Top

Published in:

Open Access 01-04-2022 | Guillain-Barré Syndrome | COVID-19

Bilateral facial palsy after COVID-19 vaccination

Authors: Valentina Andreozzi, Beatrice D’arco, Pasquale Pagliano, Antonella Toriello, Paolo Barone

Published in: Neurological Sciences | Issue 7/2022

Abstract

Guillain-Barrè syndrome (GBS) is an acute immune-mediated neuropathy, possibly triggered by a recent infection or vaccination, and driven by an immune attack targeting the peripheral nervous system. GBS typically leads to ascending limb weakness, often with sensory and cranial nerve involvement 1–2 weeks after immune stimulation, but emergency and neurology physicians should be aware of its important clinical heterogeneity. In rare cases, bilateral facial nerve palsy can be the main clinical manifestation, as the case of the variant formerly known as bilateral facial weakness with paresthesias. An increasing number of case reports of GBS in patients receiving COVID-19 vaccination have been reported both during the pre-clinical phase and after large-scale authorities’ approval. We report two cases of bifacial palsy with paresthesias, a rare variant of GBS, both occurring after the first dose of COVID-19 vaccine Vaxzevria™ (formerly COVID-19 vaccine AstraZeneca), showing a favorable outcome after high-dose immunoglobulin therapy, and discuss the literature of GBS post-COVID-19 vaccination.

Available only for authorised users

Ehrenfeld M, Tincani A, Andreoli L, Cattalini M, Greenbaum A, Kanduc D, Alijotas-Reig J, Zinserling V, Semenova N, Amital H, Shoenfeld Y (2020) COVID-19 and autoimmunity. Autoimmun Rev 19(8):102597. https://doi.org/10.1016/j.autrev.2020.102597CrossRefPubMedPubMedCentral

Kajumba MM, Kolls BJ, Koltai DC, Kaddumukasa M, Kaddumukasa M, Laskowitz DT (2020) COVID-19-associated Guillain-Barre syndrome: atypical para-infectious profile, symptom overlap, and increased risk of severe neurological complications [published online ahead of print, 2020 Nov 21]. SN Compr Clin Med 1–13. https://doi.org/10.1007/s42399-020-00646-w

Malek E, Salameh J (2019) Guillain-Barre syndrome. Semin Neurol 39(5):589–595. https://doi.org/10.1055/s-0039-1693005CrossRefPubMed

Ropper AH, Wijdicks EFM, Truax BT (1991) Guillain-Barré syndrome. F.A. Davis, Philadelphia

Zhao H, Shen D, Zhou H, Liu J, Chen S (2020) Guillain-Barré syndrome associated with SARS-CoV-2 infection: causality or coincidence? Lancet Neurol 19(5):383–384. https://doi.org/10.1016/S1474-4422(20)30109-5CrossRefPubMedPubMedCentral

Goh Y, Beh DLL, Makmur A, Somani J, Chan ACY (2020) Pearls & Oy-sters: facial nerve palsy in COVID-19 infection. Neurology 95(8):364–367. https://doi.org/10.1212/WNL.0000000000009863CrossRefPubMed

Abu-Rumeileh S, Abdelhak A, Foschi M, Tumani H, Otto M (2021) Guillain-Barré syndrome spectrum associated with COVID-19: an up-to-date systematic review of 73 cases. J Neurol 268(4):1133–1170. https://doi.org/10.1007/s00415-020-10124-xCrossRefPubMed

Juliao Caamaño DS, Alonso BR (2020) Facial diplegia, a possible atypical variant of Guillain-Barré Syndrome as a rare neurological complication of SARS-CoV-2. J Clin Neurosci 77:230–232. https://doi.org/10.1016/j.jocn.2020.05.016CrossRefPubMedPubMedCentral

Dufour C, Co TK, Liu A (2021) GM1 ganglioside antibody and COVID-19 related Guillain Barre Syndrome - a case report, systemic review and implication for vaccine development. Brain Behav Immun Health 12:100203. https://doi.org/10.1016/j.bbih.2021.100203CrossRefPubMedPubMedCentral

10.

Hodgson SH, Mansatta K, Mallett G, Harris V, Emary KRW, Pollard AJ (2021) What defines an efficacious COVID-19 vaccine? A review of the challenges assessing the clinical efficacy of vaccines against SARS-CoV-2. Lancet Infect Dis 21(2):e26–e35. https://doi.org/10.1016/S1473-3099(20)30773-8CrossRefPubMed

11.

Márquez Loza AM, Holroyd KB, Johnson SA, Pilgrim DM, Amato AA (2021) Guillain- Barré syndrome in the placebo and active arms of a COVID-19 vaccine clinical trial: temporal associations do not imply causality. Neurology 6 https://doi.org/10.1212/WNL.0000000000011881

12.

Filosto M, Cotti Piccinelli S, Gazzina S, Foresti C, Frigeni B, Servalli MC, Sessa M, Cosentino G, Marchioni E, Ravaglia S, Briani C, Castellani F, Zara G, Bianchi F, Del Carro U, Fazio R, Filippi M, Magni E, Natalini G, Palmerini F, Perotti AM, Bellomo A, Osio M, Scopelliti G, Carpo M, Rasera A, Squintani G, Doneddu PE, Bertasi V, Cotelli MS, Bertolasi L, Fabrizi GM, Ferrari S, Ranieri F, Caprioli F, Grappa E, Broglio L, De Maria G, Leggio U, Poli L, Rasulo F, Latronico N, Nobile-Orazio E, Padovani A, Uncini A (2021) Guillain-Barré syndrome and COVID-19: an observational multicentre study from two Italian hotspot regions. J Neurol Neurosurg Psychiatry 92(7):751–756. https://doi.org/10.1136/jnnp-2020-324837CrossRefPubMed

13.

Brouwer MC, Ascione T, Pagliano P (2020) Neurologic aspects of COVID-19: a concise review. Infez Med 28(suppl 1):42–45PubMed

14.

Palaiodimou L, Stefanou MI, Katsanos AH, Fragkou PC, Papadopoulou M, Moschovos C, Michopoulos I, Kokotis P, Bakirtzis C, Naska A, Vassilakopoulos TI, Chroni E, Tsiodras S, Tsivgoulis G (2021) Prevalence, clinical characteristics and outcomes of Guillain-Barré syndrome spectrum associated with COVID-19: a systematic review and meta-analysis. Eur J Neurol 28(10):3517–3529. https://doi.org/10.1111/ene.14860CrossRefPubMedPubMedCentral

15.

Luijten LWG, Leonhard SE, van der Eijk AA, Doets AY, Appeltshauser L, Arends S, Attarian S, Benedetti L, Briani C, Casasnovas C, Castellani F, Dardiotis E, Echaniz-Laguna A, Garssen MPJ, Harbo T, Huizinga R, Humm AM, Jellema K, van der Kooi AJ, Kuitwaard K, Kuntzer T, Kusunoki S, Lascano AM, Martinez-Hernandez E, Rinaldi S, Samijn JPA, Scheidegger O, Tsouni P, Vicino A, Visser LH, Walgaard C, Wang Y, Wirtz PW, Ripellino P, Jacobs BC (2021) IGOS consortium. Guillain-Barré syndrome after SARS-CoV-2 infection in an international prospective cohort study. Brain 23:awab279 https://doi.org/10.1093/brain/awab279

16.

Gaál T, Szeszák G, Torák G, Salacz P (2021) Diplegia nervi facialis paraesthesiával - ritka Guillain-Barré-szindróma-variáns, SARS-CoV-2-infekciót követően [Bifacial weakness with paresthesia – a rare Guillain–Barré syndrome subtype associated with SARS-CoV-2 infection]. Orv Hetil. 162(45):1803–1807. Hungarian. https://doi.org/10.1556/650.2021.32355.

17.

Yang HB, Lee HS (2021) Facial diplegia: a rare subtype of Guillain-Barré syndrome in a patient with minimally symptomatic COVID-19. J Clin Neurol 17(4):590–592. https://doi.org/10.3988/jcn.2021.17.4.590CrossRefPubMedPubMedCentral

18.

Tran C, Drury B, Yuen HW, Rosenthal J, Neeki MM (2021) Miller-Fisher syndrome presenting as facial diplegia with COVID-19 co-infection. Cureus 13(8):e17060. https://doi.org/10.7759/cureus.17060CrossRefPubMedPubMedCentral

19.

Judge C, Moheb N, Castro Apolo R, Dupont JL, Gessner ML, Yacoub HA (2020) Facial diplegia as a rare late neurologic manifestation of SARS-CoV-2 infection. J Neurol Res 10(6):235–236. https://doi.org/10.14740/jnr606CrossRefPubMedPubMedCentral

20.

Haber P, Sejvar J, Mikaeloff Y, DeStefano F (2009) Vaccines and Guillain-Barré syndrome. Drug Saf 32(4):309–323. https://doi.org/10.2165/00002018-200932040-00005CrossRefPubMed

21.

Schonberger LB, Bregman DJ, Sullivan-Bolyai JZ, Keenlyside RA, Ziegler DW, Retailliau HF, Eddins DL, Bryan JA (1979) Guillain-Barre syndrome following vaccination in the National Influenza Immunization Program, United States, 1976–1977. Am J Epidemiol 110(2):105–123. https://doi.org/10.1093/oxfordjournals.aje.a112795CrossRefPubMed

22.

Lasky T, Terracciano GJ, Magder L, Koski CL, Ballesteros M, Nash D, Clark S, Haber P, Stolley PD, Schonberger LB, Chen RT (1998) The Guillain-Barré syndrome and the 1992–1993 and 1993–1994 influenza vaccines. N Engl J Med 339(25):1797–1802. https://doi.org/10.1056/NEJM199812173392501CrossRefPubMed

23.

Souayah N, Nasar A, Suri MF, Qureshi AI (2009) Guillain-Barré syndrome after vaccination in United States: data from the Centers for Disease Control and Prevention/Food and Drug Administration Vaccine Adverse Event Reporting System (1990–2005). J Clin Neuromuscul Dis 11(1):1–6. https://doi.org/10.1097/CND.0b013e3181aaa968CrossRefPubMed

24.

Ghaderi, Sara & Gunnes, Nina & Bakken, Inger & Magnus, Per & Trogstad, Lill & Håberg, Siri. (2015). Risk of Guillain-Barré syndrome after exposure to pandemic influenza A(H1N1)pdm09 vaccination or infection: a Norwegian population-based cohort study. Eur J Epidemiol 31https://doi.org/10.1007/s10654-015-0047-0

25.

Allen CM, Ramsamy S, Tarr AW, Tighe PJ, Irving WL, Tanasescu R, Evans JR (2021) Guillain-Barré syndrome variant occurring after SARS-CoV-2 vaccination. Ann Neurol 90(2):315–318. https://doi.org/10.1002/ana.26144CrossRefPubMed

26.

Maramattom BV, Krishnan P, Paul R, Padmanabhan S, Cherukudal Vishnu Nampoothiri S, Syed AA, Mangat HS (2021) Guillain-Barré syndrome following ChAdOx1-S/nCoV-19 vaccine. Ann Neurol. 90(2):312–314. https://doi.org/10.1002/ana.26143CrossRefPubMed

27.

Kumar P, Charaniya R, Bahl A, Ghosh A, Dixit J (2016) Facial diplegia with paresthesia: an uncommon variant of Guillain-Barre syndrome. J Clin Diagn Res 10(7):OD01–2. https://doi.org/10.7860/JCDR/2016/19951.8092

28.

Oo WM, Giri P, de Souza A (2021) AstraZeneca COVID-19 vaccine and Guillain- Barré syndrome in Tasmania: a causal link? J Neuroimmunol 360:577719. https://doi.org/10.1016/j.jneuroim.2021.577719CrossRefPubMedPubMedCentral

29.

Jain E, Pandav K, Regmi P, Michel G, Altshuler I (2021) Facial diplegia: a rare, atypical variant of Guillain-Barré syndrome and Ad26.COV2.S vaccine. Cureus 13(7):e16612. https://doi.org/10.7759/cureus.16612CrossRefPubMedPubMedCentral

30.

Rossetti A, Gheihman G, O’Hare M, Kosowsky JM (2021) Guillain-Barré syndrome presenting as facial diplegia after COVID-19 vaccination: a case report [published online ahead of print, 2021 Aug 7]. J Emerg Med. S0736–4679(21)00644–2. https://doi.org/10.1016/j.jemermed.2021.07.062

31.

Patel SU, Khurram R, Lakhani A, Quirk B (2021) Guillain-Barre syndrome following the first dose of the chimpanzee adenovirus-vectored COVID-19 vaccine, ChAdOx1. BMJ Case Rep 14(4):e242956. https://doi.org/10.1136/bcr-2021-242956CrossRefPubMedPubMedCentral

32.

Azam S, Khalil A, Taha A (2021) Guillain-Barré syndrome in a 67-year-old male post COVID-19 vaccination (Astra Zeneca). Am J Med Case Reports 9(8):424–427. https://doi.org/10.12691/ajmcr-9-8-10CrossRef

33.

Hasan T, Khan M, Khan F, Hamza G (2021) Case of Guillain-Barré syndrome following COVID-19 vaccine. BMJ Case Rep 14(6):e243629. https://doi.org/10.1136/bcr-2021-243629CrossRefPubMedPubMedCentral

34.

Prasad A, Hurlburt G, Podury S, Tandon M, Kingree S, Sriwastava S (2021) A novel case of bifacial diplegia variant of Guillain-Barré syndrome following Janssen COVID-19 vaccination. Neurol Int 13(3):404–409. https://doi.org/10.3390/neurolint13030040CrossRefPubMedPubMedCentral

35.

Nasuelli NA, De Marchi F, Cecchin M, De Paoli I, Onorato S, Pettinaroli R, Savoini G, Godi L (2021) A case of acute demyelinating polyradiculoneuropathy with bilateral facial palsy after ChAdOx1 nCoV-19 vaccine. Neurol Sci 42(11):4747–4749. https://doi.org/10.1007/s10072-021-05467-wCrossRefPubMedPubMedCentral

36.

Kanabar G, Wilkinson P (2021) Guillain-Barré syndrome presenting with facial diplegia following COVID-19 vaccination in two patients. BMJ Case Rep 14(10):e244527. https://doi.org/10.1136/bcr-2021-244527CrossRefPubMedPubMedCentral

37.

Dang YL, Bryson A (2021) Miller-Fisher syndrome and Guillain-Barre syndrome overlap syndrome in a patient post Oxford-AstraZeneca SARS-CoV-2 vaccination. BMJ Case Rep 14(11):e246701. https://doi.org/10.1136/bcr-2021-246701CrossRefPubMedPubMedCentral

38.

Badoiu A, Moranne O, Coudray S, Ion IM (2021) Clinical variant of Guillain-Barre syndrome with prominent facial diplegia after AstraZeneca coronavirus disease 2019 vaccine. J Clin Neuromuscul Dis 23(2):115–116. https://doi.org/10.1097/CND.0000000000000383CrossRefPubMed

39.

Heinz FX, Stiasny K (2021) Distinguishing features of current COVID-19 vaccines: knowns and unknowns of antigen presentation and modes of action. NPJ Vaccines 6(1):104. https://doi.org/10.1038/s41541-021-00369-6CrossRefPubMedPubMedCentral

40.

Yilmaz M, Tarakcioglu M, Bayazit N, Bayazit YA, Namiduru M, Kanlikama M (2002) Serum cytokine levels in Bell’s palsy. J Neurol Sci 197(1–2):69–72. https://doi.org/10.1016/s0022-510x(02)00049-7CrossRefPubMed

Title: Bilateral facial palsy after COVID-19 vaccination
Authors: Valentina Andreozzi
Beatrice D’arco
Pasquale Pagliano
Antonella Toriello
Paolo Barone
Publication date: 01-04-2022
Publisher: Springer International Publishing
Keywords: Guillain-Barré Syndrome
Facial Palsy
COVID-19 Vaccination
Vaccination
Published in: Neurological Sciences / Issue 7/2022
Print ISSN: 1590-1874
Electronic ISSN: 1590-3478
DOI: https://doi.org/10.1007/s10072-022-05982-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Bilateral facial palsy after COVID-19 vaccination

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 7/2022

Critical headache: reporting a type of headache in the acute stage of a disease, described by Avicenna

Cognitive impairment and markers of optical neurodegeneration in early multiple sclerosis

Oxygen pulse best predicts energy expenditure during stair ascent and descent in individuals with chronic stroke

The association between stroke and COVID-19-related mortality: a systematic review and meta-analysis based on adjusted effect estimates

Effects of low-intensity training on the brain and muscle in the congenital muscular dystrophy 1D model

Health care providers’ effect on long-term mortality after the first-ever stroke: application of shared frailty survival models