ABSTRACT
Guillain-Barre syndrome (GBS) is an immune-mediated acute polyradiculoneuropathy and commonly occurs after a preceding infection or immunization sequalae. Following the severe acute respiratory syndrome-coronavirus-2 virus pandemic with co-introduction of massive vaccinations, several GBS cases associated with coronavirus disease 2019 (COVID-19) infection per se or after vaccination for COVID-19 were reported internationally. Herein, we report two cases of Korean GBS presenting with tetraplegia after two different COVID-19 vaccinations (42-year old man by AstraZeneca and 48-year woman by Pfizer vaccines) within four weeks after vaccination. The patients were diagnosed with clinical examination, serial electromyography, and compatible laboratory results and improved after comprehensive rehabilitative treatment and intravenous immunoglobulin therapy. Furthermore, we performed an electrodiagnostic follow-up study of each case to examine their unique characteristics.
Subject(s)
BNT162 Vaccine/adverse effects , ChAdOx1 nCoV-19/adverse effects , Guillain-Barre Syndrome/pathology , Quadriplegia/pathology , Vaccination/adverse effects , Adult , BNT162 Vaccine/immunology , COVID-19/prevention & control , ChAdOx1 nCoV-19/immunology , Electromyography , Female , Guillain-Barre Syndrome/rehabilitation , Guillain-Barre Syndrome/therapy , Humans , Immunoglobulins, Intravenous/therapeutic use , Male , Middle Aged , Quadriplegia/rehabilitation , Quadriplegia/therapy , SARS-CoV-2/immunologyABSTRACT
INTRODUCTION: Respiratory complications (RC) are a leading cause of death after spinal cord injury (SCI) due to compromised immune function and respiratory muscle weakness. Thus, individuals with SCI are at high risk of developing COVID-19 related RC. Results of a SCI clinical trial showed a supervised respiratory muscle training (RMT) program decreased risk of developing RC. The feasibility of conducting unsupervised RMT is not well documented. Four publications (n = 117) were identified in which unsupervised RMT was performed. Significant improvements in respiratory outcomes were reported in two studies: Maximal Inspiratory and Expiratory Pressure (MIP40% and MEP25%, respectively), Peak Expiratory Flow (PEF9%), seated and supine Forced Vital Capacity (FVC23% and 26%, respectively), and Peak Cough Flow (28%). This review and case report will attempt to show that an inspiratory muscle training (IMT) home exercise program (HEP) is feasible and may prepare the respiratory system for RC associated with COVID-19 in patients with SCI. CASE PRESENTATION: A 23-year-old with tetraplegia (P1), history of mechanical ventilation, and hospitalization for RC, completed 27 IMT HEP sessions in one month. MIP and sustained MIP (SMIP) increased from baseline by 28% and 26.5%, respectively. Expiratory volumes and rates also improved (FVC, FEV1, and PEF: 11.7%, 8.3%, and 14.2%, respectively). DISCUSSION: The effects of COVID-19 on patients with SCI remains inconclusive, but recent literature and the results of this case suggest that unsupervised IMT is feasible and may limit the severity of RC in patients with SCI who contract COVID-19.
Subject(s)
Betacoronavirus , Breathing Exercises/methods , Coronavirus Infections/prevention & control , Inhalation/physiology , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Respiratory Tract Infections/prevention & control , Spinal Cord Injuries/therapy , COVID-19 , Coronavirus Infections/physiopathology , Humans , Male , Pneumonia, Viral/physiopathology , Quadriplegia/complications , Quadriplegia/physiopathology , Quadriplegia/therapy , Respiratory Tract Infections/physiopathology , SARS-CoV-2 , Spinal Cord Injuries/complications , Spinal Cord Injuries/physiopathology , Young AdultSubject(s)
Betacoronavirus , Coronavirus Infections/prevention & control , Equipment Reuse , Pandemics/prevention & control , Personal Protective Equipment , Plasma Exchange , Pneumonia, Viral/prevention & control , Betacoronavirus/isolation & purification , COVID-19 , COVID-19 Testing , Child, Preschool , Clinical Laboratory Techniques , Combined Modality Therapy , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Disinfection , Equipment Contamination/prevention & control , Female , Humans , Immunoglobulins, Intravenous/therapeutic use , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Infusion Pumps , Methylprednisolone/therapeutic use , Myelitis, Transverse/therapy , Plasma Exchange/instrumentation , Plasma Exchange/nursing , Pneumonia, Viral/complications , Quadriplegia/therapy , Respiration, Artificial , SARS-CoV-2ABSTRACT
During the pandemic of coronavirus disease 2019, it is possible for rehabilitation physicians and personnel to take care of patients with concurrent spinal cord injury and coronavirus disease 2019. Here, we describe a case of acute cervical spinal cord injury resulting in complete tetraplegia C5 American Spinal Injury Association Impairment Scale A with unrecognized, severe acute respiratory syndrome coronavirus 2 infection. This resulted in large-scale quarantines of related surgical and rehabilitation staff, and the unexpected death of the patient despite receiving the treatments according to the standard guideline. Rehabilitation personnel who take care of acute spinal cord injury patients with coronavirus disease 2019 should consider the effect of spinal cord injury on the course of coronavirus disease 2019, the effect of coronavirus disease 2019 and its treatments on the course of spinal cord injury, and risks of severe acute respiratory syndrome coronavirus 2 transmission between patients and rehabilitation staff, to continue providing safe and effective rehabilitation programs.