Bickerstaff encephalitis as a form of Guillain-Barre Syndrome in a patient with Covid-19

Abstract

Introduction: Guillain-Barré Syndrome is the most common cause of acute flaccid paralysis. The classic form of the syndrome has not undergone major changes in its clinical features, however, the spectrum of its clinical variants is extensive, and advances in molecular biology and immunology have allowed these forms of the syndrome to be better characterized. Clinical case: A 42-year-old male patient, with a positive diagnosis of Covid-19 ten days earlier, who presented with worsening muscle weakness, inability to stand up and hoarse voice, to which was added difficulty swallowing and sitting. The neurological examination identified dysarthria, quadriparesis predominantly in the lower limbs, positive signs of cranial nerves II, III, IV, VI, VII and IX, and globally abolished reflexes. A brain CT scan showed no signs of an ischemic or hemorrhagic stroke. The patient was diagnosed with Guillain-Barré Syndrome in its brainstem variant. General management as well as Intacglobin IV were started, but the patient progressed to respiratory failure requiring mechanical ventilation. He made an almost complete recovery and was discharged after 3 weeks. Conclusions: The incidence of Guillain-Barré syndrome related to Covid-19 is not yet fully understood. Early and timely evaluation of the patient and their symptoms and signs is key to the diagnosis and treatment of Guillain-Barré syndrome. Neurophysiological studies are essential in our institution for a better diagnosis of these cases.