This 5 year old girl came to our hospital with fever and non specific myalgia 8 days back followed 3 days later by progressive ascending quadriparesis.
Her nerve conduction velocities were suggestive of an acute motor axonal neuropathy. However her nasopharyngeal swab for COVID 19 was positive.
What must we know about GBS associated with COVID 19?
Caress et al have reviewed 37 cases of GBS associated with COVID 19 published in literature so far.https://doi.org/10.1002/mus.27024
The time to onset of neurological symptoms after COVID 19 ranged from 3-28 days ( mean 11 days). It appears to be slightly more rapid than usual.
The vast majority (84%) were symptomatic with primary COVID symptoms during the GBS.
Interestingly facial diplegia was seen in almost a quarter of patients.
The requirement for ventilation was 37.8% slightly higher than the routine 20-30% in the garden variety of GBS. It may to some extent be explainable because of the associated respiratory involvement in SARS COV2 infection.
CSF PCR for SARS CoV 2 was negative in all the 18 in whom it was tested so a direct viral damage seems unlikely.
The COVID 19 virus attaches via the spike protein to the ACE 2 receptors and also to gangliosides containing silica acid residues.
So the hypothesis is that anti COVID antibodies in our bodies may inadvertently attack the gangliosides resulting in GBS. However antiganglioside antibodies have been seen in only 12% of the patients in whom they were tested.
Treatment has been mostly IVIG or PLEX. One must be careful with IVIG since their is an underlying hypercoagulable state in SARS CoV-2 infections. Most people would avoid PLEX because of the possibility of hemodynamic compromise.
The risk of GBS with the COVID19 vaccine also needs to be monitored.
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