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Bilateral facial weakness with paraesthesia variant of Guillain-Barré syndrome following Vaxzevria COVID-19 vaccine
  1. Guendalina Beatrice Bonifacio1,
  2. Dharmini Patel1,
  3. Sarah Cook1,
  4. Elena Purcaru1,2,
  5. Michael Couzins1,3,
  6. Janine Domjan1,3,
  7. Suzanne Ryan1,
  8. Ahmad Alareed3,
  9. Orla Tuohy1,3,
  10. Sean Slaght1,3,
  11. Julian Furby1,4,
  12. David Allen1,
  13. Haider A Katifi1,
  14. Lucy Kinton1
  1. 1 Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
  2. 2 Department of Neurology, Poole Hospital, Poole, UK
  3. 3 Department of Neurology, Queen Alexandra Hospital, Portsmouth, UK
  4. 4 Department of Neurology, Isle of Wight NHS Trust, Newport, UK
  1. Correspondence to Dr Guendalina Beatrice Bonifacio, Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; guendalina.bonifacio{at}

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Guillain-Barré syndrome (GBS) is a heterogeneous disorder causing muscle weakness, sensory change, dysautonomia and often involving cranial neuropathies. An immune response to recent infection or to triggers such as vaccines, is thought to be responsible. Immunological cross-reaction with the peripheral nerve causes subsequent demyelinating or axonal damage.

GBS is a continuous spectrum of disease rather than discrete phenotypes. Recognised GBS variants in order of frequency are: (1) classical; (2) Miller Fisher syndrome; (3) pharyngeal-cervical-brachial; (4) bifacial weakness with paraesthesia of limbs (BFP); and (5) paraparetic.1

At the time of publication, no reports of BFP variant GBS post COVID-19 vaccination have been described.

We report five remarkably similar cases of BFP post-Vaxzevria. All of them presented to Wessex hospitals: Queen Alexandra Hospital, Portsmouth; Southampton General Hospital; Poole Hospital; and St Mary’s Hospital, Isle of Wight, within a 3-month period.

Case 1

A 66-year-old man developed interscapular back and leg pain, particularly severe at night, 1 week after his first dose of Vaxzevria. He had paraesthesia of both hands and feet and was unsteady. Ten days later, he developed bilateral facial weakness with numbness of the tongue and mouth.

Examination revealed marked bilateral lower motor neuron (LMN) facial weakness. Tone, power and reflexes were normal in the limbs except absent right ankle jerk. Light touch and pinprick sensation was reduced symmetrically in both lower limbs to the knee and vibration to the ankles. His gait was ataxic.

Case 2

A 43-year-old man …

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  • Contributors GBB and DP were responsible for the planning, drafting, execution and final amendments to this letter as first coauthors. SC and EP were involved in the drafting and execution stages. MC, JD, SR, AA, OT, SS, JF, DA and HAK are contributing authors in the critical revision and provision of supplementary information. LK has contributed to planning, execution, critical revision and final amendments and is the overall guarantor to this letter.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.