key: cord-1018850-aqb9tctv
authors: Finsterer, Josef; Scorza, Fulvio Alexandre; Scorza, Carla Alessandra; Fiorini, Ana Claudia
title: SARS-CoV-2 associated Guillain-Barre syndrome requires appropriate exclusion of possible differentials
date: 2021-08-09
journal: J Emerg Med
DOI: 10.1016/j.jemermed.2021.07.069
sha: 612707b40b6b41e4925d719290d3f8ac3cf9fc79
doc_id: 1018850
cord_uid: aqb9tctv

nan

With interest we read the article by Yakoby et al. about a 35yo male who was diagnosed with Guillain-Barre syndrome (GBS) 16 days after onset of COVID-19 [1] . SARS-CoV-2 associated GBS (SC2-GBS) was suspected upon the clinical presentation and the temporal link between the viral infection and the GBS [1] . Quadruparesis and sensory disturbances started 9 days after onset of COVID-19. The patient benefited from immunoglobulins [1] . It was concluded that emergency physicians need to be alert for SC2-GBS [1] . The study is appealing but has several limitations which raise the following comments and concerns.

The first limitation of the study is that the diagnosis GBS was not confirmed by electrophysiologic investigations, such as nerve conduction studies (NCSs) or needle electromyography. GBS is usually diagnosed upon the validated Brighton criteria which requires the results of NCSs. Since results of NCSs were not available, the diagnosis GBS remains uncertain, and classification of the GBS subtype is not feasible. GBS subtypes that should be considered in the index patient include acute, demyelinating, inflammatory polyneuropathy (AIDP), acute, motor, axonal neuropathy (AMAN), and acute, motor and sensory, axonal neuropathy (AMSAN). Other GBS subtypes are implausible given the clinical presentation.

A second limitation is that no reference limits for laboratory parameters were provided. Thus, it is impossible to assess the amount of blood and cerebrospinal fluid (CSF) abnormality reported in the index patient.

A third limitation is that the CSF was investigated neither for the presence or absence of SARS-CoV-2 RNA nor for cytokines IL-8. IL-6. IL-1beta, or TNF-alpha, which have been reported to be elevated in the CSF of patients with neuro-COVID [2] . 

Guillain-Barré Syndrome after Novel Coronavirus Disease 2019

SARS-CoV-2 encephalitis is a cytokine release syndrome: evidences from cerebrospinal fluid analyses

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