Guillain–Barré syndrome associated with leptomeningeal enhancement following SARS-CoV-2 infection

• Published in: Clinical medicine (London, England) Vol. 20; no. 4; pp. e93 - e94
• Main Authors: Sancho-Saldaña, Agustín, Lambea-Gil, Álvaro, Liesa, Jose Luis Capablo, Caballo, Maria Rosario Barrena, Garay, Maria Haddad, Celada, David Rivero, Serrano-Ponz, Marta
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-07-2020; Royal College of Physicians
• Subjects: Axis, Cervical Vertebra; Betacoronavirus; Brain Stem - diagnostic imaging; coronavirus; Coronavirus Infections - complications; Coronaviruses; COVID-19; COVID-19 rapid report; Female; Guillain-Barre syndrome; Guillain-Barre Syndrome - cerebrospinal fluid; Guillain-Barre Syndrome - diagnostic imaging; Guillain-Barre Syndrome - virology; Guillain–Barré syndrome; Humans; leptomeningeal enhancement; Magnetic Resonance Imaging; Middle Aged; Middle East respiratory syndrome; Neural Conduction; Pandemics; Pneumonia, Viral - complications; Respiratory diseases; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Spinal Cord - diagnostic imaging; Middle East; China; COVID-19; Guillain–Barré syndrome; coronavirus; SARS-CoV-2; leptomeningeal enhancement
• ISSN: 1470-2118; 1473-4893
• DOI: 10.7861/clinmed.2020-0213

Patients with coronavirus disease 2019 (COVID-19) typically present with respiratory symptoms, but little is known about the disease's potential neurological complications.
We report a case of Guillain–Barré syndrome (GBS) following a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, in association with leptomeningeal enhancement.
A 56-year-old woman presented with recent unsteadiness and paraesthesia in both hands. Fifteen days earlier, she complained of fever, dry cough and shortness of breath. Her chest X-ray showed a lobar consolidation and PCR was positive for SARS-CoV-2; she was admitted due to mild COVID-19 pneumonia.
In the first 48 hours of hospitalisation, she started to experience lumbar pain and weakness of the proximal lower extremities, progressing to bilateral facial nerve palsy, oropharyngeal weakness and severe proximal tetraparesis with cervical flexion 2/5 on the MRC scale. Full spine magnetic resonance imaging (MRI) showed a brainstem and cervical leptomeningeal enhancement. Analysis of cerebrospinal fluid (CSF) revealed albumin–cytological dissociation. Microbiological studies on CSF, including SARS-CoV-2, were negative. Nerve conduction studies were consistent with demyelinating neuropathy. She was treated with intravenous immunoglobulin, with significant neurological improvement noted over the next 2 weeks.
Leptomeningeal enhancement is an atypical feature in GBS, but could be a marker of its association with SARS-CoV-2 infection.