Cause Of Acute Flaccid Paralysis Research Articles

A Case Report of Guillain-Barre Syndrome in an Eleven-Month Infant

Guillain-Barre syndrome (GBS) is an acute immune-mediated progressive predominantly motor symmetric polyradiculoneuropathy which causes demyelination and leads to weakness, ataxia and areflexia. There are a variety of forms of the syndrome; and despite being the most common cause of acute flaccid paralysis in children, it has a low incidence under 18 years old, and it is even rarer in children less than 2 years of age. Very few cases have been reported under 12 months of age. We describe a case of an 11-month-old male infant presenting with weakness and inability to ambulate who was diagnosed with GBS.

Description of non-polio enteroviruses identified in two national surveillance programmes in South Africa.

BackgroundHuman enteroviruses (EV) consist of 106 serotypes and four species: EV-A, EV-B, EV-C and EV-D. Enteroviruses cause clinical symptoms varying from severe to mild. Knowledge of EV burden in South Africa is limited, and as non-polio EV are important causes of acute flaccid paralysis (AFP) and meningitis, information on the circulating serotypes is vital.MethodsBetween 2010 and 2012, a total of 832 stool and viral isolate specimens were obtained from two national surveillance programmes at the National Institute for Communicable Diseases: the Rotavirus Sentinel Surveillance Programme (RSSP) and the AFP surveillance programme. Real-time polymerase chain reaction and Sanger sequencing were performed to detect and serotype EV.ResultsNon-polio EV were detected in 446 specimens, of which 308 were sequenced. Stool specimens yielded a greater variety of serotypes than viral cultures. EV-B viruses were predominant (58.44%), whilst EV-C viruses were detected in 31% of the specimens tested. South African prevalence for these viruses was higher than other countries, such as France with less than 2%, and Spain and the United States with less than 10%. The most common serotype detected was Enterovirus 99 (EV-C, 8.63%), which has not been reported in other regions.ConclusionDirect sequencing from stool specimens yields a broader, more comprehensive description of EV infections compared to sequencing from viral cultures. Disease-associated serotypes were detected, but only in small numbers. This study provides a baseline for EV strain circulation; however, surveillance needs to be expanded to improve EV knowledge in South Africa.

Etiology and Clinical Features of Acute Flaccid Paralysis among Children in Gadarif, Sudan

Acute Flaccid Paralysis (AFP) is a rare but a serious neurological condition characterized by sudden weakness or paralysis of one or more extremities, the respiratory or bulbar muscles and reduced muscle tone without other obvious cause. Death occurs in about 7.5% of AFP affected patients worldwide. AFP is the most common sign of acute polio. Therefore, AFP studies are important for surveillance during polio outbreaks to differentiate polio cases from AFP cases. There is a lack of information about the clinical features & causative factors of AFP among children in Gadarif, Sudan. The identification of AFP cases and its causative factors are important in the management & prevention of the disease. This study assessed the etiology and the clinical features of AFP among children in Gadarif, Sudan aiming at effective management & prevention of the disease. It was a prospective cross sectional study conducted at Gadarif Pediatrics Teaching Hospital during the period of January 2017-December 2019. It comprised 73 children with confirmed AFP, ages 6 months to < 15 years old. Our study revealed that Poliomyelitis was not the cause of AFP. AFP was significantly affected children with youngest ages 0-5 years old and from the rural areas. Guillain-Barré syndrome (GBS) was the leading cause of AFP followed by meningitis, traumatic neuritis and hypokalemia and we believed that infections were the main triggers of GBS. Gender did not affect the prevalence of the AFP. Fever and paraplegia were the most prevalent clinical signs at onset of the weakness. Over 50% of the AFP victims showed symmetric paralysis. It is obviously that AFP-based awareness, provision of high-quality health services and fighting of illiteracy and poverty in the rural areas of Sudan are urgently needed for effective management of AFP.

Clinical audit on the management of Guillain-Barre syndrome cases admitted to Assiut University Children Hospital

Introduction Guillain-Barre syndrome (GBS) is the most common cause of acute flaccid paralysis in children. It is characterized by progressive, symmetrical weakness, and areflexia in a previously healthy child. GBS should be diagnosed quickly in patients presenting with rapidly progressive paralysis. Meticulous monitoring and supportive care are needed in all GBS patients. Efforts focus on the follow-up of clinical course and outcome to improve the care and treatment of individual patients. Materials and methods The study included pediatric patients with GBS referred to Assiut University Children Hospital in 9 months from November 2016 to July 2017. Information was taken from resident doctors and mothers. Results Intravenous immunoglobulin (IVIG) was administered to 17 (80.95%) cases. Four (19.05%) cases who presented in the improving phase of motor disability were managed supportively and recovered completely. Plasmapheresis was done to three (14.3%) cases, who did not respond well to IVIG. Complete recovery was observed in 17 (80.95%) cases and four (19.05%) cases experienced only incomplete recovery. Discussion Nerve conduction velocity is very useful to diagnose GBS. IVIG and supportive care are considered key elements in the management of childhood GBS. IVIG administration early in the course of the disease results in better recovery. Plasmapheresis may be an effective option in cases with poor response to IVIG therapy.

Guillain-Barré Syndrome.

This article reviews the clinical features, diagnosis and differential diagnosis, prognosis, pathogenesis, and current and upcoming treatments of Guillain-Barré syndrome (GBS). GBS is an acute inflammatory neuropathic illness with striking clinical manifestations and significant morbidity. A substantial proportion of patients with GBS do not respond to current immunomodulatory therapies (ie, plasma exchange and IV immunoglobulin [IVIg]), highlighting the need for new therapies. Prognostic models that can accurately predict functional recovery and the need for artificial ventilation have emerged. These models are practical, and online calculators are available for clinical use, facilitating early recognition of patients with poor outcome and the opportunity to personalize management decisions. Clinical and experimental studies have identified innate immune effectors (complement, macrophage lineage cells, and activating Fcγ receptors) as important mediators of inflammatory nerve injury. Two complement inhibitors are undergoing clinical testing for efficacy in GBS. GBS is the most common cause of acute flaccid paralysis in the United States and worldwide. New treatments for GBS have not emerged since the 1990s. Our understanding of the pathogenesis of this disorder has progressed, particularly over the past decade; as a result, new therapeutic agents targeting different components of the complement cascade are at advanced stages of clinical development.

Difficulties of differential diagnostics of Guillain–Barré syndrome in children. The discussion of two clinical cases

Guillain–Barré syndrome – an acute demyelinating autoimmune disease characterized by lesions of the peripheral nervous system and consequently peripheral paralysis, paresthesias and/or pain. Guillain–Barré syndrome is a predominant cause of acute flaccid paralysis, which may occur at any age. We present two clinical cases of flaccid paralysis with patients at the age of 7 and 5 years requiring verification of the diagnosis.

A CASE REPORT ON GUILLAIN BARRE SYNDROME (G B SYNDROME) IN CHILD – AN SUCCESSFUL APPROACH IN AYURVEDA

Guillain Barre Syndrome is an autoimmune disorder encompassing a heterogeneous group of pathological and clinical entities. Antecedent infections are thought to trigger an immune response which subsequently cross reacts with nerves leading to demyelination or axonal degeneration. The condition can occur at any age. One of the earliest descriptions of what we know today as guillian barre syndrome is found in Land-ry’s report on 10 Patients with “ascending paralysis” in 1859. The annual incidence of G B Syndrome is around 1-3/100000 population according to epidemiological studies from Europe, USA and Australia. The age specific curve seems to show a bimodal distribution with peaks in young adults and the elderly. The risk of G B Syndrome is lower during pregnancy and increases after delivery. However, it can occur to children as well which is the common cause of acute flaccid paralysis (AFP) wherein the clinical features are acute paralysis evolving over days or weeks with loss of tendon reflexes. Pain is the most common symptom experienced by the patients. Here is a case report on a child aged 2 and half years suffering from G B syndrome who underwent Panchakarma treatment in Ayurveda under 2 phases that include Sarvanga Abhyanga, Sarvanga Shastika Shali Pinda Sweda, Dhanyamla Dhara, Agnilepa, Rajayapana Basti along with Physiotherapy and there were significant results observed.

Clinical Course and Predictors of Poor Functional Outcome in Guillain-Barré Syndrome. A Retrospective Study

Introduction: Guillain-Barré syndrome (GBS) is the most common cause of acute flaccid paralysis. It carries great morbidity due to an overall high rate of poor functional outcome. This study is conducted to study the predictors of poor functional outcome. Methods: This study a retrospective observational study, which was conducted in Rashid Hospital Tertiary Center in Dubai between 2009 and 2019. Functional status was assessed and followed by the GBS disability score. Functional outcome at 6 months was evaluated for possible predicting factors as well as associated outcomes. Results: Out of the 82 cases, the mean age at presentation is 37 ± 14.4, with 64 (78%) males. Around one-third of cases (37.8%) had residual deficits at 6 months. Follow-up after 6 months showed that cases with a poor functional outcome are older (p = 0.035) and have presented with a high disability score (p < 0.001) and a higher need for mechanical ventilation (p < 0.001). Axonal type of nerve injury resulted in poor functional outcome at 6 months compared to the demyelinating type of nerve injury (p = 0.034). Lower rate of improvement at 1 month and poor functional outcome at 6 months resulted in a longer hospital stay (p < 0.001). Conclusion: A poor functional status at presentation, axonal type of nerve injury, and the early requirement for mechanical ventilation are found to predict poor functional improvement after 6 months from diagnosis. These factors must be kept in consideration to facilitate more vigilant management of patient’s associated high morbidity.

Acute Flaccid Myelitis: A Single Pediatric Center Experience From 2014 to 2019.

Acute flaccid myelitis has emerged as the leading cause of acute flaccid paralysis in children. Acute flaccid myelitis leads to significant physical disability; hence, objective outcome measures to study disease severity and progression are desirable. In addition, nerve transfer to improve motor function in affected children needs further study. Retrospective study of acute flaccid myelitis subjects managed at Children's Healthcare of Atlanta from August 2014 to December 2019. Clinical, electromyography and nerve conduction study, neuropsychological functional independence (WeeFIM), and nerve transfer data were reviewed. Fifteen children (11 boys and 4 girls) mean age 5.1±3.2 years (range 14 months to 12 years) were included. All subjects (n = 15) presented with severe asymmetric motor weakness and absent tendon reflexes. Motor nerve conduction study of the affected limbs in 93% (n = 14) showed absent or markedly reduced amplitude. Ten patients received comprehensive inpatient rehabilitation and neuropsychological evaluation. Admission and discharge WeeFIM scores showed deficits most consistent and pronounced in the domains of self-care and mobility. Multiple nerve transfer surgery was performed on 13 limbs (9 upper and 4 lower extremities) in 6 children. Postsurgery (mean duration of 10.4 ± 5.7 months) follow-up demonstrated improvement on active movement scale (AMS) in 4 subjects. Acute flaccid myelitis affects school-age children with asymmetric motor weakness, absent tendon reflexes, and reduced or absent motor amplitude on nerve conduction study. Comprehensive rehabilitation and nerve transfer led to improvement in motor function on neuropsychology WeeFIM and AMS scores.

A nomogram to predict mechanical ventilation in Guillain-Barré syndrome patients.

Guillain-Barré syndrome (GBS) is one of the most common causes of acute flaccid paralysis, with up to 20%-30% of patients requiring mechanical ventilation. The aim of our study was to develop and validate a mechanical ventilation risk nomogram in a Chinese population of patients with GBS. A total of 312 GBS patients were recruited from January 1, 2015, to June 31, 2018, of whom 17% received mechanical ventilation. The least absolute shrinkage and selection operator (LASSO) regression model was used to select clinicodemographic characteristics and blood markers that were then incorporated, using multivariate logistic regression, into a risk model to predict the need for mechanical ventilation. The model was characterized and assessed using the C-index, calibration plot, and decision curve analysis. The model was validated using bootstrap resampling in a prospective study of 114 patients recruited from July 1, 2018, to July 10, 2019. The predictive model included hospital stay, glossopharyngeal and vagal nerve deficits, Hughes functional grading scale scores at admission, and neutrophil/lymphocyte ratio (NLR). The model showed good discrimination with a C-index value of 0.938 and good calibration. A high C-index value of 0.856 was reached in the validation group. Decision curve analysis demonstrated the clinical utility of the mechanical ventilation nomogram. A nomogram incorporating hospital stay, glossopharyngeal and vagal nerve deficits, Hughes functional grading scale scores at admission, and NLR may reliably predict the probability of requiring mechanical ventilation in GBS patients.

Molecular Pathogenicity of Enteroviruses Causing Neurological Disease.

Enteroviruses are single-stranded positive-sense RNA viruses that primarily cause self-limiting gastrointestinal or respiratory illness. In some cases, these viruses can invade the central nervous system, causing life-threatening neurological diseases including encephalitis, meningitis and acute flaccid paralysis (AFP). As we near the global eradication of poliovirus, formerly the major cause of AFP, the number of AFP cases have not diminished implying a non-poliovirus etiology. As the number of enteroviruses linked with neurological disease is expanding, of which many had previously little clinical significance, these viruses are becoming increasingly important to public health. Our current understanding of these non-polio enteroviruses is limited, especially with regards to their neurovirulence. Elucidating the molecular pathogenesis of these viruses is paramount for the development of effective therapeutic strategies. This review summarizes the clinical diseases associated with neurotropic enteroviruses and discusses recent advances in the understanding of viral invasion of the central nervous system, cell tropism and molecular pathogenesis as it correlates with host responses.

Clinical profile and predictors for outcome in children presenting with Guillain-Barré syndrome.

Introduction:Acute Flaccid Paralysis (AFP) is a group of diverse clinical conditions with Guillain–Barré syndrome (GBS) as one of the most common cause. The aim of this study was to study the clinical features and predictors for the requirement of ventilation in children with GBS.Materials and Methods:This is a prospective observational study done at a tertiary care hospital where all consecutive children less than 15 years who presented with AFP were enrolled. Demographic characteristics, symptomatology, and physical findings of those patients who were diagnosed with GBS were recorded using a pre-defined questionnaire. Univariate analysis was done to identify clinical variables associated with a higher requirement of ventilation.Results:Of a total of 53 children with AFP enrolled in the study, a total of 30 patients were diagnosed with GBS. A total of 12 (40%) patients required ventilation, while five of these patients eventually died. The following variants of GBS were identified: AIDP (13/30), AMAN (12/30), and ASMAN (2/30). Lower limbs were affected in 97% of the patients, whereas upper limbs were affected in 83% of the patients. Deep tendon reflexes of the upper limb and lower limb were preserved in 56% and 7% of the patients, respectively. Presence of antecedent URTI was associated with a lower requirement of ventilation. Presence of bulbar palsy, lower upper limb power on presentation, and absence of deep tendon reflex in upper limbs were associated with a higher requirement of ventilation.Conclusion:GBS is an important cause of AFP in India with no significant difference between the variants in terms of frequency and prognosis. Simple physical findings can be used by primary care physicians to predict the requirement of higher levels of care.

Guillain-Barre, Syndrome: Clinical Profile

Guillain–Barre Syndrome (GBS) is an acute, immune-mediated polyradiculoneuropathy and an important cause of acute flaccid paralysis (AFP) worldwide. Respiratory insufficiency requiring v entilator occurs in 30% of patients that prolong the hospital stay, leading to morbidity and mortality. There had been relatively few studies of Guillain-Barresyndrome in adults from North India. Objective: To evaluate clinical profile, epidemiological, laboratory and electro-diagnostic feature of patients with Guillain Barre Syndrome in adults and use of intravenous immunoglobulin (IVIg) in addition to supportive care. Materials and Methods: This was a prospective study of 50 patients with GBS admitted to our medicine department in rural tertiary care institution Dr.RPGMC Tanda. We studied the epidemiological, clinical, electrophysiological features and their outcome.Result In our study 50 cases were taken, motor weakness was the most common presenting feature. Antecedent illness was found in 48% of cases in the preceding two weeks, which included nonspecific illness, acute respiratory infection, diarrhea, and viral infection like chickenpox. At onset, sensory symptoms (pain and paresthesia) were noted in 16% of the cases and limb weakness in 77%. On admission, a majority (64%) was in Hughes neurological disability grading stage III-IV’ all had limb weakness at the peak deficit; autonomic disturbance was seen in 35.8%, and bulbar palsy in 6%. Duration of illness was less than three weeks in 60% of cases. The one patient had undergone repiratory distress and kept on ventilator for 23 days and survived. Conclusions: Male preponderance and motor weakness was the most common presenting illness and a majority achieved full recovery in our study. Although IVIg may be useful in the treatment of GBS, the key issue is excellent intensive care unit management.

Acute Motor Axonal Neuropathy in a 5-Month-Old Child

AbstractGuillain–Barré syndrome (GBS) is an acute inflammatory polyneuropathy characterized by rapidly progressive, essentially symmetric weakness and areflexia in a previously otherwise healthy child. It is the most common cause of acute flaccid paralysis in children, and its reported incidence is 1 to 2/100,000 population. Prior infection is a well-established predating event in GBS. The commonly recognized variants of GBS are acute inflammatory demyelinating polyneuropathy (AIDP), acute motor axonal neuropathy (AMAN), acute motor sensory axonal neuropathy, and Miller–Fisher syndrome. AIDP is the most prevalent form. As Guillain–Barrè syndrome represents an important differential diagnosis in infancy with pronounced and progressive hypotonia, we herein report a case of AMAN in a 5-month-old male infant without known exposure to immunomodulating factors or infections.

Evaluation of the Acute Flaccid Paralysis Surveillance System in Polio-Free Jordan, 2012-2016: Retrospective Secondary Analysis.

BackgroundAs part of the polio-eradication strategy, the World Health Organization (WHO) has established a global acute flaccid paralysis (AFP) surveillance system. AFP surveillance has successfully helped Jordan achieve polio-free certification. However, there is a substantial risk of polio importation from neighboring countries including Syria and Iraq.ObjectiveThis study aimed to evaluate the AFP surveillance in Jordan and identify areas that need improvement.MethodsThis retrospective study is a secondary analysis of data that were routinely collected between 2012 and 2016 by Jordan’s Expanded Program on Immunization. The WHO’s minimum performance indicators were used to evaluate the AFP surveillance.ResultsCumulatively, 328 AFP cases had been reported. Almost half (n=168, 51.3%) of the patients were aged 1-5 years, and 55.8% (n=183) were male. All cases were discarded (classified as a nonpolio case). The most common cause of AFP was Guillain-Barre Syndrome (n=115, 35.1%). The annualized nonpolio AFP rate increased from 1.4/100,000 children below 15 years of age in 2012 to 4.3 in 2016. National and subnational sensitivities were not met in 2012 and 2013. Adequacy of stool specimens and timeliness of specimens arriving at and processed in the laboratory were constantly above the minimum target. Timeliness of the investigation met the expected target but with a decreasing trend. The nonpolio enterovirus isolation rate was below the target, except in 2016.ConclusionsThe AFP surveillance system in Jordan is performing well; however, additional efforts are needed to strengthen the subnational sensitivity. The cold chain from sample collection to laboratory testing has to be maintained to ensure the reliability of stool specimens required for isolation of the nonpolio enterovirus.

A RARE CASE OF RECURRENT GUILLAIN BARRE SYNDROME.

After the reduction of poliomyelitis, Guillain–Barre syndrome (GBS) has become the most common cause of acute flaccid paralysis in the developed and developing countries. Although it is a monophasic illness, GBS might reoccur in 1–6% of patients, after an asymptomatic period of several months to years. Risk factors for recurrent GBS (RGBS) include age less than 30, milder symptoms, and history of Miller-Fisher syndrome variant in the first episode. A recurrence was defined as two or more episodes that fulfilled the National Institute of Neurological and Communicative Disorders and Stroke criteria for GBS, with a minimum time between episodes of 2 months (when fully recovered in between) or 4 months (when only partially recovered). There appears to be no significant difference between GBS and RGBS episodes with respect to clinical symptoms and triggering events. We report a 12-year-old girl who presented with a second attack of GBS after an interval of 6 years with similar signs and symptoms. Nerve conduction study in both the episodes was of acute motor axonal neuropathy variety.

Incidence of Guillain-Barré Syndrome (GBS) in Latin America and the Caribbean before and during the 2015-2016 Zika virus epidemic: A systematic review and meta-analysis.

BackgroundA severe neurological disorder, Guillain-Barré syndrome (GBS) is the leading cause of acute flaccid paralysis. Enhanced surveillance of GBS in Latin America and the Caribbean (LAC) following the 2015–2016 Zika virus (ZIKV) epidemic presents an opportunity to estimate, for the first time, the regional incidence of GBS.Methods and findingsFor this systematic review and meta-analysis, we searched nine scientific databases and grey literature from January 1, 1980 to October 1, 2018. Sources with primary data on incident GBS cases in LAC within a well-defined population and timeframe, published in English, Spanish, Portuguese, or French, were included. We calculated the annual GBS incidence rates (IRs) and 95% confidence intervals (CIs) for each source based on published data. Following an assessment of heterogeneity, we used random-effects meta-analysis to calculate the pooled annual IR of GBS. The study is registered with PROSPERO, number CRD42018086659. Of the 6568 initial citation hits, 31 were eligible for inclusion. Background annual GBS IRs in Latin America ranged from 0.40 in Brazil to 2.12/100,000 in Chile. The pooled annual IR in the Caribbean was 1.64 (95% CI 1.29–2.12, I2<0.01, p = 0.44). During the ZIKV epidemic, GBS IRs ranged from 0.62 in Mexico to 9.35/100,000 in Martinique. GBS increased 2.6 (95% CI 2.3–2.9) times during ZIKV and 1.9 (95% CI 1.1–3.4) times during chikungunya outbreaks over background rates. A limitation of this review is that the studies included employed different methodologies to find and ascertain cases of GBS, which could contribute to IR heterogeneity. In addition, it is important to consider that data on GBS are lacking for many countries in the region.ConclusionsBackground IRs of GBS appear to peak during arboviral disease outbreaks. The current review contributes to an understanding of the epidemiology of GBS in the LAC region, which can inform healthcare system planning and preparedness, particularly during arboviral epidemics.Trial registrationRegistered with PROSPERO: CRD42018086659.

Clinical, Autonomic &amp; Electrophysiological Features in Patients with Guillain Barre Syndrome in a Tertiary Care Hospital of Bangladesh

Background: Guillain-Barre Syndrome (GBS) is the most common cause of acute flaccid paralysis in the adult population. It is an acute post infectious immune mediated peripheral neuropathy with a marked variation in pathology, clinical presentation and prognosis.&#x0D; Objective: The aim of the study were to evaluate clinical profile, to assess autonomic involvement &amp; electrophysiological findings in adult patients with GBS.&#x0D; Methods: An observational, cross sectional study was carried out in the Department of Neurology, BSMMU, Dhaka from March, 2015 to September, 2017. Total 43 patients of GBS fulfilling the inclusion criteria were recruited as the study population. Detailed clinical examination, CSF study &amp; nerve conduction study were done. Disability status was measured by Hughes functional grading scale. For autonomic assessment 35 adult healthy control were also included for comparison. Then following tests of autonomic nervous system were performed in both patient and control group 1) resting heart rate and heart rate on changing posture (30: 15 ratio) 2) supine blood pressure and blood pressure on changing posture 3) heart rate response to valsalva maneuver 4) heart rate response to deep breathing and E: I ratio 5) sphincter disturbance by symptoms questionnaire.&#x0D; Results: The mean age of patients was 35±12 years (range18 to 65 years) with slight male predominance (58.1%). Major clinical presentation was weakness of all 4 limbs followed by sensory complaints (44.2%). 7% of the patient had breathing difficulty and dysphagia. Only 4.7 % had diplopia. Among the symptoms of autonomic dysfunction most common symptoms was constipation (30.2 %) followed by palpitation (14%), urinary retention (7%), lightheadedness and urinary incontinence (4.7%). Cranial nerve palsy was present in 34.9% of cases among them facial palsy was found commonly (27.9%), followed by bulbar palsy (7%) and ophthalmoplegia (4.7%). One patient (2.3%) had both facial palsy and ophthalmoplegia. AIDP, AMAN and AMSAN subtypes comprised 32.6%, 37.2% and 20.9% of cases respectively. Regarding autonomic dysfunction variation of heart rate by different maneuver like posture change, deep breathing and valsalva maneuver was found commonly. 30:15 ratio was abnormal in majority of the patients (82.4%) followed by abnormal max-min HR/min on deep breathing (58.1%) and abnormal valsalva ratio (37.2%). Other abnormalities were postural hypotension (38.2%), sinus tachycardia (25.6%), hypertension (16.3%), hypotension (4.7%), and sinus arrhythmia (4.7%). Bowel bladder dysfunction was another autonomic dysfunction among them constipation 30%, urinary retention 7% and urinary incontinence 4.7% of cases.&#x0D; Conclusion: GBS can be presented with variable presentation including autonomic dysfunction. In this study common clinical presentation was limb weakness &amp; different patterns of autonomic dysfunction was found in patients with GBS. Common electrophysiological subtype was AMAN. So in addition to clinical &amp; electrophysiological analysis autonomic evaluation is essential in every patients with GBS as autonomic dysfunction is one of important cause of mortality.&#x0D; Bangladesh Journal of Neuroscience 2019; Vol. 35 (2): 57-62

Cryptococcal meningitis presenting as acute flaccid paralysis: A case report

Cryptococcus is a cosmopolitan fungus with tropism for the nervous system and a higher prevalence of infection in immunosuppressed patients. Neurological compromise caused by this microorganism mainly debuts as a meningeal syndrome (headache, fever, neck stiffness) with predominant encephalic involvement. In this report we present the rare case of a non-HIV patient with flaccid paralysis and peripheral nerve involvement due to crytpococcal meningitis. This is a 53-years-old woman, with a past-medical history of diabetes, who presented with dysarthria, unilateral peripheral facial paralysis, asymmetric ascending quadriparesis, generalized hyporeflexia and urinary retention. Neuroimaging was initially reported as negative for vascular or demyelinating diseases. Electrophysiological studies were performed, and acute flaccid paralysis of undetermined etiology was defined as a temporal clinical diagnosis. Cerebrospinal fluid molecular analysis confirmed the presence of Cryptococcus neoformans var. gatti; posteriorly, antifungal treatment with amphotericin B and fluconazole was started. Polyneuroradiculopathy symptoms significantly improved over the in-hospital stay. In conclusion, spinal cord and peripheral nerve involvement by Cryptococcus is an infrequent cause of acute flaccid paralysis that should be considered in the differential diagnosis even in HIV-negative patients.

A follow-up study on Guillain-Barre syndrome and validation of Brighton criteria

Background: Guillain-Barre syndrome (GBS) is the major cause of acute flaccid paralysis (AFP). Comprehensive classification and predictive measures need to be created for GBS. This study was conducted to evaluate GBS patients' prognosis and Brighton criteria validity in Iranian population. Methods: This retrospective cohort study was conducted using medical records of patients with GBS admitted to Ghaem Hospital, Mashhad, Iran. After collecting data from cerebrospinal fluid (CSF) analysis, nerve conduction studies, and clinical examinations, Brighton criteria and GBS disability scores were calculated. Patients ultimately received follow-up telephone calls after 15 to 45 months of admission, checking on one's clinical status and the ability to walk independently. Data were analyzed using SPSS software. Results: Patients were mostly men (78.0%) with the mean age of 48.58 years. GBS onset was reported more frequently in spring. According to Brighton criteria, 41.4%, 51.6%, and 7.0% of the patients were classified as levels 1, 2, and 4, respectively. For GBS disability score, 54.7%, 16.4%, 9.4%, and 6.2% of the patients had grades of 4, 3, 2, and 1, respectively. 37 patients (39.4%) restored the ability to walk within the first month, while 3 patients (3.2%) were unable to walk by the end of the second year. Significant relationship was observed between the ability of walking independently and GBS disability score (P < 0.001). Conclusion: In the Iranian GBS population, less than half of the patients met level 1 of Brighton criteria and more than half of them reached the GBS disability score of 4, and walking ability was correlated to GBS disability score.