Diagnosis Of Guillain-Barre Syndrome Research Articles

Cervical Myelopathy with Concomitant Guillain-Barré Syndrome: A Case Report.

We present a case of a 67-year-old female patient with concomitant cervical spondylotic myelopathy (CSM) and Guillain-Barré syndrome (GBS). Surgical intervention, including cervical decompression and arthrodesis, was performed to address cervical myelopathy symptoms. Despite initial improvement, the patient's motor function deteriorated, leading to the diagnosis of GBS. The patient's hospital course was protracted with a complicated recovery. This case emphasizes the clinical details of coexisting CSM and GBS, highlighting the importance of diagnosing and considering demyelinating diseases when determining the optimal timeline for surgical intervention. These findings inform decision-making for clinicians encountering similar patient presentations.

Sural nerve involvement in patients with acute inflammatory demyelinating polyneuropathy variant of Guillain-Barre syndrome with sural sparing at initial presentation

Introduction: Neurophysiological testing is a valuable tool in the diagnosis of Guillain-Barre syndrome (GBS). Sural sparing is a usual feature of acute inflammatory demyelinating polyneuropathy (AIDP) type GBS. However, sural involvement has been reported in later stages of GBS. It is important to identify patterns of sural nerve involvement to differentiate GBS from its mimickers and to stage the disease. This research aimed to detect the pattern of sural nerve involvement in AIDP-GBS cases with normal electrophysiological responses in the sural nerve at the beginning.Objectives: To determine the location and timing of sural nerve involvement in AIDP-GBS.Methods: This prospective follow up study included diagnosed cases of AIDP-GBS with preserved bilateral sural responses. Nerve conduction and somatosensory evoked potentials (SSEP) were done on admission and weekly thereafter for four consecutive weeks. The last evaluation was done four weeks after the fourth study.Results: All patients (100%) showed normal distal sural responses over the initial four weeks of follow up. They continued to remain normal up to eight weeks in eight patients (53.3%). Two patients had gradual prolongation of their sural SSEP on consecutive studies. One of them had gradual reduction of sural sensory nerve action potential and nerve conduction velocity along with the prolongation of sural SSEP latencies. The difference of SSEP latency increments in the left sural nerve of these two patients was statistically significant (p<0.05). The right sural SSEP latency difference was not significant.Conclusion: Sparing of the distal sural sensory response was demonstrated in 100% of AIDP-GBS cases during the first four weeks of follow up. More than 50% of the cohort demonstrated preserved sural sensory responses for eight weeks from the initial presentation. Two out of fifteen patients showed statistically significant proximal sural sensory pathway involvement with increasing SSEP latencies. This finding suggests that in some patients, the sural sensory pathway may get affected at its proximal segments or at the central nervous system before the distal nerve is affected.

Utility of cerebrospinal fluid protein biomarkers in predicting the outcome of Guillain-Barre syndrome

Objectives The study aimed to investigate the potential of peripheral myelin protein 2 (P2) and Alpha B-crystallin (αBC) as predictive biomarkers in Guillain-Barré syndrome (GBS). Given the unpredictability of GBS prognosis, the need for specific and reliable biomarkers for disease development and intensity assessment is crucial. Material and Methods A prospective observational study was conducted on a cohort of 220 individuals diagnosed with GBS at a tertiary general hospital in South India. P2 and αBC levels in cerebrospinal fluid (CSF) were quantified using ELISA assay kits. The study spanned from March 2021 to April 2023, with participants aged 18–60 years. The study protocol adhered to ethical standards, and the Brighton criteria were employed for GBS diagnosis. CSF samples were collected at admission and two weeks post-onset. Data analysis utilised SPSS, and statistical significance was set at p < 0.05. Results Upon admission, mean P2 levels were 2.2 ± 0.5 ng/mL, and αBC levels were 9.8 ± 2.3 ng/mL. After two weeks, P2 increased to 4.8 ± 0.8 ng/mL, and αBC increased to 15.1 ± 2.3 ng/mL. A positive correlation was observed between the rise in P2 and αBC levels and enhanced muscle strength at 4 weeks and 6 months. Conclusion The study suggests a significant increase in P2 and αBC levels in GBS patients, correlating with improved muscle strength. P2 and αBC ratios in CSF between the second and first weeks may serve as prognostic markers for GBS. Limitations include a small sample size and the absence of a control group, necessitating caution in generalizability.

Injudicious use of cranio-spinal imaging in Guillain-Barré syndrome in a low resource country.

Background: Many patients being investigated for Guillain-Barré syndrome (GBS) undergo unnecessary neuroimaging. The objective of this study was to determine the proportion of patients with GBS undergoing neuroimaging investigation, and to investigate any association with different GBS variants using the Brighton criteria. Methods: This cross-sectional observational study was conducted in the leading tertiary care hospital in Pakistan; 148 patients being investigated for, and subsequently diagnosed with GBS between January 2017 and March 2020 were enrolled. Participants were asked if they had undergone neuroimaging of the craniospinal axis before or during hospital admission, and the purpose of any computed tomography (CT) scan was investigated. We enquired whether fundoscopy had been performed before lumbar puncture (LP) and determined the level of certainty based on the Brighton criteria. Results: The majority of participants were men (n = 107, 73%), with a mean age of 42.85 ± 18.40 years. The mean waiting time to their first interaction with a neurologist was 5.20 ± 4.01 days, and the demyelinating variant of GBS was more common than the axonal variant (1.6:1). Most patients were diagnosed with level I certainty using the Brighton criteria (n = 113, 76%). Brain and spine magnetic resonance imaging (MRI) were performed ahead of admission in 48 (32%) and 59 (39%) patients, respectively. Brain CT scan was performed in 121 (82%) patients before LP, while 27 (18%) only underwent fundoscopic examination before LP. Conclusion: Clinical examination is fundamental in the diagnosis of GBS. Neuroimaging may be inappropriate and unnecessary, and may detract attention from crucial peripheral neuropathy measures while misusing limited resources.

DAMAGE TO THE PERIPHERAL NERVOUS SYSTEM IN COVID-19 INFECTION

The article provides information about damage to the peripheral nervous system during COVID-19 infection and clarifies the possible mechanisms of development. Also in modern medical literature, a large amount of data on neurological pathologies associated with COVID-19 - damage to the central and peripheral nervous system - has been reviewed and epidemiological indicators of these injuries have been analyzed. The role of immune disorders in the occurrence and further development of damage to the peripheral nervous system was assessed. Guillain-Barre syndrome (GBS), one of the rare neurological pathologies that develops due to COVID-19, is described. Literary data were analyzed to determine the clinical course of GBS and elucidate its probable autoimmune pathogenesis. A clinical observation of the development of GBS against the background of typical manifestations of COVID-19 in a 56-year-old male patient is presented. The interval from the first manifestations of COVID-19 to the manifestation of GBS was 13 days. The GBS that developed was severe, required invasive ventilation, and developed acute kidney injury. It is suggested that the information presented about the pathogenetic mechanism, clinical manifestations, diagnosis and treatment of GBS in patients may stimulate research towards bringing greater clarity to these issues.

Predictors of Treatment Outcome and Clinical Profile among Guillain- Barre Syndrome Patients in South India.

Guillain-Barre syndrome (GBS) is one of the principal causes of acute neuromuscular weakness and paralysis worldwide. Its clinic-epidemiological profile and factors influencing its treatment outcomes in developing countries are very minimally studied. The study aimed to find out the risk factors, clinical presentation, management, and predictors of treatment outcomes among GBS patients admitted in two tertiary care hospitals. Medical records of 121 inpatients with GBS confirmed based on the Brighton criteria over the recent five-year period from June 2017 to May 2022 were examined. Assessment of the severity of GBS was done using the Hughes functional grading scale. The mean age at onset was 36.8 ± 18.9 years. The majority of the patients [82 (67.8%)] were males. Antecedent illnesses within 1 month of onset of GBS were present among 34 (28.1%) patients. The majority of them developed respiratory tract illnesses [13 (38.2%)]. Recurrent history of GBS was observed among 4 (3.3%) patients. The median time gap between the onset of antecedent illnesses and the onset of GBS was 5 days (IQR 3, 10). The most common symptom among GBS patients was the weakness of the muscles of the extremities [117 (96.7%)]. The pattern of progression of weakness among 53 (45.3%) of these patients was from the lower to upper limbs. The most common sign noted was hypotonia [64(52.9%)]. Complications due to GBS were observed among 12 (9.9%) patients. The most common complication among them was respiratory distress in 11 (91.7%) patients, followed by autonomic dysfunctions in 8 (66.7%). Albuminocytological dissociation in cerebrospinal fluid was noted among 48 (39.7%) patients. The majority of patients in nerve conduction studies had acute inflammatory demyelinating polyneuropathy [61(50.4%)]. The majority of the GBS patients [68 (56.2%)] were treated using intravenous immunoglobulin (IVIG). 95 (78.5%) patients improved with treatment at the time of discharge. In multivariable analysis, the absence of antecedent illnesses (p =0.029), Brighton's diagnostic certainty levels 1 and 2 of GBS (p =0.024), and being on IVIG treatment (p =0.05) were associated with improvement in disease condition among the patients. Appropriate diagnosis of GBS using both clinical and laboratory evidence and providing appropriate treatment along with more supervision among GBS patients with a history of antecedent illnesses will help improve their prognosis at the time of discharge.

Association Between Guillain-Barré Syndrome and COVID-19 Infection and Vaccination: A Population-Based Nested Case-Control Study.

Existing data regarding occurrence of Guillain-Barré syndrome (GBS) after coronavirus disease 2019 (COVID-19) infection and vaccination are inconclusive. We aimed to assess the association between GBS and both severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and COVID-19 vaccine. We conducted a nested case-control study in a cohort of 3,193,951 patients aged 16 years or older, without a diagnosis of prior GBS, from the largest health care provider in Israel. Participants were followed from January 1, 2021, until June 30, 2022, for the occurrence of GBS. Ten randomly selected controls were matched to each case of GBS on age and sex. We assessed both SARS-CoV-2 infection and COVID-19 vaccine administration in the prior 6 weeks in cases and controls. Overall, 76 patients were diagnosed with GBS during follow-up and were matched to 760 controls. A positive test for SARS-CoV-2 was detected in 9 (11.8%) cases and 18 (2.4%) controls. An administration of COVID-19 vaccine was detected in 8 (10.5%) cases (all Pfizer-BioNTech [BNT162b2] vaccine) and 136 (17.9%) controls (134 Pfizer-BioNTech vaccine). Multivariable conditional logistic regression models showed that the odds ratio for GBS associated with SARS-CoV-2 infection and COVID-19 vaccine administration was 6.30 (95% CI 2.55-15.56) and 0.41 (95% CI 0.17-0.96), respectively. The results were similar when exposure to SARS-CoV-2 infection or COVID-19 vaccine administration was ascertained in the prior 4 and 8 weeks, although did not reach statistical significance for COVID-19 vaccine at 4 weeks. Our study suggests that SARS-CoV-2 infection is associated with increased risk of GBS, whereas Pfizer-BioNTech COVID-19 vaccine is associated with decreased risk of GBS.

European Academy of Neurology/Peripheral Nerve Society Guideline on diagnosis and treatment of Guillain-Barré syndrome.

Guillain-Barré syndrome (GBS) is an acute polyradiculoneuropathy. Symptoms may vary greatly in presentation and severity. Besides weakness and sensory disturbances, patients may have cranial nerve involvement, respiratory insufficiency, autonomic dysfunction and pain. To develop an evidence-based guideline for the diagnosis and treatment of GBS, using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology, a Task Force (TF) of the European Academy of Neurology (EAN) and the Peripheral Nerve Society (PNS) constructed 14 Population/Intervention/Comparison/Outcome questions (PICOs) covering diagnosis, treatment and prognosis of GBS, which guided the literature search. Data were extracted and summarised in GRADE Summaries of Findings (for treatment PICOs) or Evidence Tables (for diagnostic and prognostic PICOs). Statements were prepared according to GRADE Evidence-to-Decision (EtD) frameworks. For the six intervention PICOs, evidence-based recommendations are made. For other PICOs, good practice points (GPPs) are formulated. For diagnosis, the principal GPPs are: GBS is more likely if there is a history of recent diarrhoea or respiratory infection; CSF examination is valuable, particularly when the diagnosis is less certain; electrodiagnostic testing is advised to support the diagnosis; testing for anti-ganglioside antibodies is of limited clinical value in most patients with typical motor-sensory GBS, but anti-GQ1b antibody testing should be considered when Miller Fisher syndrome (MFS) is suspected; nodal-paranodal antibodies should be tested when autoimmune nodopathy is suspected; MRI or ultrasound imaging should be considered in atypical cases; and changing the diagnosis to acute-onset chronic inflammatory demyelinating polyradiculoneuropathy (A-CIDP) should be considered if progression continues after 8 weeks from onset, which occurs in around 5% of patients initially diagnosed with GBS. For treatment, the TF recommends intravenous immunoglobulin (IVIg) 0.4 g/kg for 5 days, in patients within 2 weeks (GPP also within 2-4 weeks) after onset of weakness if unable to walk unaided, or a course of plasma exchange (PE) 12-15 L in four to five exchanges over 1-2 weeks, in patients within 4 weeks after onset of weakness if unable to walk unaided. The TF recommends against a second IVIg course in GBS patients with a poor prognosis; recommends against using oral corticosteroids, and weakly recommends against using IV corticosteroids; does not recommend PE followed immediately by IVIg; weakly recommends gabapentinoids, tricyclic antidepressants or carbamazepine for treatment of pain; does not recommend a specific treatment for fatigue. To estimate the prognosis of individual patients, the TF advises using the modified Erasmus GBS outcome score (mEGOS) to assess outcome, and the modified Erasmus GBS Respiratory Insufficiency Score (mEGRIS) to assess the risk of requiring artificial ventilation. Based on the PICOs, available literature and additional discussions, we provide flow charts to assist making clinical decisions on diagnosis, treatment and the need for intensive care unit admission.

European Academy of Neurology/Peripheral Nerve Society Guideline on diagnosis and treatment of Guillain-Barré syndrome.

Guillain-Barré syndrome (GBS) is an acute polyradiculoneuropathy. Symptoms may vary greatly in presentation and severity. Besides weakness and sensory disturbances, patients may have cranial nerve involvement, respiratory insufficiency, autonomic dysfunction and pain. To develop an evidence-based guideline for the diagnosis and treatment of GBS, using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology a Task Force (TF) of the European Academy of Neurology (EAN) and the Peripheral Nerve Society (PNS) constructed 14 Population/Intervention/Comparison/Outcome questions (PICOs) covering diagnosis, treatment and prognosis of GBS, which guided the literature search. Data were extracted and summarised in GRADE Summaries of Findings (for treatment PICOs) or Evidence Tables (for diagnostic and prognostic PICOs). Statements were prepared according to GRADE Evidence-to-Decision (EtD) frameworks. For the six intervention PICOs, evidence-based recommendations are made. For other PICOs, good practice points (GPPs) are formulated. For diagnosis, the principal GPPs are: GBS is more likely if there is a history of recent diarrhoea or respiratory infection; CSF examination is valuable, particularly when the diagnosis is less certain; electrodiagnostic testing is advised to support the diagnosis; testing for anti-ganglioside antibodies is of limited clinical value in most patients with typical motor-sensory GBS, but anti-GQ1b antibody testing should be considered when Miller Fisher syndrome (MFS) is suspected; nodal-paranodal antibodies should be tested when autoimmune nodopathy is suspected; MRI or ultrasound imaging should be considered in atypical cases; and changing the diagnosis to acute-onset chronic inflammatory demyelinating polyradiculoneuropathy (A-CIDP) should be considered if progression continues after 8 weeks from onset, which occurs in around 5% of patients initially diagnosed with GBS. For treatment, the TF recommends intravenous immunoglobulin (IVIg) 0.4 g/kg for 5 days, in patients within 2 weeks (GPP also within 2-4 weeks) after onset of weakness if unable to walk unaided, or a course of plasma exchange (PE) 12-15 L in four to five exchanges over 1-2 weeks, in patients within 4 weeks after onset of weakness if unable to walk unaided. The TF recommends against a second IVIg course in GBS patients with a poor prognosis; recommends against using oral corticosteroids, and weakly recommends against using IV corticosteroids; does not recommend PE followed immediately by IVIg; weakly recommends gabapentinoids, tricyclic antidepressants or carbamazepine for treatment of pain; does not recommend a specific treatment for fatigue. To estimate the prognosis of individual patients, the TF advises using the modified Erasmus GBS outcome score (mEGOS) to assess outcome, and the modified Erasmus GBS Respiratory Insufficiency Score (mEGRIS) to assess the risk of requiring artificial ventilation. Based on the PICOs, available literature and additional discussions, we provide flow charts to assist making clinical decisions on diagnosis, treatment and the need for intensive care unit admission.

Case study of Guillain-Barré syndrome with acute flaccid paralysis

Guillain-Barre syndrome (GBS) is a sudden and a complicated degenerative neurological disorder which can be acute or chronic in nature. Etiology remains unclear, but pathophysiology shows demyelination of spinal nerve roots characterised by symmetrical limb weakness and muscle stiffness. Death is rare. Early diagnosis and prompt treatment should occur in severe cases. Here we discuss a rare case of GBS as paraesthesia and acute flaccid paralysis. This case report focuses on a 9-year-old male patient presenting with c/o progressive muscle weakness and paraesthesia in the lower extremities. The clinical examination revealed bilateral lower limb weakness, absent deep tendon reflexes, and diminished vibration sense, acute flaccid paralysis. Diagnostic evaluations of CT scan of brain and spine and other preliminary tests confirmed the diagnosis of GBS by demonstrating characteristic findings of demyelinating polyneuropathy and elevated protein levels without pleocytosis, respectively. Prompt initiation of intravenous immunoglobulin therapy and supportive measures, such as physical therapy, were implemented. Over a four-week period, the patient showed progressive improvement in muscle strength, starting from the slight movement in fingers and toes. This case report underscores the importance of accurate diagnosis, and timely initiation of appropriate treatment strategies in managing GBS, highlighting the efficacy of intravenous immunoglobulin therapy as a first-line intervention for GBS patients.

Vaccine patterns among patients diagnosed with Guillain-Barré Syndrome and matched counterparts in a Medicare supplemental population, 2000–2020

Some vaccines have a small risk of Guillain-Barré Syndrome (GBS), a rare autoimmune disorder characterized by paralysis if untreated. The CDC’s Advisory Committee on Immunization Practices (ACIP) guidelines do not consider GBS a precaution for future vaccines unless GBS developed within six weeks after a tetanus-toxoid–containing vaccine or influenza vaccine. Our goal was to describe vaccine patterns before and after GBS diagnosis. We matched each of 709 patients diagnosed with GBS from 2002 to 2020 with Medicare supplemental insurance to 10 counterparts without GBS (1:10) on age and sex. Propensity score-based weighting balanced covariates between groups, and we estimated weighted mean cumulative counts (wMCC) of vaccines/person before and after GBS diagnosis. Among patients with GBS, 7% were diagnosed within 42 days after a vaccine. Prior to GBS diagnosis, the wMCC of vaccines per person was similar between GBS cases and matched counterparts, but after two years of follow-up, GBS patients received 21 fewer vaccines/100 people than counterparts (wMCC difference −0.21 vaccines/person, 95% CI −0.24 to −0.18); GBS patients received 16 vaccines/100 people while matched counterparts received 36/100. Vaccine use was reduced following GBS diagnosis despite no ACIP precaution for most (93%) patients in this study. The observed drop in vaccines after GBS diagnosis indicates a disconnect between clinical practice and current recommendations.

Guillain-Barre Syndrome Mimicked by Spinal Stenosis in A Case of Chronic Prolapsed Intervertebral Disc: A Case Report

Background: Guillain-Barre Syndrome (GBS) is a rare acute autoimmune polyneuropathy, usually preceded by infections. It can be difficult to diagnose, especially in patients with underlying neurological comorbidities. Case: A 54-year-old male, with a long history of a prolapsed intervertebral disc, presented with progressive and asymmetrical onset tetraparesthesia for 4 weeks, which was associated with progressive paraparesis for 2 weeks. The diagnosis of GBS was initially missed due to a lack of relevant history of prior infection, atypical presentation (asymmetrical limb weakness), and radiological evidence of spinal stenosis. Nerve conduction study, cerebrospinal fluid analysis, and antiganglioside antibodies later confirmed the diagnosis of GBS. The patient was started on intravenous immunoglobulin and achieved significant improvement. He was discharged a week later and transferred to a rehabilitation hospital. Conclusion: GBS should not be excluded prior to diagnostic tests and lab work in neurological patients. Physicians should avoid over-reliance on radiological findings to conclude a diagnosis. Comprehensive history and examinations to understand the development of patients' presentations should be prioritized when establishing a diagnosis.

Neuropathic Tremor in Guillain-Barré Syndrome.

Neuropathic Tremor (NT) is a postural/kinetic tremor of the upper extremity, often encountered in patients with chronic neuropathies such as paraprotein-associated and hereditary neuropathies. To describe the clinical and electrophysiological features of NT in a previously underrecognized setting- during recovery from Guillain-Barré Syndrome (GBS). Patients with a documented diagnosis of GBS in the past, presenting with tremor were identified from review of clinical records. Participants underwent structured, videotaped neurological examination, and electrophysiological analysis using tri-axial accelerometry-surface electromyography. Tremor severity was assessed using the Fahn-Tolosa-Marin Tremor Rating Scale. We describe the clinical and electrophysiological features of 5 patients with GBS associated NT. Our cohort had a fine, fast, and slightly jerky postural tremor of frequency ranging from 8 to 10 Hz. Dystonic posturing and overflow movements were noted in 4/5 patients. Tremor appeared 3 months-5 years after the onset of GBS, when patients had regained near normal muscle strength and deep tendon jerks were well elicitable. Electrophysiological analysis of tremor strongly suggested the presence of a central oscillator in all patients. NT is not limited to chronic inflammatory or hereditary neuropathies and may occur in the recovery phase of GBS. The tremor is characterized by a high frequency, jerky postural tremor with dystonic posturing. Electrophysiological evaluation suggests the presence of a central oscillator, hypothetically the cerebellum driven by impaired sensorimotor feedback.

Sympathetic skin response (SSR) in pediatric Guillain-Barré syndrome.

In the present study, sympathetic skin response (SSR) characteristics were explored in children with Guillain-Barré syndrome (GBS) and the value of early diagnosis and prognostic evaluation in GBS complicated by autonomic dysfunction (AD) was evaluated. A total of 25 children with GBS and 30 healthy controls (HCs) were enrolled in this prospective study. SSR findings for the two groups were compared. SSR and nerve conduction study (NCS) results were compared among patients with GBS, and differences in clinical characteristics between the groups with abnormal and normal SSR were analyzed. Within the GBS group, six patients (24%) required mechanical ventilation, 17 patients (66.7%) had AD, 18 patients (72%) had an abnormal SSR, and 13 patients (52%) had AD combined with SSR abnormalities. There was a statistically significant difference in SSR latency in the lower limbs between the GBS group and HCs (P < 0.05). There was no statistically significant difference between SSR and NCS results in the acute phase of GBS (P > 0.05), and there was no significant difference in the rate of AD or in Hughes functional grade at nadir between the groups with abnormal and normal SSR (P>0.05). However, there was a statistically significant difference between the results of SSR and NCS tests during the recovery phase (P = 0.003). Abnormal SSR mainly occurred in cases of the acute inflammatory demyelinating polyradiculoneuropathy (AIDP) subtype. In addition, SSR was abnormal in all pediatric GBS patients with poor prognosis 1 month after onset of symptoms. Two-thirds of the children with GBS have AD. SSR could be used for early diagnosis and follow-up of GBS and may also be helpful in evaluating disease severity and short-term prognosis.

Assessment of the relationship between COVID -19 and Guillain Barre syndrome: a single center pandemic experience

Background &amp; Objective: This study aimed to determine the relationship between COVID-19 infection/ vaccination and Guillain-Barré syndrome (GBS) and to compare clinical characteristics and functional outcomes between COVID-19-related and non-COVID-19 GBS patients. Method: The medical files of the patients who sought treatment with the diagnosis of GBS between March 2020 and July 2022 were retrospectively analyzed. The patients were divided into groups as COVID-19-related GBS (C-GBS) and non-COVID-19 GBS (NC-GBS). Demographic and clinical characteristics, neurological examination findings, treatment protocols, and outcomes, including functional status, ambulation level, independence in daily living activities, and anxiety-depression levels of the patients with GBS, were recorded. Results: A total of 25 patients were included in the study. GBS was found to be associated with COVID-19 in 9 (36%) patients. Among them, 5 (20%) patients developed GBS after COVID-19 infection and 4 (16%) after the COVID-19 vaccine. The latency between COVID-19 infection and the onset of GBS ranged from 7 to 60 days, and the latency between vaccination and the onset of GBS ranged from 3 to 60 days. The clinical presentation and features, disease severity, and electrodiagnostic patterns of C-GBS patients were similar to NC-GBS patients. Also, there was no significant difference between patients with C-GBS and NC-GBS regarding functional status, ambulation level, functional independence in daily activities, and anxiety-depression levels. Conclusion: GBS is not uncommon in COVID-19. In this study, 20% of GBS cases admitted to our hospital during the pandemic seem to be associated with COVID-19 infection and 16% with COVID-19 vaccination. However, clinical features and functional outcomes of C-GBS and NC-GBS cases are similar.

Особливості маніфестації неврологічних симптомів гострих полінейропатій та їх диференційна діагностика в дітей при коронавірусній хворобі (COVID-19)

The relevance of the problem of diagnosis and treatment of polyneuropathy in children is due to the diverse clinical manifestations of this pathology, which are often acute and can lead to severe, life-threatening complications. Guillain-Barré syndrome (GBS) refers to acute or subacute, often post-infectious, immune-mediated polyneuropathies accompanied by axonal damage to nerve trunks and peripheral nerves. The present study is devoted to the assessment of neurological symptoms in the acute course of GBS, including its differential diagnosis with musculoskeletal lesions in coronavirus disease (COVID-19) in childhood. Purpose - to determine the features of the debut and characterize the neurological symptoms of acute polyneuropathies in children, including GBS in COVID-19. Materials and methods. We examined 10 children with confirmed GBS. Clinical-anamnestic, general clinical, clinical-neurological, clinical-instrumental and clinical-laboratory methods of examination were used. Results. In 1 of the examined patients aged 6 years, GBS developed in the acute period of COVID-19 and manifested as acute flaccid paresis in the distal, and after 4 days - severe weakness of the thigh muscles in combination with leg pain. In 8 of the examined patients, the debut of GBS occurred within 7-21 days after an acute respiratory viral infection. Of these, 6 children had the acute phase of COVID-19 14-21 days before the onset of GBS, which was confirmed by the results of an oropharyngeal PCR-test. The acute phase of COVID-19 in these patients was manifested by fever up to 38.0º, ague, hyposmia, lasting from 3 to 5 days. Severe pain in the legs was noted in all patients with GBS. The absence of elevated levels of creatine phosphokinase, alanine aminotransferase, aspartate aminotransferase according to biochemical blood tests in patients and the absence of myoglobin in the urine excluded rhabdomyolysis of skeletal muscles. Electroneuromyography (ENMG) confirmed the neural type of lesion in the legs. Conclusions. In most patients, the debut of GBS occurred 3 weeks after the acute phase of COVID-19. Pain syndrome and symmetrical flaccid paresis were the leading symptoms of the course of GBS in children. Reduced excitation conduction velocity along the motor fibres of the tibial and peroneal nerves, according to the results of ENMG, allowed confirming the diagnosis of GBS. Differential diagnosis of GBS with musculoskeletal lesions, in particular, the exclusion of the diagnosis of rhabdomyolysis in COVID-19 in children, allowed for timely prescription of adequate therapy. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Evidence of Lumbosacral Plexus Involvement on MR Neurography in Early Guillain-Barré Syndrome (P14-8.015)

<h3>Objective:</h3> To describe a case of early Guillain-Barré Syndrome (GBS) with novel findings of lumbosacral plexus involvement on MR neurography. <h3>Background:</h3> GBS is an acute inflammatory polyradiculoneuropathy characterized by progressive sensory loss, weakness, areflexia, CSF albumino-cytologic dissociation and cauda equina enhancement on MRI. Diagnosis of early GBS can be challenging, as CSF and electrodiagnostic studies can be normal/non-diagnostic in the first 1–2 weeks. We describe a case of early GBS with cauda equina enhancement and lumbosacral plexus abnormalities on MR neurography, seen only three days after symptoms onset and before any diagnostic abnormalities in CSF or electrodiagnostic testing were detected. <h3>Design/Methods:</h3> NA <h3>Results:</h3> A 67-year-old man presented with a 3-day history of rapidly progressive gait instability and leg weakness, 14 days after an uncomplicated L5-S1 fusion. Diffuse arm and leg weakness, distal leg sensory loss, hypoactive arm reflexes and absent leg reflexes were detected on exam. CSF analysis showed normal cells and protein (55mg/dL, reference&lt;60mg/dl). Electrodiagnostic testing showed mildly prolonged F-response latencies of the median and ulnar nerves, absent peroneal F-response, normal tibial F-response latency and absent tibial H-responses, without other findings suggestive of demyelination, and normal needle EMG. Lumbar spine MRI showed enhancement of ventrally positioned nerve roots of the cauda equina and no central or foraminal stenosis. Lumbosacral plexus MR neurography showed prominent enlargement, hyperintensity and enhancement of bilateral lower lumbosacral nerve roots and the proximal sciatic nerves. Plasma exchange was initiated with subsequent improvement in his symptoms and exam findings. <h3>Conclusions:</h3> Diagnosis of early GBS can be challenging, as CSF and electrodiagnostic testing can be normal/non-diagnostic. MRI and MR neurography are useful surrogate tests which may have greater sensitivity in detecting early GBS compared to CSF and electrodiagnostic testing. Involvement of the lumbosacral plexus by imaging is a novel finding, which can further assist in diagnosing early GBS cases. <b>Disclosure:</b> Dr. Weng has nothing to disclose. The institution of Darryl Sneag, 12603 has received research support from GE Healthcare. Dr. Pavlakis has nothing to disclose.

Guillain-Barré Syndrome Following Primary Cytomegalovirus Infection in a Patient with Liver Transplantation: a Case Report (P10-5.002)

<h3>Objective:</h3> To report the case of a patient who underwent liver transplantation and developed Guillain-Barré syndrome (GBS) as a result of primary cytomegalovirus (CMV) infection. <h3>Background:</h3> GBS is the most common etiology of paralysis worldwide and it is an autoimmune-mediated neuropathy that is frequently caused by a preceding infection. Although the relationship between CMV and GBS is well known, only about 4% of cases are specifically attributable to this infection. Likewise, few cases of GBS have been reported in the context of liver transplant recipients, and in the majority of cases, it is not ascribable to the CMV infection. <h3>Design/Methods:</h3> Not applicable. <h3>Results:</h3> A 66-year-old male patient with a 5-month medical history of liver transplantation secondary to hepatocellular carcinoma, is seen in the emergency room with a progressive ascending limb weakness and foot dysesthesias for the past eight days. Interestingly, three days before the onset of the symptoms, he presented a self-resolved gastrointestinal infection. Neurological examination revealed decreased strength and areflexia in all extremities, especially in the lower limbs. Nerve conduction studies and electromyography showed an acute inflammatory demyelinating polyneuropathy (AIDP) consistent with the diagnosis of GBS. Lumbar puncture ruled out any potential neuro infections and revealed the typical albuminocytologic dissociation. Additionally, a FilmArray panel was negative for other gastrointestinal pathogens. However, a significant CMV serum viral load indicated an active infection. Therapy with IV immunoglobulin and valganciclovir was started, with symptoms considerably improving after five days. <h3>Conclusions:</h3> GBS can be a rare complication after solid organ transplantation. Although post-transplant immunosuppression is known to increase the likelihood of contracting CMV opportunistic infections, GBS has not been frequently linked to this condition. Also, to our knowledge, this is one of few reports where it occurs after a primary CMV infection in the context of a liver transplant recipient, while other frequent etiologies were ruled out. <b>Disclosure:</b> Dr. Toro has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Watch Neurology . Dr. Gaitan Alfonso has nothing to disclose. Thomas Medina has nothing to disclose. Dr. Reyes has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck. Dr. Reyes has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Reyes has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for BIIB. Dr. Reyes has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Merck. Dr. Reyes has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Novartis. Dr. Reyes has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Biogen.

Predictors of Mechanical Ventilation Among 1960 Obese Patients Admitted With Guillain-Barré syndrome in the United States (P12-8.015)

<h3>Objective:</h3> To understand the impact of obesity on the need for mechanical ventilation following admission for Guillain-Barré syndrome (GBS) and the associated risk of mortality. <h3>Background:</h3> Obesity is a fast-growing risk factor predisposing to many complications. Its impact on the outcomes of GBS patients has not been properly reported in the literature. <h3>Design/Methods:</h3> Obese patients with a principal diagnosis of GBS were pooled from the 2019 National Inpatient Sample. Logistic regression models, adjusting for confounders, were used to identify potential risk factors for requiring mechanical ventilation and overall mortality risk. <h3>Results:</h3> A total of 1960 obese patients with GBS were admitted in 2019, and 240 (12.2%) required mechanical ventilation. Arthropathies (aOR 4.876, 95% CI 2.582–9.206, p&lt;0.01), chronic pulmonary disease (aOR 2.223, 95% CI 1.505–3.283, p&lt;0.01), acute kidney injury (aOR 6.068, 95% CI 4.047–9.097, p&lt;0.01), ventricular tachycardia (aOR 3.401, 95% CI 1.353–8.549, p&lt;0.01), and paroxysmal atrial fibrillation (aOR 8.176, 95% CI 4.608–14.505, p&lt;0.01) were potential risk factors for requiring mechanical ventilation. Meanwhile hypothyroidism (aoR 0.370, 95% CI 0.216–0.634, p&lt;0.01), diabetes (aOR 0.611, 95% CI 0.398–0.936, p=0.024), and patients covered by Medicaid (aOR 0.351, 95% CI 0.184–0.669, p&lt;0.01), or private insurances (aOR 0.557, 0.351–0.883, p=0.013) (compared to Medicare) were at lower risk. Obese GBS patients using mechanical ventilation also had a higher risk of death (10.4% vs. 0.9%, aOR 47.586, 95% CI 12.334–169.823, p&lt;0.01). <h3>Conclusions:</h3> Several factors influence the risk of requiring mechanical ventilation among obese GBS patients. Obese patients using mechanical ventilation were at risk of poorer outcomes. <b>Disclosure:</b> Dr. Sanikommu has nothing to disclose. Dr. Sombans has nothing to disclose. Dr. Ramphul has nothing to disclose. Dr. Verma has nothing to disclose. Dr. Kumar has nothing to disclose. Dr. Ramphul has nothing to disclose. Dr. Meena has nothing to disclose. Dr. Kumari has nothing to disclose. Dr. Gonzalez Mejias has nothing to disclose. Dr. Jairam Das Lohana has nothing to disclose. Dr. Arti has nothing to disclose.

Neutrophil-to-lymphocyte ratio as a biomarker for Guillain-Barré Syndrome: A systematic review with meta-analysis (P10-5.004)

<h3>Objective:</h3> We conducted a systematic review and meta-analysis to summarize the evidence on neutrophil-lymphocyte ratio (NLR) as a potential biomarker for Guillain-Barré syndrome (GBS). <h3>Background:</h3> GBS is an immune-mediated neuropathy. This has raised the possibility that the NLR may be a biomarker of its activity. <h3>Design/Methods:</h3> We systematically searched databases (PubMed, Ovid-Medline, Embase, Scopus, Web of Science, SciELO, LILACS, and Google Scholar) until October 2021 for studies evaluating pre-treatment NLR values in GBS patients. A meta-analysis using a random-effects model to estimate pooled effects was planned for each outcome and a narrative synthesis when this was not possible. Subgroup and sensitivity analysis were planned. GRADE criteria were used to identify the certainty of evidence for each result. <h3>Results:</h3> We screened ten studies for full-text review from 745 in the initial search. Regarding GBS patients versus healthy controls, a meta-analysis of six studies (968 patients) demonstrated a significant increase in NLR values in GBS patients (MD: 1.76; 95% CI: 1.29, 2.24; I2 = 86%) with moderate certainty due to heterogeneity and irrespective of GBS diagnosis criteria used. Regarding GBS prognosis, assessed by Hughes Score ≥3, NLR had a sensitivity ranged 67.3 and 81.5 and a specificity between 67.3 to 87.5 with low certainty due to imprecision, and heterogeneity. In relation to respiratory failure, NLR had a sensitivity of 86.5 and specificity of 68.2 with high and moderate certainty, respectively. Regarding sensitive analysis, these suggest that the results estimated by meta-analysis were stable. <h3>Conclusions:</h3> With moderate certainty, mean NLR is higher in GBS patients compared to healthy controls. Furthermore, we found that NLR could be a prognostic factor for disability and respiratory failure with low and moderate certainty, respectively. These results may prove useful for NLR in GBS patients; however, further research is needed. <b>Disclosure:</b> Mr. Cabanillas Lazo has nothing to disclose. Mr. Vicuña has nothing to disclose. Miss Cruzalegui Bazán has nothing to disclose. Miss Pascual-Guevara has nothing to disclose. Dr. Mori has received personal compensation in the range of $0-$499 for serving as a Consultant for Roche. Dr. Mori has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Mori has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi. Dr. Mori has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Sanofi. Carlos Alva-Diaz has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche Farma. Carlos Alva-Diaz has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Roche Farma. The institution of Carlos Alva-Diaz has received research support from Roche farma.