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

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.