Medical Director of Physical Medicine and Rehabilitation Memorial Healthcare System Hollywood, Florida, United States
Case Diagnosis: Lingular fasiculations related to Guillain Barre Syndrome secondary to COVID-19
Case Description: We present a 37 year old female with a past medical history of asthma, morbid obesity, ovarian cancer status post peritoneal dissection, omentectomy, right oophorectomy, and hypertension. She was intubated secondary to hypoxemic respiratory failure in the setting of COVID-19 pneumonia. Following extubation, she was sent to a skilled nursing facility given her current functional status. As she improved, she transferred to inpatient rehabilitation with critical illness polyneuropathy with myopathy. She was also noted to have lingular fasiculations on physical exam which she stated were not present prior to her hospitalization. She had no history of neurological disorder. After a comprehensive inpatient rehabilitation course, she achieved modified independence for transfers and community ambulation with supervision. She also noticed improvement in her lingular fasiculations.
Discussions: On literature review, multiple cases of Guillain Barre Syndrome have been reported in association with COVID-19. Albumino cytologic dissociation as well as Central Nervous System enhancement on MRI. While we did not perform Cerebrospinal Fluid studies or EMG on our patient, it is quite possible that lingular fasiculations in a patient with no neurological history post COVID-19 infections represent an atypical presentation of Guillain Barre Syndrome. While no neurological intervention was warranted in her case, increased vigilance for atypical signs of Guillain Barre can help the rehabilitation course of post COVID-19 patients and help them avoid long term neurological sequelae.
Conclusions: The acute rehabilitation setting is the first line in the indentification of neurological sequelae for patients who have undergone prolonged acute hospitilization courses due to COVID-19. Increased vigilance on neurological exam in such patients could allow for early intervention and a greater chance for discharge home in such patients.