Two separate case series from India and the UK have reported a total of 11 cases of an unusual presentation of Guillain-Barré syndrome characterised by a noticeable facial weakness, following vaccination with AstraZeneca vaccine. These case series have been published in the Annals of Neurology.

• The first case series from Kerala described seven patients, who developed Guillain-Barré syndrome within 2 weeks of the first dose of vaccination. All patients progressed to areflexic quadriplegia and 6 of the 7 patients required mechanical ventilation for respiratory failure. All seven patients developed bilateral facial paresis, which usually occurs in fewer than 20% of unselected cases. Four patients also developed other cranial neuropathies such as abducens palsy and trigeminal sensory nerve involvement. Such cranial nerve involvement in Guillain-Barré syndrome is rare in India, occurring in less than 5% of cases.
• The second case series from the UK described four patients, who developed bifacial weakness (facial diplegia) and normal facial sensation with paraesthesias variant GBS. The onset of symptoms was within three weeks of the first dose of the vaccine.  Deep tendon reflexes were normal, and there were no objective sensorimotor signs in the limbs. Cerebellar, bulbar, and respiratory function were normal, as were extraocular movements. No evidence of dysautonomia was observed during their inpatient stays.

While these studies have definitely shown a temporal association with the vaccine, a cause and effect relationship is yet to be established.

The benefits of Covid-19 vaccines certainly outweigh the risks. And everybody should take the vaccine. The purpose of accounts of adverse effects such as these is to increase awareness, so that physicians remain alert about potential adverse effects such as these, so that timely action can be taken.

(Source: Ann Neurol 2021; DOI: 10.1002/ana.26143; Ann Neurol 2021; DOI: 10.1002/ana.26144)