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Post COVID-19 Guillain–Barre syndrome presents as sensory dominant neuropathy with reversible conduction failure

Abdulrahman M. AlTahan, Mohammed H. AlAnazi, Faisal A. AlTahan and Fatima A. AlAbandi
Neurosciences Journal January 2023, 28 (1) 57-61; DOI: https://doi.org/10.17712/nsj.2023.1.20220057

Article Figures & Data

Figures

  • Figure 1
    Figure 1

    - Sequential CMAPs studies. Serial NCS on weeks 1, 4, and 24 showed gradual recovery of motor DLs; Median nerve: 8.6, 5.7, and 3.4 ms. Ulnar nerve: 5.5, 4.2, and 2.9 ms. Common Peroneal nerve: 10, 9.2, and 5 ms. Also show gradual recovery of CMAP amplitude at weeks 1, 4, and 24; Median nerve: 9.9, 12.7, and 14.8 mv, ulnar nerve: 5.7, 10.4, and 12 mv, common peroneal nerve: 1.6, 4 and 8.3 mv. CMAP - compound muscle action potential. DL - distal latency, ms - milli-second, mv - milli-volt

  • Figure 2
    Figure 2

    - Sequential sensory nerve action potentials studies. Serial NCS on weeks 1,4 and 24 showing mild changes in sensory OLs; Median nerve: 3, 2.4, and 2 ms. Ulnar nerve: 2.2, 2.4, and 2.1 ms. Sural nerve: 3, 3, and 3 ms. But SNAPs amplitude recovery at weeks 1, 4, and 24 was significant in upper limbs; Median nerve: 5, 15, and 36 µv. Ulnar nerve: 13,15 and 44 µv. Sural nerve: 29, 18, and 17 µv. SNAP - sensory nerve action potential. OL - onset latency, ms - milli-second, µv - micro-volt

Tables

  • Table 1

    - Timeline of the patient’s clinical condition.

    Dates
    16/07/21Positive PCR test for COVID-19 virus, a few days after the onset of a feverish illness.
    05/08/2021Presented with a 1-week history of severe sensory symptoms and walking difficulty. NCS results were consistent with a diagnosis of Guillan-Barre Syndrome.
    11/8/2021Admitted to hospital: CSF showed Cyto-albuminologic dissociation consistent with Guillan-Barre Syndrome. Started IV Immunoglobulin 5 days course.
    19/8/2021Follow-up: improved symptoms.
    09/09/21Follow-up: almost full clinical recovery. NCS: showed significant recovery of distal latencies and CMAP amplitude without temporal dispersion, consistent with conduction reversible failure.
    28/01/22NCS: showed almost full recovery of different parameters without temporal dispersion, consistent with conduction reversible failure and probable axonal GBS.

    NCS - nerve conduction study, CMAPs - compound motor action potentials, GBS - Guillain–Barre syndrome, CSF - Cerebrospinal fluid, PCR - Polymerase chain reaction

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