Guillain–Barré syndrome

Editor – We read with great interest the article by Sancho-Saldaña et al.¹ Firstly, we would like to congratulate the authors who have nicely described a case of Guillain–Barré syndrome (GBS) following a SARS-CoV-2 infection and was found to have a leptomeningeal enhancement in magnetic resonance imaging (MRI) of the spine. Although there is numerous reporting on the neurological involvement of SARS-CoV-2 infection that has been published in the literature, we believe it is still justified to report any extrapulmonary cases of SARS-CoV-2 infection, as we are still learning about the disease. We have written a comprehensive review of literature on all published scientific articles of SARS-CoV-2 infection with neurological involvement and summarised the wide spectrum of presentation which can present with or without respiratory symptoms.² However, this article is the first to report leptomeningeal enhancement in addition to the GBS, which warranted further investigation.

Nevertheless, there is some important information that is missing in the article, which is the background history of the patient, especially in terms of her underlying comorbidity and also the list of regular medication that she is taking. We believe this information is vital to determine the aetiology and prognosis of the condition. Apart from that, we believe a follow-up reporting is warranted on the rate and status of recovery after rehabilitation and the presence of other neurological sequelae.

At any rate, we agree with the authors that the causal relationship between GBS and SARS-CoV-2 infection follows the classical para-infectious and post-infectious pattern, as shown in this patient. Moreover, although leptomeningeal enhancement is not uncommon in GBS, we believe that further study and close follow-up is imperative because, apart from being a supplementary diagnostic sign in GBS, it can be linked to the development of a neurological dysfunction, such as multiple sclerosis that can lead to long-term or permanent neurological disabilities.³