Disclosures: Elinor H. Naor, DO: No financial relationships or conflicts of interest

Case Diagnosis: 91 year old female with a history of Covid-19 infection with bilateral lower extremity paresis secondary to Guillain Barre Syndrome

Case Description: Patient had a fall without loss of consciousness or head trauma, secondary to progressive bilateral lower extremity weakness, for which she presented to the emergency room. Stroke and cord compression workup was negative. However, she did test positive for COVID-19–symptoms first noted 18 days prior to onset of weakness. Shortly after discharge, her paraparesis worsened prompting neurological evaluation. NCS/EMG studies were suggestive of mixed axonal and demyelinating sensorimotor polyneuropathy of bilateral lower extremities. Patient was readmitted for IVIG infusion for GBS with some improvement in her strength.

Setting: Acute Inpatient RehabilitationAssessment/

Results: Physical exam (pre-IVIG): diffuse areflexia, flaccidity in bilateral lower extremity, intact sensation to light touch, decreased vibratory sensation in bilateral fingers and bilateral lower extremities, proprioception intact throughout. NCS: motor NCS absent bilateral tibial and right peroneal nerves, absent right tibial H reflex. EMG: increased insertional and spontaneous activities: right vastus lateralis, tibialis anterior, peroneus longus, flexor digitorum longus, and bilateral gastrocnemius; reduced recruitment of voluntary motor units: right dorsal interosseous, right gastrocnemius. Physical exam (post-IVIG/in rehab): Minimal improved lower extremity strength. Significant loss of function despite intense rehabilitation.

Discussion: To date, it is known that COVID-19 triggers an inflammatory immune-mediated response. This reaction may play a role in the development of GBS. In this case report; clinical presentation, positive COVID-19 testing, and NCS and EMG findings supported the diagnosis of GBS and consequent correlation.

Conclusion: The association of GBS with COVID-19 infection has been reported; however, to our knowledge, this is one of few cases presented through a rehabilitation perspective. Given the varied presentation of COVID-19 infection, it is important for physicians to identify acute neurological changes in those with a history of infection to facilitate early treatment and improve functional outcomes.

Level of Evidence: Level IV

« Back to AAPM&R Annual Assembly 2021

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/rehabilitation-of-guillain-barre-syndrome-following-covid-19-infection/