Guillain–Barré syndrome after SARS-CoV-2 vaccination in a patient with previous vaccine-associated Guillain–Barré syndrome

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Figure 1:
Waveforms from (A) motor and (B) sensory nerve conduction studies of a 63-year-old man with Guillain–Barré syndrome (GBS). These nerve conduction studies are compatible with GBS, with both axonal and demyelinating features, as shown by decreased velocity and decreased amplitude. The motor deficit was most pronounced in the left fibular (peroneal) and tibial nerves, as shown by the complete lack of conduction. A severe sensory deficit was also present in the sensory nerves studied. Note: Abv = above, AHB = abductor hallucis brevis, ADM = abductor digiti minimi, APB = abductor pollicis brevis, Bel = below, EDB = extensor digitorum brevis, mA = milliamps, ms/Div = millisecond per division, mV/Div = millivolt/division, NCS+ = nerve conduction study, μs = microseconds.

Table 1:

Nerve conduction studies from a 63-year-old man with Guillain–Barré syndrome^*

Sites	Latency, ms	Amplitude, mV	Negative area, ms*mV	Minimum F-wave latency, ms	Distance, cm	CV, m/s
Motor sites
Left median (APB)
Wrist	14.9	2.3	13.7	NR	7
Elbow	20.4	1.67	11.5		23	42
Left ulnar (ADM)
Wrist	3.6	6.4	23.5	37.6	6
Below elbow	8.3	5.0	21.8		27	57
Above elbow	11.4	4.8	21.5		11	35
Left radial (EIP)
Forearm	2.9	5.4	26.9		8
Upper arm	8.9	3.8	17.9		26	43
Axilla	9.1	2.1	10.2		-	-
Wrist				NR
Left fibular (EDB)
Ankle	NR	NR	NR		9
Left fibular (tibial anterior)
Fibular head	4.5	3.8	24.4		-
Popliteal fossa	7.5	3.8	-		10	33
Left tibial (AHB)
Ankle	NR	NR	NR		-
Left facial (nasalis)
Mastoid	5.4	0.63	3.0
	Onset latency, ms	Peak latency, ms	Amplitude of onset potential, μV	*Negative area, msμV**	Distance, cm	CV, m/s
Sensory sites
Left median
Wrist-digit II	NR	NR	NR	NR	14	NR
Left ulnar
Wrist-digit V	NR	NR	NR	NR	12	NR
Left sural
Calf-latency mall	NR	NR	NR	NR	14	NR
Left superficial peroneal
12 cm AMM	NR	NR	NR	NR	12	NR

Note: ADM = abductor digiti minimi, AHB = abductor hallucis brevis, AMM = anterior medial malleolar, APB = abductor pollicis brevis, CV = conduction velocity, EDB = extensor digitorum brevis, EIP = extensor indicis proprius, NR = no response.
↵* Latency is the time it takes for the impulse to generate a response. In demyelination, this is prolonged, as shown in the latency times for the wrist (normal < 2.2 ms) and elbow (normal < 4.4 ms) of the left median APB, and at the wrist of the left ulnar ADM (normal < 2.2 ms). F-wave is a measure of motor conduction time of the entire nerve. In demyelination, this is prolonged, as shown in the left ulnar ADM.