# Bilateral Facial Paralysis in an Atypical Clinical Onset of COVID-Associated Guillain-Barre Syndrome

## TL;DR

A 42-year-old man developed bilateral facial paralysis as an unusual symptom of Guillain-Barre Syndrome following a COVID-19 infection.

## Contribution

This case highlights an atypical clinical presentation of GBS associated with COVID-19, specifically bilateral facial paralysis.

## Key findings

- The patient exhibited bilateral facial paralysis five weeks after testing positive for COVID-19.
- Cerebrospinal fluid analysis showed albuminocytological dissociation, supporting a GBS diagnosis.
- The patient responded well to intravenous immunoglobulin therapy.

## Abstract

Coronavirus disease (COVID-19) has been associated with a diverse range of extrapulmonary manifestations since its global outbreak in 2019. One of its rare complications is Guillain-Barre Syndrome (GBS), a post-infectious neurological disorder that manifests with a characteristic ascending limb paralysis. Here, we describe the atypical case of a 42-year-old African American male who developed bilateral facial paralysis within five weeks of testing positive for COVID-19. Initial diagnostic imaging and blood studies were negative for acute pathology. Albuminocytological dissociation found in a subsequent analysis of the patient’s cerebrospinal fluid and his appropriate therapeutic response to intravenous immunoglobulin (IVIg) indicated GBS as the most likely diagnosis.