INTRODUCTION: We report a case series two patients of Guillain-Barré syndrome (GBS) associated with previous COVID-19 that both patients survived. GBS is an immune-mediated disease that affects peripheral nerves and can cause life-threatening complications. CASE REPORTS: In both cases (53-year-old female and 59-year-old male) with severe GBS with complications, the smell of sense was investigated subjectively using Sniffin' sticks identification tests and objectively using objective olfactometry by the evaluation of olfactory event-related potentials (OERPs). Both patients had good results of the subjective Sniffin' sticks identification test without patholgical findings. Results of objective examination of OERPs: the P2-N1 wave complex was equipotent. No olfactory disturbance could be detected in either case, OERPs were plentiful in both cases. CONCLUSION: The presentation of a case series two patients of post-covid GBS are an example of one of the many complications of COVID-19 that can cause prolonged recovery. Despite the severe course of GBS and the long recovery time, both patients returned to normal life. An expanded prospective study is planned for the future to investigate post-covid olfactory impairment. The prevalence of GBS associated with COVID-19 is still unknown but it is evident that both mild and severe forms of GBS have been described in patients.

3rd Faculty of Medicine Charles University Prague Czech Republic

Department of Neurology Military University Hospital Prague Czech Republic

Department of Otorhinolaryngology and Maxillofacial Surgery Military University Hospital Prague Czech Republic

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Zuberbühler P, Conti ME, León-Cejas L, Maximiliano-González F, Bonardo P, Miquelini A, Halfon J, Martínez J, Gutiérrez MV, Reisin R. Guillain-Barre syndrome associated to COVID-19 infection: a review of published case reports. Rev Neurol 2021;72(6):203-12. doi: 10.33588/rn.7206.2020487 PubMed DOI

Park DH, Kang CK, Choe PG, Kim NJ, Park WB, Oh MD. How We Have Treated Severe to Critically Ill Patients With Coronavirus Disease 2019 in Korea. J Korean Med Sci 2022;37(49):e353. doi: 10.3346/jkms.2022.37.e353 PubMed DOI

Scheidl E, Diez Canseco D, Hadji-Naumov A, Bereznai B. Guillain-Barre syndrome during SARSCoV-2 pandemic: a case report and review of recet literature. J Peripher Nerv Syst 2020;25(2):204-7. doi: 10.1111/jns.12382 PubMed DOI

Romero-Sánchez CM, Díaz-Maroto I, Fernández-Díaz E, Sánchez-Larsen Á, Layos-Romero A, García-García J, González E, Redondo-Peñas I, Perona-Moratalla AB, Del Valle-Pérez JA, Gracia-Gil J, Rojas-Bartolomé L, Feria-Vilar I, Monteagudo M, Palao M, Palazón-García E, Alcahut-Rodríguez C, Sopelana-Garay D, Moreno Y, Ahmad J, Segura T. Neurologic manifestations in hospitalized patients with COVID-19: The ALBACOVID registry. Neurology 2020;95(8):e1060-e1070. doi: 10.1212/WNL.0000000000009937 PubMed DOI

Klimek L, Hagemann J, Döge J, Freudelsperger L, Cuevas M, Klimek F, Hummel T. Olfactory and gustatory disorders in COVID-19. Allergo J Int 2022;31(7):243-50. doi: 10.1007/s40629-02200216-7 DOI

Klimek L, Hagemann J, Hummel T, Altundag A, Hintschich C, Stielow S, Bousquet J. Olfactory dysfunction is more severe in wild-type SARS-CoV-2 infection than in the Delta variant (B.1.617.2). World Allergy Organ J 2022;15(6):100653. doi: 10.1016/j.waojou.2022.100653 PubMed DOI

Manganotti P, Pesavento V, Buoite Stella A, Bonzi L, Campagnolo E, Bellavita G, Fabris B, Luzzati R. Miller Fisher syndrome diagnosis and treatment in a patient with SARS-CoV-2. J Neurovirol 2020;26(4):605-6. doi: 10.1007/s13365-020-00858-9 PubMed DOI

Červený K, Janoušková K, Vaněčková K, Zavázalová Š, Funda D, Astl J, Holy R. Olfactory Evaluation in Clinical Medical Practice. J Clin Med 2022;11(22):6628. doi: 10.3390/jcm11226628 PubMed DOI

Vodička J, Pellant A, Chrobok V. Screening of olfactory function using odourized markers. Rhinology 2007;45(2):164-8.

Kovar D, Holy R, Voldrich Z, Fundova P, Astl J. The Contribution of CT Navigation in Endoscopic Sinus Surgery: An Evaluation of Patient Postoperative Quality of Life and Olfaction Function Results. Otorinolaryngol. Foniatr 2017;66(4):205-9.

Lapid H, Hummel T. Recording odor-evoked response potentials at the human olfactory epithelium. Chem Senses 2013;38(1):3-17. doi: 10.1093/chemse/bjs073 PubMed DOI

Huart C, Legrain V, Hummel T, Rombaux P, Mouraux A. Time-frequency analysis of chemosensory event-related potentials to characterize the cortical representation of odors in humans. PLoS One 2012;7(3):e33221. doi: 10.1371/journal.pone.0033221 PubMed DOI

Lötsch J, Hummel T. The clinical significance of electrophysiological measures of olfactory function. Behav Brain Res 2006;170(1):78-83. doi: 10.1016/j.bbr.2006.02.013 PubMed DOI

Dalakas MC. Guillain-Barré syndrome: The first documented COVID-19-triggered autoimmune neurologic disease: More to come with myositis in the offing. Neurol Neuroimmunol Neuroinflamm 2020;7(5):e781. doi: 10.1212/NXI.0000000000000781 PubMed DOI

Dubé M, Le Coupanec A, Wong AHM, Rini JM, Desforges M, Talbot PJ. Axonal Transport Enables Neuron-to-Neuron Propagation of Human Coronavirus OC43. J Virol 2018;92(17):e00404-18. doi: 10.1128/JVI.00404-18 PubMed DOI

Hummel T, Sekinger B, Wolf SR, Pauli E, Kobal G. 'Sniffin' sticks': olfactory performance assessed by the combined testing of odor identification, odor discrimination and olfactory threshold. Chem Senses 1997;22(1):39-52. doi: 10.1093/chemse/22.1.39 PubMed DOI

The importance of olfactory and trigeminal event-related potentials (OERPs/TERPs) in the assessment of olfactory function in subjects with chronic rhinosinusitis with nasal polyposis

Olfactory event-related potentials (OERPs) and trigeminal event-related potentials (TERPs) in subjects after Covid-19 infection: single-center prospective study

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