?
Received Date : 25 Apr 2022
Accepted Date : 02 Jun 2022
Available Online : 13 Jun 2022
Sinan ELİAÇIKa, Funda UYSAL TANa, Aysel KOCAGÜL ÇELİKBAŞb
aDepartment of Neurology, Hitit University School of Medicine, Çorum, Türkiye
bDepartment of Infection Disease and Microbiology, Hitit University School of Medicine, Çorum, Türkiye
Doi: 10.31609/jpmrs.2022-90845 - Makale Dili: EN
J PMR Sci. 2022;25(3):346-54
ÖZET
Amaç: Şiddetli akut solunum yolu sendromu koronavirüs hastalığı-
2019 [coronavirus disease-2019 (COVID-19)], öncelikle solunum sistemini
etkiler, ancak merkezî ve periferik nörolojik bulgular giderek daha fazla tanınmakta
ve literatürde sunulmaktadır. Amacımız, COVID-19 polinöropati
ilişkisine ışık tutmaktır. Gereç ve Yöntemler: Çalışma, COVID-19 enfeksiyonundan
sonra gelişen akut polinöropatili hastalardan oluşuyordu. Tüm
hastalarda tanı polimeraz zincir reaksiyonu pozitifliği ile kesinleşti. On altı
hastada elektrofizyolojik, laboratuvar bulguları ve nörolojik muayene ile
akut polinöropati tanısı kondu. Tüm hastalara polinöropatinin olası nedenlerini
dışlamak için etiyolojik araştırmalar yapıldı. Bulgular: Hastaların yaş
ortalaması 64,3’tü (29-83 yıl); vakaların çoğu kadındı (13 kadın, 3 erkek).
COVID-19 semptomlarının başlangıcı ile akut polinöropatinin ilk semptomları
arasındaki süre 11 ile 63 gün (ortalama: 21,5 gün) arasında değişmekte
idi. Elektronöromiyografide 8 hastada akut motor-duyusal aksonal
nöropati, 6 hastada akut motor aksonal nöropati ve 2 hastada akut inflamatuar
demiyelinizan polinöropati bulguları saptandı Beş hasta lomber ponksiyonu
kabul etti; beyin omurilik sıvısı analizinde 2 hastada normal protein
seviyesi diğerlerinde albüminositolojik disosiasyon saptandı. Sonuç: Bu
makale; akut polinöropati ile COVID-19 arasındaki olası nedensel ilişkinin
farkındalığı, nörolojik komplikasyonlar açısından COVID-19 hastalarının
daha uzun süreli takibinin gerektiğini göstermektedir.
Anahtar Kelimeler: Guillain-Barré sendromu; COVID-19; akut polinöropati
ABSTRACT
Objective: Severe acute respiratory syndrome coronavirus
disease-2019 (COVID-19) primarily affects the respiratory system but central
and peripheral neurological manifestations have been increasingly recognized
and reported. Our aim is to shed light on the relationship between
COVID-19 and polyneuropathy. Material and Methods: The study consisted
of patients with acute polyneuropathy that developed after the
COVID-19 infection. All patients were confirmed serologically with polymerase
chain reaction positivity. In 16 patients, acute polyneuropathy was
diagnosed with an electrophysiological, laboratory findings and neurological
examination. All patients underwent etiological studies to exclude possible
causes of polyneuropathy. Results: The average age of the patients
was 64.3 (29-83) years; most cases were female (13 vs 3). The interval between
the onset of symptoms of COVID-19 and the first symptoms of acute
polyneuropathy ranged from 11 to 63 (mean: 21.5) days. On electroneuromyography,
there was acute motor-sensory axonal neuropathy in 8 patients,
6 patients had acute motor axonal neuropathy and 2 patients had acute
inflammatory demyelinating polyneuropathy findings. Five patients accepted
lumbar puncture; on analysis of the cerebrospinal fluid (CSF), 2 patient
had normal protein level and the others showed an albuminocytological
dissociation, increased protein in the CSF without increase in
cell count, characteristic of the Gullain-Barré syndrome (GBS). Conclusion:
This article; awareness of the possible causal association between
acute polyneuropathy and COVID-19, recommends long-term follow-up of
COVID-19 patients for neurologic complications.
Keywords: Guillain-Barré syndrome; COVID-19; acute polyneuropathy
REFERENCES
- Mao L, Jin H, Wang M, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol. 2020;77:683-90. [Crossref] [PubMed] [PMC]
- Koralnik IJ, Tyler KL. COVID-19: a global threat to the nervous system. Ann Neurol. 2020;88:1-11. [Crossref] [PubMed] [PMC]
- Leonhard SE, Mandarakas MR, Gondim FAA, et al. Diagnosis and management of Guillain-Barré syndrome in ten steps. Nat Rev Neurol. 2019;15:671-83. [Crossref] [PubMed] [PMC]
- Kieseier BC, Mathey EK, Sommer C, et al. Immune-mediated neuropathies. Nat Rev Dis Primers. 2018;4:31. [Crossref] [PubMed]
- Willison HJ, Jacobs BC, van Doorn PA. Guillain-Barré syndrome. Lancet. 2016;388:717-27. [Crossref] [PubMed]
- Wakerley BR, Yuki N. Polyneuritis cranialis--subtype of Guillain-Barré syndrome? Nat Rev Neurol. 2015;11:664. [Crossref] [PubMed]
- Shahrizaila N, Lehmann HC, Kuwabara S. Guillain-Barré syndrome. Lancet. 2021;397:1214-28. [Crossref] [PubMed]
- Elzouki AN, Osman MAM, Ahmed MAE, et al. COVID-19 infection presented as Guillain-Barré Syndrome: Report of two new cases and review of 116 reported cases and case series. Travel Med Infect Dis. 2021;44:102169. [Crossref] [PubMed] [PMC]
- Costello F, Dalakas MC. Cranial neuropathies and COVID-19: Neurotropism and autoimmunity. Neurology. 2020;95:195-196. [Crossref] [PubMed]
- Dalakas MC. Guillain-Barré syndrome: the first documented COVID-19-triggered autoimmune neurologic disease: More to come with myositis in the offing. Neurol Neuroimmunol Neuroinflamm. 2020;7:e781. [Crossref] [PubMed] [PMC]
- Wang L, Shen Y, Li M, et al. Clinical manifestations and evidence of neurological involvement in 2019 novel coronavirus SARS-CoV-2: a systematic review and meta-analysis. J Neurol. 2020;267:2777-89. [Crossref] [PubMed] [PMC]
- Montalvan V, Lee J, Bueso T, et al. Neurological manifestations of COVID-19 and other coronavirus infections: a systematic review. Clin Neurol Neurosurg. 2020;194:105921. [Crossref] [PubMed] [PMC]
- Rahimi K. Guillain-Barre syndrome during COVID-19 pandemic: an overview of the reports. Neurol Sci. 2020;41:3149-56. [Crossref] [PubMed] [PMC]
- Aladawi M, Elfil M, Abu-Esheh B, et al. Guillain Barre syndrome as a complication of COVID-19: a systematic review. Can J Neurol Sci. 2022;49:38-48. [Crossref] [PubMed] [PMC]
- Trujillo Gittermann LM, Valenzuela Feris SN, von Oetinger Giacoman A. Relation between COVID-19 and Guillain-Barré syndrome in adults. Systematic review. Neurologia (Engl Ed). 2020;35:646-54. [Crossref] [PubMed] [PMC]
- Fletman EW, Stumpf N, Kalimullah J, et al. Guillain-Barré syndrome associated with COVID-19: an atypical, late-onset presentation. Neurol Sci. 2021;42:4393-5. [Crossref] [PubMed] [PMC]
- Cao-Lormeau VM, Blake A, Mons S, et al. Guillain-Barré syndrome outbreak associated with Zika virus infection in French Polynesia: a case-control study. Lancet. 2016;387:1531-9. [Crossref] [PubMed] [PMC]
- Cappello F, Gammazza AM, Dieli F, et al. Does SARS-CoV-2 trigger stress-inducedautoimmunity by molecular mimicry? A hypothesis. J Clin Med. 2020;9:2038. [Crossref] [PubMed] [PMC]
- Needham EJ, Chou SH, Coles AJ, et al. Neurological implications of COVID-19 infections. Neurocrit Care. 2020;32:667-71. [Crossref] [PubMed] [PMC]
- Lucchese G, Flöel A. SARS-CoV-2 and Guillain-Barré syndrome: molecular mimicry with human heat shock proteins as potential pathogenic mechanism. Cell Stress Chaperones. 2020;25:731-5. [Crossref] [PubMed] [PMC]
- Dufour C, Co TK, Liu A. GM1 ganglioside antibody and COVID-19 related Guillain Barre ayndrome-a case report, systemic review and implication for vaccine development. Brain Behav Immun Health. 2021;12:100203. [Crossref] [PubMed] [PMC]
- Hussain FS, Eldeeb MA, Blackmore D, et al. Guillain Barré syndrome and COVID-19: possible role of the cytokine storm. Autoimmun Rev. 2020;19:102681. [Crossref] [PubMed] [PMC]
- Thepmankorn P, Bach J, Lasfar A, et al. Cytokine storm induced by SARS-CoV-2 infection: the spectrum of its neurological manifestations. Cytokine. 2021;138:155404. [Crossref] [PubMed] [PMC]
- Garcia MA, Barreras PV, Lewis A, et al. Cerebrospinal fluid in COVID-19 neurological complications: no cytokine storm or neuroinflammation. medRxiv. 2021;16:636-734. [Crossref] [PubMed] [PMC]
- Shoraka S, Ferreira MLB, Mohebbi SR, et al. SARS-CoV-2 infection and Guillain-Barré syndrome: a review on potential pathogenic mechanisms. Front Immunol. 2021;12:674922. [Crossref] [PubMed] [PMC]
- Zhou Z, Kang H, Li S, et al. Understanding the neurotropic characteristics of SARS-CoV-2: from neurological manifestations of COVID-19 to potential neurotropic mechanisms. J Neurol. 2020;267:2179-84. [Crossref] [PubMed] [PMC]
- Zhao H, Shen D, Zhou H, et al. Guillain-Barré syndrome associated with SARS-CoV-2 infection: causality or coincidence? Lancet Neurol. 2020;19:383-4. [Crossref] [PubMed] [PMC]
- Carod-Artal FJ. Neurological complications of coronavirus and COVID-19. Rev Neurol. 2020;70:311-22. [Crossref] [PubMed]
- Sedaghat Z, Karimi N. Guillain Barre syndrome associated with COVID-19 infection: a case report. J Clin Neurosci. 2020;76:233-5. [Crossref] [PubMed] [PMC]
- Helms J, Kremer S, Merdji H, et al. Neurologic features in severe SARS-CoV-2 infection. N Engl J Med. 2020;382:2268-70. [Crossref] [PubMed] [PMC]
- Toscano G, Palmerini F, Ravaglia S, et al. Guillain-Barré syndrome associated with SARS-CoV-2. N Engl J Med. 2020;382(26):2574-6. [Crossref] [PubMed] [PMC]
- Abu-Rumeileh S, Abdelhak A, Foschi M, et al. Guillain-Barré syndrome spectrum associated with COVID-19: an up-to-date systematic review of 73 cases. J Neurol. 2021;268(4):1133-70. [Crossref] [PubMed] [PMC]
- Mehta P, McAuley DF, Brown M, et al; HLH Across Speciality Collaboration, UK. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020;395:1033-4. [Crossref] [PubMed] [PMC]
- Abbaspour N, Hurrell R, Kelishadi R. Review on iron and its importance for human health. J Res Med Sci. 2014;19:164-74. [PubMed] [PMC]
- American Diabetes Association [Internet]. 1995-2022. American Diabetes Association®. [Cited: May 22, 2020]. How COVID-19 Impacts People with Diabetes. Available from: [Link]
- Paterson RW, Brown RL, Benjamin L, et al. The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings. Brain. 2020;143:3104-20. [PubMed] [PMC]
- Raahimi MM, Kane A, Moore CE, et al. Late onset of Guillain-Barré syndrome following SARS-CoV-2 infection: part of 'long COVID-19 syndrome'? BMJ Case Rep. 2021;14:e240178. [Crossref] [PubMed] [PMC]
- Milovanovic B, Djajic V, Bajic D, et al. Assessment of autonomic nervous system dysfunction in the early phase of infection with SARS-CoV-2 Virus. Front Neurosci. 2021;15:640835. [Crossref] [PubMed] [PMC]