Department of Neurology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels, Belgium.
Department of Neurology, Cliniques de l'Europe, Avenue de Fré 206, 1180, Brussels, Belgium.
Acta Neurol Belg. 2022 Jun;122(3):703-707. doi: 10.1007/s13760-021-01787-y. Epub 2021 Sep 2.
A growing number of Guillain-Barré syndrome (GBS) and Miller Fisher Syndrome (MFS) cases following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are reported. Nevertheless, this association is still debated, and pathophysiology remains unclear.
Between April and December 2020, in three hospitals located in Brussels, Belgium, we examined four patients with GBS following SARS-CoV-2 infection.
Neurological onset occurred 3 weeks after SARS-CoV-2 symptoms in all patients. Three patients presented with acute inflammatory demyelinating polyneuropathy (AIDP) and had negative anti-ganglioside testing: two suffered from a severe SARS-CoV-2 infection and had good clinical outcome after intravenous immunoglobulin (IVIG) treatment; one with mild SARS-CoV-2 infection had spontaneously favorable evolution without treatment. The fourth patient had critical SARS-CoV-2 infection and presented acute motor and sensory axonal neuropathy (AMSAN) with clinical features highly suggestive of brainstem involvement, as well as positive anti-ganglioside antibodies (anti-GD1b IgG) and had partial improvement after IVIG.
We report four cases of SARS-CoV-2-associated GBS. The interval of 3 weeks between SARS-CoV-2 symptoms and neurological onset, the clinical improvement after IVIG administration, and the presence of positive anti-ganglioside antibodies in one patient further support the hypothesis of an immune-mediated post-infectious process. Systematic extensive antibody testing might help for a better understanding of physiopathology.
越来越多的严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 感染后出现格林-巴利综合征 (GBS) 和米勒-费舍尔综合征 (MFS) 病例。然而，这种关联仍存在争议，病理生理学仍不清楚。
在 2020 年 4 月至 12 月期间，我们在比利时布鲁塞尔的三家医院检查了 4 例 SARS-CoV-2 感染后发生的 GBS 患者。
所有患者的神经发病均发生在 SARS-CoV-2 症状后 3 周。3 名患者表现为急性炎症性脱髓鞘性多发性神经病 (AIDP)，抗神经节苷脂检测阴性：2 名患者患有严重 SARS-CoV-2 感染，静脉注射免疫球蛋白 (IVIG) 治疗后临床结局良好；1 名 SARS-CoV-2 感染较轻的患者自行出现良好的演变，无需治疗。第 4 名患者患有严重 SARS-CoV-2 感染，表现为急性运动和感觉轴索性神经病 (AMSAN)，具有高度提示脑干受累的临床特征，以及阳性抗神经节苷脂抗体 (抗-GD1b IgG)，IVIG 治疗后部分改善。
我们报告了 4 例 SARS-CoV-2 相关 GBS 病例。SARS-CoV-2 症状与神经发病之间 3 周的间隔、IVIG 给药后的临床改善以及 1 名患者存在阳性抗神经节苷脂抗体进一步支持了免疫介导的感染后过程的假说。系统的广泛抗体检测可能有助于更好地了解病理生理学。
