Guillain-Barré Syndrome with Demyelinating Brain Lesions Following COVID-19: A Rare Neuroimaging Presentation Case Report

Guillain-Barré Syndrome with Demyelinating Brain Lesions Following COVID-19: A Rare Neuroimaging Presentation Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Guillain-Barré Syndrome with Demyelinating Brain Lesions Following COVID-19: A Rare Neuroimaging Presentation Case Report Tarek Daoud, Ayimen Khan, Ramin Hamidi, Mohiuddin Hadi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6355693/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Guillain-Barré Syndrome (GBS) is a postinfectious immune-mediated disorder affecting peripheral nerves and nerve roots. Since the COVID-19 pandemic, multiple studies have suggested a potential association between COVID-19 infection and GBS. While post-COVID GBS typically presents with progressive limb weakness and hyporeflexia, severe cases requiring lung transplantation or involving demyelinating brain lesions are exceedingly rare. This case highlights a unique neuroradiological manifestation of post-COVID GBS. Case Presentation A 32-year-old previously healthy female developed progressive respiratory decline following a COVID-19 infection in January 2023. Over the next year, her respiratory function deteriorated, requiring intubation and mechanical ventilation by June 2024. She subsequently required Extracorporeal Membrane Oxygenation (ECMO) support and ultimately underwent a bilateral lung transplant in July 2024. During her hospitalization, she developed progressive diffuse limb weakness, more pronounced in the lower extremities. Neurological examination revealed lower extremity areflexia and upper extremity hyperreflexia. Cerebrospinal fluid (CSF) analysis demonstrated albumino-cytologic dissociation, consistent with GBS. MRI findings included scattered T2/FLAIR hyperintensities in the brain’s juxtacortical, subcortical, and deep white matter, suggestive of demyelination. Additionally, cauda equina nerve roots appeared thickened and avidly enhancing, a hallmark imaging feature of GBS. Conclusion This case represents a rare presentation of post-COVID-19 GBS with both demyelinating brain lesions and cauda equina nerve root enhancement. While peripheral nerve involvement is a well-established feature of GBS, the presence of white matter demyelination suggests a broader neuroinflammatory process. Recognizing these atypical imaging findings is crucial for early diagnosis and management, particularly in post-COVID patients with progressive neurological decline. Guillain-Barre syndrome COVID-19 Post-infectious neuropathy demyelinating disease acute inflammatory demyelinating polyneuropathy neuroimaging Figures Figure 1 Figure 2 Background Guillain Barre syndrome (GBS) is a postinfectious immune-mediated syndrome affecting the peripheral nerves and nerve roots with an overall incidence of 1.1–1.8/100,000 per year.[ 1 ] Since the COVID-19 pandemic, there have been several studies and case reports suggesting an association between COVID-19 infection and the development of GB syndrome.[ 2 ] The Diagnosis of GBS relies on clinical history and physical examination, especially in the absence of highly sensitive and specific biomarkers. This is supported by cerebrospinal fluid (CSF) analysis findings and electrodiagnostic studies. Classically, CSF analysis in GBS shows a disproportionate elevation in protein level with a normal cell count, known as albumino-cytologic dissociation.[ 3 ] In a recent systematic review that included 156 articles and 436 patients, the clinical presentation of post-COVID GBS was similar to that related to other etiologies. Patients with post-COVID GBS primarily presented with distal limb weakness that progressed cranially, along with sensory abnormalities, including paraesthesia and altered sensations, as well as diminished or absent reflexes (hyporeflexia/areflexia).[ 2 , 3 ]. The most common subtype of GBS associated with COVID-19 was acute inflammatory demyelinating polyneuropathy (AIDP) and more than 50% of patients’ CSF analyses revealed albumino-cytologic dissociation.[ 2 ] The most common imaging finding in GBS is avid enhancement and thickening of the cauda equina nerve roots.[ 4 ] In rare cases, Guillain-Barré Syndrome (GBS) can present as severe, recurrent disseminated encephalomyelitis, with brain MRI showing white matter demyelinating plaques.[ 5 ] Case presentation A 32-year-old previously healthy female developed progressive respiratory decline following a COVID-19 infection in January 2023. Over time, her respiratory symptoms progressively deteriorated, necessitating intubation and mechanical ventilation in June 2024. Subsequently, she required Extracorporeal Membrane Oxygenation (ECMO) support and ultimately underwent a bilateral lung transplant in July 2024. During her hospitalization, the patient developed diffuse symmetric limb weakness, with greater severity in the lower extremities. This weakness also impacted her respiratory muscles, leading to orthopnea and hypercapnia. Clinical examination revealed areflexia in the lower extremities alongside hyperreflexia in the upper extremities. Cerebrospinal fluid (CSF) analysis demonstrated albumino-cytologic dissociation. MRI of the brain revealed scattered juxtacortical, subcortical, and deep white matter non-enhancing T2 and FLAIR hyperintensities suggestive of demyelination (Fig. 1 ). MRI of the lumbar spine revealed thickening and enhancement of the cauda equina nerve roots typical of that seen with the acute inflammatory demyelinating polyneuropathy (AIDP) variant of GBS (Fig. 2 ). The patient underwent five cycles of plasma exchange (PLEX) and intravenous immunoglobulin (IVIG), resulting in substantial improvement in respiratory muscle function and upper extremity strength, whereas lower limb motor recovery remained limited. Conclusions This case report highlights a rare presentation of post-COVID-19 Guillain-Barré syndrome (GBS) characterized by both demyelinating brain lesions and cauda equina nerve root enhancement. The presence of white matter demyelination suggests a broader neuroinflammatory process beyond typical peripheral nerve involvement in GBS. While the exact pathophysiology remains under investigation, the immune response triggered by COVID-19 is believed to contribute to the development of this postinfectious, immune-mediated syndrome. Recognizing these atypical imaging findings is crucial for early diagnosis and management, particularly in post-COVID patients experiencing progressive neurological decline. This case underscores the importance of considering GBS in the differential diagnosis of neurological complications following COVID-19 infection and contributes to a better understanding of the broader neurological sequelae associated with the disease. Abbreviations • AIDP – Acute Inflammatory Demyelinating Polyneuropathy • ADC – Apparent Diffusion Coefficient • COVID-19 – Coronavirus Disease 2019 • CSF – Cerebrospinal Fluid • DWI – Diffusion-Weighted Imaging • ECMO – Extracorporeal Membrane Oxygenation • FLAIR – Fluid-Attenuated Inversion Recovery • GBS – Guillain-Barré Syndrome • GRE – Gradient Echo • IVIG – Intravenous Immunoglobulin • MRI – Magnetic Resonance Imaging • PLEX – Plasma Exchange • T1WI – T1-Weighted Imaging • T2WI – T2-Weighted Imaging Declarations Ethics approval and consent to participate Ethical approval was not required for this single-patient case report, in accordance with our institution’s policies. Consent for publication Written informed consent was obtained from the patient for publication of this case report and accompanying images. Competing interests The authors declare that they have no competing interests. Funding No funding was received for this study. Author Contribution T.D. collected the clinical data and imaging, and drafted the manuscript. A.K. contributed to the literature review. R.H. and M.H. reviewed the imaging findings and provided critical revisions and editorial feedback. All authors read and approved the final manuscript. Acknowledgements Not applicable. Availability of data and materials Not applicable. References McGrogan A, Madle GC, Seaman HE, de Vries CS. The epidemiology of Guillain-Barre syndrome worldwide. A systematic literature review. Neuroepidemiology. 2009;32(2):150-63. doi: 10.1159/000184748. Pimentel V, Luchsinger VW, Carvalho GL, Alcara AM, Esper NB, Marinowic D, et al. Guillain-Barre syndrome associated with COVID-19: A systematic review. Brain Behav Immun Health. 2023;28:100578. doi: 10.1016/j.bbih.2022.100578. Leonhard SE, Mandarakas MR, Gondim FAA, Bateman K, Ferreira MLB, Cornblath DR, et al. Diagnosis and management of Guillain–Barré syndrome in ten steps. Nature Reviews Neurology. 2019;15(11):671-83. doi: 10.1038/s41582-019-0250-9. Resorlu M, Guven M, Aylanc H, Karatag O. Lumbar magnetic resonance imaging findings in Guillain-Barre syndrome. Spine J. 2016;16(10):e709-e10. doi: 10.1016/j.spinee.2016.03.034. Korn A, Huberle E, Bornemann A. [Development of a severe multiphase disseminated encephalomyelitis in Guillain-Barre syndrome--MRI findings]. Rofo. 2010;182(6):525-7. doi: 10.1055/s-0029-1245302. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6355693","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":439036889,"identity":"dada17a7-10a9-4ffc-9635-d4037fc213a5","order_by":0,"name":"Tarek Daoud","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCklEQVRIie3NMUvEMBTA8VcOLku4W1MQ8xVSCrdU6VdJKLSLgyBIBsEewk2FW9tvURfnSsFb6p4xXTrX0UVMOAfB9nR0yH8J7/F+BMDl+qd5OSzsG2gNgM28bbSdm+lz/I2EjB9J3vA/kg3hX9uTJEavfV9CRNckeZJctme0TMwvEs5Xik8SjLMwqCELqjK9VbxrMVPCkA5Cf45AuvQ1tF6trjZK7AzBz3kjdiDqObIe0LshsSXXltDCkg+4nyUkXXo1tMISsAQOW0Ny4GyOqGHhlyxLqmK4IbzLMLOEv5Cg6vQkQfvUeytkdLlHyeM4yiimD6jX490FXR2mfznGfq7IiXOXy+Vy/dYnk/dmlPSx1cYAAAAASUVORK5CYII=","orcid":"","institution":"University of Louisville","correspondingAuthor":true,"prefix":"","firstName":"Tarek","middleName":"","lastName":"Daoud","suffix":""},{"id":439036890,"identity":"7710894c-a27a-49fe-9df5-c960713df726","order_by":1,"name":"Ayimen Khan","email":"","orcid":"","institution":"University of Louisville","correspondingAuthor":false,"prefix":"","firstName":"Ayimen","middleName":"","lastName":"Khan","suffix":""},{"id":439036894,"identity":"38872e33-0481-4ef0-ae6f-dd174866dfbf","order_by":2,"name":"Ramin Hamidi","email":"","orcid":"","institution":"University of Louisville","correspondingAuthor":false,"prefix":"","firstName":"Ramin","middleName":"","lastName":"Hamidi","suffix":""},{"id":439036896,"identity":"8ed87cb5-7767-4056-b3f9-849eba7b9c99","order_by":3,"name":"Mohiuddin Hadi","email":"","orcid":"","institution":"University of Louisville","correspondingAuthor":false,"prefix":"","firstName":"Mohiuddin","middleName":"","lastName":"Hadi","suffix":""}],"badges":[],"createdAt":"2025-04-01 19:38:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6355693/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6355693/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":81938269,"identity":"2d4ab438-626d-465d-9542-7d1524d2c2c8","added_by":"auto","created_at":"2025-05-05 06:35:58","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":536576,"visible":true,"origin":"","legend":"\u003cp\u003eAxial brain MRI demonstrates scattered T2-FLAIR hyperintensities in the juxtacortical, subcortical, and deep white matter, suggestive of demyelination (A). GRE (B), DWI (C), and ADC (D) show no hemorrhage or diffusion restriction. Non-contrast (E) and post-contrast (F) T1-weighted images reveal no abnormal enhancement, suggesting the absence of active inflammation or blood-brain barrier disruption. These findings are suggestive of a subacute or chronic demyelinating process, supporting an atypical central nervous system manifestation of post-COVID-19 Guillain-Barré syndrome.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6355693/v1/ac80ed95621f4705ff6f9850.png"},{"id":81939630,"identity":"475d3345-312d-4d82-8a62-c010c5f89b62","added_by":"auto","created_at":"2025-05-05 06:43:58","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":906250,"visible":true,"origin":"","legend":"\u003cp\u003eMRI of the lumbar spine reveals classic features of Guillain-Barré syndrome. The sagittal post-contrast T1-weighted image (A) demonstrates diffuse, smooth, and symmetric enhancement of the cauda equina nerve roots. The axial non-contrast T1-weighted image (B) shows thickening of the cauda equina nerve roots. In contrast, the axial post-contrast T1-weighted image (C) confirms prominent enhancement of the cauda equina. These findings are characteristic of the acute inflammatory demyelinating polyneuropathy (AIDP) variant of GBS.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-6355693/v1/99c070c5ba7024dc97df0318.png"},{"id":100414612,"identity":"d888f3d8-c629-4911-994f-1e2f414e3232","added_by":"auto","created_at":"2026-01-16 13:19:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2095646,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6355693/v1/5942f06f-172a-4f33-b094-87545a55290f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Guillain-Barré Syndrome with Demyelinating Brain Lesions Following COVID-19: A Rare Neuroimaging Presentation Case Report","fulltext":[{"header":"Background","content":"\u003cp\u003eGuillain Barre syndrome (GBS) is a postinfectious immune-mediated syndrome affecting the peripheral nerves and nerve roots with an overall incidence of 1.1\u0026ndash;1.8/100,000 per year.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] Since the COVID-19 pandemic, there have been several studies and case reports suggesting an association between COVID-19 infection and the development of GB syndrome.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe Diagnosis of GBS relies on clinical history and physical examination, especially in the absence of highly sensitive and specific biomarkers. This is supported by cerebrospinal fluid (CSF) analysis findings and electrodiagnostic studies. Classically, CSF analysis in GBS shows a disproportionate elevation in protein level with a normal cell count, known as albumino-cytologic dissociation.[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eIn a recent systematic review that included 156 articles and 436 patients, the clinical presentation of post-COVID GBS was similar to that related to other etiologies. Patients with post-COVID GBS primarily presented with distal limb weakness that progressed cranially, along with sensory abnormalities, including paraesthesia and altered sensations, as well as diminished or absent reflexes (hyporeflexia/areflexia).[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The most common subtype of GBS associated with COVID-19 was acute inflammatory demyelinating polyneuropathy (AIDP) and more than 50% of patients\u0026rsquo; CSF analyses revealed albumino-cytologic dissociation.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe most common imaging finding in GBS is avid enhancement and thickening of the cauda equina nerve roots.[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eIn rare cases, Guillain-Barr\u0026eacute; Syndrome (GBS) can present as severe, recurrent disseminated encephalomyelitis, with brain MRI showing white matter demyelinating plaques.[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/p\u003e"},{"header":"Case presentation","content":"\u003cp\u003eA 32-year-old previously healthy female developed progressive respiratory decline following a COVID-19 infection in January 2023. Over time, her respiratory symptoms progressively deteriorated, necessitating intubation and mechanical ventilation in June 2024. Subsequently, she required Extracorporeal Membrane Oxygenation (ECMO) support and ultimately underwent a bilateral lung transplant in July 2024.\u003c/p\u003e \u003cp\u003eDuring her hospitalization, the patient developed diffuse symmetric limb weakness, with greater severity in the lower extremities. This weakness also impacted her respiratory muscles, leading to orthopnea and hypercapnia. Clinical examination revealed areflexia in the lower extremities alongside hyperreflexia in the upper extremities. Cerebrospinal fluid (CSF) analysis demonstrated albumino-cytologic dissociation.\u003c/p\u003e \u003cp\u003eMRI of the brain revealed scattered juxtacortical, subcortical, and deep white matter non-enhancing T2 and FLAIR hyperintensities suggestive of demyelination (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). MRI of the lumbar spine revealed thickening and enhancement of the cauda equina nerve roots typical of that seen with the acute inflammatory demyelinating polyneuropathy (AIDP) variant of GBS (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe patient underwent five cycles of plasma exchange (PLEX) and intravenous immunoglobulin (IVIG), resulting in substantial improvement in respiratory muscle function and upper extremity strength, whereas lower limb motor recovery remained limited.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis case report highlights a rare presentation of post-COVID-19 Guillain-Barr\u0026eacute; syndrome (GBS) characterized by both demyelinating brain lesions and cauda equina nerve root enhancement. The presence of white matter demyelination suggests a broader neuroinflammatory process beyond typical peripheral nerve involvement in GBS. While the exact pathophysiology remains under investigation, the immune response triggered by COVID-19 is believed to contribute to the development of this postinfectious, immune-mediated syndrome. Recognizing these atypical imaging findings is crucial for early diagnosis and management, particularly in post-COVID patients experiencing progressive neurological decline. This case underscores the importance of considering GBS in the differential diagnosis of neurological complications following COVID-19 infection and contributes to a better understanding of the broader neurological sequelae associated with the disease.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003e\u0026bull;\u0026nbsp;\u003c/strong\u003eAIDP \u0026ndash; Acute Inflammatory Demyelinating Polyneuropathy\u003c/p\u003e\n\u003cp\u003e\u0026bull; ADC \u0026ndash; Apparent Diffusion Coefficient\u003c/p\u003e\n\u003cp\u003e\u0026bull; COVID-19 \u0026ndash; Coronavirus Disease 2019\u003c/p\u003e\n\u003cp\u003e\u0026bull; CSF \u0026ndash; Cerebrospinal Fluid\u003c/p\u003e\n\u003cp\u003e\u0026bull; DWI \u0026ndash; Diffusion-Weighted Imaging\u003c/p\u003e\n\u003cp\u003e\u0026bull; ECMO \u0026ndash; Extracorporeal Membrane Oxygenation\u003c/p\u003e\n\u003cp\u003e\u0026bull; FLAIR \u0026ndash; Fluid-Attenuated Inversion Recovery\u003c/p\u003e\n\u003cp\u003e\u0026bull; GBS \u0026ndash; Guillain-Barr\u0026eacute; Syndrome\u003c/p\u003e\n\u003cp\u003e\u0026bull; GRE \u0026ndash; Gradient Echo\u003c/p\u003e\n\u003cp\u003e\u0026bull; IVIG \u0026ndash; Intravenous Immunoglobulin\u003c/p\u003e\n\u003cp\u003e\u0026bull; MRI \u0026ndash; Magnetic Resonance Imaging\u003c/p\u003e\n\u003cp\u003e\u0026bull; PLEX \u0026ndash; Plasma Exchange\u003c/p\u003e\n\u003cp\u003e\u0026bull; T1WI \u0026ndash; T1-Weighted Imaging\u003c/p\u003e\n\u003cp\u003e\u0026bull; T2WI \u0026ndash; T2-Weighted Imaging\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003eEthical approval was not required for this single-patient case report, in accordance with our institution\u0026rsquo;s policies.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eWritten informed consent was obtained from the patient for publication of this case report and accompanying images.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eNo funding was received for this study.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eT.D. collected the clinical data and imaging, and drafted the manuscript. A.K. contributed to the literature review. R.H. and M.H. reviewed the imaging findings and provided critical revisions and editorial feedback. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMcGrogan A, Madle GC, Seaman HE, de Vries CS. The epidemiology of Guillain-Barre syndrome worldwide. A systematic literature review. Neuroepidemiology. 2009;32(2):150-63. doi: 10.1159/000184748.\u003c/li\u003e\n\u003cli\u003ePimentel V, Luchsinger VW, Carvalho GL, Alcara AM, Esper NB, Marinowic D, et al. Guillain-Barre syndrome associated with COVID-19: A systematic review. Brain Behav Immun Health. 2023;28:100578. doi: 10.1016/j.bbih.2022.100578.\u003c/li\u003e\n\u003cli\u003eLeonhard SE, Mandarakas MR, Gondim FAA, Bateman K, Ferreira MLB, Cornblath DR, et al. Diagnosis and management of Guillain\u0026ndash;Barr\u0026eacute; syndrome in ten steps. Nature Reviews Neurology. 2019;15(11):671-83. doi: 10.1038/s41582-019-0250-9.\u003c/li\u003e\n\u003cli\u003eResorlu M, Guven M, Aylanc H, Karatag O. Lumbar magnetic resonance imaging findings in Guillain-Barre syndrome. Spine J. 2016;16(10):e709-e10. doi: 10.1016/j.spinee.2016.03.034.\u003c/li\u003e\n\u003cli\u003eKorn A, Huberle E, Bornemann A. [Development of a severe multiphase disseminated encephalomyelitis in Guillain-Barre syndrome--MRI findings]. Rofo. 2010;182(6):525-7. doi: 10.1055/s-0029-1245302.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Guillain-Barre syndrome, COVID-19, Post-infectious neuropathy, demyelinating disease, acute inflammatory demyelinating polyneuropathy, neuroimaging","lastPublishedDoi":"10.21203/rs.3.rs-6355693/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6355693/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGuillain-Barré Syndrome (GBS) is a postinfectious immune-mediated disorder affecting peripheral nerves and nerve roots. Since the COVID-19 pandemic, multiple studies have suggested a potential association between COVID-19 infection and GBS. While post-COVID GBS typically presents with progressive limb weakness and hyporeflexia, severe cases requiring lung transplantation or involving demyelinating brain lesions are exceedingly rare. This case highlights a unique neuroradiological manifestation of post-COVID GBS.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase Presentation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA 32-year-old previously healthy female developed progressive respiratory decline following a COVID-19 infection in January 2023. Over the next year, her respiratory function deteriorated, requiring intubation and mechanical ventilation by June 2024. She subsequently required Extracorporeal Membrane Oxygenation (ECMO) support and ultimately underwent a bilateral lung transplant in July 2024.\u003c/p\u003e\n\u003cp\u003eDuring her hospitalization, she developed progressive diffuse limb weakness, more pronounced in the lower extremities. Neurological examination revealed lower extremity areflexia and upper extremity hyperreflexia. Cerebrospinal fluid (CSF) analysis demonstrated albumino-cytologic dissociation, consistent with GBS.\u003c/p\u003e\n\u003cp\u003eMRI findings included scattered T2/FLAIR hyperintensities in the brain’s juxtacortical, subcortical, and deep white matter, suggestive of demyelination. Additionally, cauda equina nerve roots appeared thickened and avidly enhancing, a hallmark imaging feature of GBS.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis case represents a rare presentation of post-COVID-19 GBS with both demyelinating brain lesions and cauda equina nerve root enhancement. While peripheral nerve involvement is a well-established feature of GBS, the presence of white matter demyelination suggests a broader neuroinflammatory process. Recognizing these atypical imaging findings is crucial for early diagnosis and management, particularly in post-COVID patients with progressive neurological decline.\u003c/p\u003e","manuscriptTitle":"Guillain-Barré Syndrome with Demyelinating Brain Lesions Following COVID-19: A Rare Neuroimaging Presentation Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-05 06:27:53","doi":"10.21203/rs.3.rs-6355693/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a32ece66-78da-406e-a907-e30b2fa7630f","owner":[],"postedDate":"May 5th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-16T11:40:19+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-05 06:27:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6355693","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6355693","identity":"rs-6355693","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}