Presentation Of Guillain-Barré Syndrome Research Articles

Systemic lupus erythematosus presenting as Guillain‒Barre syndrome

A 37-year-old male patient presented with acute symmetrical ascending areflexic flaccid quadriparesis progressive in nature for the past 6 days before admission preceded by tingling sensation in both hands and feet with the right-sided lower motor type of facial nerve palsy for 2 days. Clinically, this was consistent with Guillain–Barre (GB) syndrome and was given intravenous immunoglobulin (IVIG). Cerebrospinal fluid study and nerve conduction study also supported the clinical diagnosis of GB syndrome. He developed Type 2 respiratory failure on the 4th day of admission for which he was intubated. After successful extubation, his weakness even worsened markedly despite IVIG therapy and was subjected to plasmapheresis following which the weakness improved remarkably. On further investigation for the associated fever, arthralgia, pallor, nephritis, antinuclear antibody (3+ coarse speckled pattern), anti-smith antibody, and anti-dsDNA antibody positivity were detected with low serum complement levels, and renal biopsy revealing class III lupus nephritis. He was put on oral corticosteroids and cyclophosphamide which resulted in further clinical improvement. The initial presentation of GB syndrome of systemic lupus erythematosus is uncommon and makes this case interesting.

A rare presentation of Guillain-Barre syndrome with GQ1b positivity: A case report

A rare presentation of Guillain-Barre syndrome with GQ1b positivity: A case report

Prompt identification of loss of voice in a child can save a life, Guillian-Barre syndrome with vocal cord paralysis in a young boy

Guillain-Barre syndrome presenting as bilateral vocal cord paralysis is extremely rare in the paediatric age group. We report an unusual case of GBS in which the patient manifested loss of voice resulting from bilateral vocal cord paralysis with lower limb weakness. In conclusion, we emphasize that early recognition of atypical presentations of GBS warrants complete evaluation and institution of prompt and appropriate management.

Unusual clinical presentation of Guillain Barre syndrome: a case report

Background: Guillen barre syndrome is the most frequent cause of flaccid paralysis in the world, it is characterized by an acute demyelinating, autoimmune and multiple etiology polyneuropathy, among which are included infectious agents such as Campylobacter jejuni, Zika virus, of genetic and environmental factors.
 Case Report: We present the case of a 56-year-old Colombian male patient with a history of hypertension, who entered the intensive care unit with symptoms of atypical asymmetric motor neurological compromise, which rapidly progressed to ventilatory failure and subsequent confinement síndrome.
 Discussion: Guillen barre síndrome establishes a potentially fatal disease, the semiology of pain, paresthesia, symmetric-progressive, distal weakness, instability, hipo/areflexia, constitute a neurological emergency. There are Clinical variants establishing a great.

Rare presentation of Guillain-Barre syndrome with complete heart block and neuropathic chest pain mimicking acute coronary syndrome: a case report

Rare presentation of Guillain-Barre syndrome with complete heart block and neuropathic chest pain mimicking acute coronary syndrome: a case report

An unusual presentation of Guillain-Barre Syndrome: Bilateral ptosis with anti-GQ1b Antibody Positivity

An unusual presentation of Guillain-Barre Syndrome: Bilateral ptosis with anti-GQ1b Antibody Positivity

Zika virus disease, microcephaly and Guillain-Barr\xe9 syndrome in Colombia: epidemiological situation during 21\xa0months of the Zika virus outbreak, 2015\u20132017

BackgroundThe Zika virus disease (ZVD) has had a huge impact on public health in Colombia for the numbers of people affected and the presentation of Guillain-Barre syndrome (GBS) and microcephaly cases associated to ZVD.MethodsA retrospective descriptive study was carried out, we analyze the epidemiological situation of ZVD and its association with microcephaly and GBS during a 21-month period, from October 2015 to June 2017. The variables studied were: (i) ZVD cases, (ii) ZVD cases in pregnant women, (iii) laboratory-confirmed ZVD in pregnant women, (iv) ZVD cases associated with microcephaly, (v) laboratory-confirmed ZVD associated with microcephaly, and (vi) ZVD associated to GBS cases. Average number of cases, attack rates (AR) and proportions were also calculated. The studied variables were plotted by epidemiological weeks and months. The distribution of ZVD cases in Colombia was mapped across the time using Kernel density estimator and QGIS software; we adopted Kernel Ridge Regression (KRR) and the Gaussian Kernel to estimate the number of Guillain Barre cases given the number of ZVD cases.ResultsOne hundred eight thousand eighty-seven ZVD cases had been reported in Colombia, including 19,963 (18.5%) in pregnant women, 710 (0.66%) associated with microcephaly (AR, 4.87 cases per 10,000 live births) and 453 (0.42%) ZVD associated to GBS cases (AR, 41.9 GBS cases per 10,000 ZVD cases). It appears the cases of GBS increased in parallel with the cases of ZVD, cases of microcephaly appeared 5 months after recognition of the outbreak. The kernel density map shows that throughout the study period, the states most affected by the Zika outbreak in Colombia were mainly San Andrés and Providencia islands, Casanare, Norte de Santander, Arauca and Huila. The KRR shows that there is no proportional relationship between the number of GBS and ZVD cases. During the cross validation, the RMSE achieved for the second order polynomial kernel, the linear kernel, the sigmoid kernel, and the Gaussian kernel are 9.15, 9.2, 10.7, and 7.2 respectively.ConclusionsThis study updates the epidemiological analysis of the ZVD situation in Colombia describes the geographical distribution of ZVD and shows the functional relationship between ZVD cases and GBS.

When atypical onset is the rule: The importance of contrast-enhanced spinal cord imaging in two cases of guillain-barre syndrome in toddlers

Objective: The clinical presentation of Guillain-Barre syndrome (GBS) in toddlers is likely to harbour atypical features, prompting delayed diagnosis which can be detrimental for patients. Moreover, CSF analysis and nerve conduction study (NCS) are likely to be negative in the first days after symptoms onset. In order to highlight the wide clinical spectrum of the disease in this age-window we report on 2 children (age 2 years) with GBS in which imaging of the spinal cord was helpful for early diagnosis. Methods: Both children underwent clinical evaluation, routine blood test and screening for infectious diseases on both serum and CSF. EMG and contrast-enhanced MRI of the spinal cord were performed within one week. EMG was repeated within one month. Results: Pt1 referred to the Hospital because of refusal to walk, neck stiffness and meningeal irritation with onset 2 days after a self-resolved febrile episode. Lumbar puncture analysis performed in the suspect of meningitis showed increased proteins levels and 1 cell. In the following 3 days the boy developed symmetric tetraplegia, tachycardia and disappearance of tendon reflexes. NCS and Spinal cord MRI were performed under sedation 5 days after symptoms onset and were suggestive for GBS (later classified as AMSAN). Pt2 developed acute asymmetrical gait disturbance and right limb pain one week after a febrile episode. After negative orthopedic assessment, neurological examination revealed the absence of the right Achilles tendon reflex. NCS was negative. CSF analysis showed protein level 51 mg/dL and 13 cells. Spinal cord MRI showed asymmetrical enhancement of lumbar nerve roots. Both patients were immediately treated with intravenous immunoglobulin right after imaging studies. Pt1 regained independent walking after 5 months of physiotherapy, Pt2 fully recovered in one month. Conclusion: Contrast-enhanced Imaging of the spinal cord can provide useful data in toddlers with GBS considering the frequency of atypical onset.

Guillain-Barre Syndrome Presenting with Acute Motor Sensory Neuropathy following a MRSA Infection: A Case Report

A case report is presented of a 3-year-old boy who came with the complaints of weakness of lower limbs since 5 days and upper limbs since 3 days. On examination he had generalized hypotonia and areflexia. Power of the limbs was low with weak grip. Sensory and motor nerve conduction studies revealed acute motor axonal neuropathy involving both upper and lower limbs. Culture of blood and sputum revealed MRSA infection. Patient was managed with IV fluids and broad spectrum IV antibiotics. He was started on IvIg. The clinical manifestation of Guillain-Barre syndrome followed a combined MRSA infection. So this case report reveals an evolutionary significanceantecedent infection to the cause of Guillain-Barre syndrome.

Pattern of presentation of Guillain-Barre syndrome in three tertiary level Hospital in Bangladesh

Introduction: Guillain-Barre syndrome (GBS) is an acute frequently severe and fulminating peripheral neuropathy that is autoimmune in nature. It occurs at a rate of between 1 and 4 per 1,00,000 cases annually. In the United States, 5000-6000 cases occur per year. Males are at slightly higher risk of developing GBS than females and in western countries, adults are more frequently affected than children. Objective: This study was carried out to observe the pattern of presentation of GBS among Bangladeshi population. Methods: This is an observational longitudinal study done in Combined Military Hospital (CMH), Bangobandhu Sheikh Mujib Medical University (BSSMU) and National Institute of Neuroscience Hospital (NINS) during the period of January 2010 to June 2012. A total number of 50 GBS patients were included in this study. Results: A total of 50 patients were studied, the mean age of the patients was 30.40± 1.56 and male was found predominant. About 80% of the patients presented with the typical pattern of Landrys are ascending paralysis, 12% had bulbar involvement first and the rest 8% had mixed presentation, 56% patients had facial nerve involvement and 16% patients had bulbar cranial nerve involvement. About 62% patients presented with pain and paresthesia though none had any abnormality in pain, touch and temperature sensation but 10% patients had position sense and 50% had some degree of vibration sense 50 JAFMC Bangladesh. Vol 10, No 1 (June) 2014 abnormality. Ten patients had respiratory muscle weakness requiring Intensive Care Unit (ICU) support. All patients had acute flaccid type of paraplegia or quadriplegia having hyporeflexia or areflexia (mostly). About 56% patients had autonomic involvement but none had sphincter disturbance. On electrophysiology, 56% patients had demyelination type of nerve injury, 36% had mixed and 8% had axonal type of nerve injury. Conclusion: The pattern of presentation of GBS cases was not much variable and was found to be the studies done before. DOI: http://dx.doi.org/10.3329/jafmc.v10i1.22923 Journal of Armed Forces Medical College Bangladesh Vol.10(1) 2014

Sensory Guillain-Barre syndrome presenting as `Burning Feet Syndrome’: A case report

길랑 바레 증후군은 주로 말초, 척수, 뇌신경을 침범하여 급성 혹은 아급성 마비를 일으키는 다발성 신경염으로 대칭적인 진행성 운동 마비와 심부 건반사 소실, 뇌척수액 단백질 수치 상승을 특징으로 한다. 길랑 바레 증후군은 다양한 병리 기전을 가진 질병군으로 현재는 면역 병리학적 조사나 전기 생리학적 검사 소견에 따라 급성 염증성 탈수초성 다발성 신경병과...

Recurrent Guillain–Barre syndrome presenting with stereotypic manifestations, positive anti-ganglioside antibodies and prompt recovery

Recurrent Guillain–Barre syndrome presenting with stereotypic manifestations, positive anti-ganglioside antibodies and prompt recovery

Guillain-Barre Syndrome Presenting with Perioral Numbness Followed by Diffuse T-Wave Inversion (P06.146)

Objective: To describe a case of Guillain-Barre syndrome (GBS) presenting with perioral numbness and T-wave inversion on electrocardiogram (EKG). Background This is the first case report of a patient with GBS presenting with cranial nerve involvement followed by EKG abnormalities. It emphasizes the importance of close monitoring of these patients with rapidly progressing autonomic dysfunction and potentially fatal cardiac arrhythmias. Design/Methods: Case report. Results: A 59 year-old male with a recent diagnosis of sarcoidosis, presented with perioral numbness followed two days later by progressive lower extremity weakness for which he presented to the emergency room. Cerebrospinal fluid (CSF) revealed albumino-cytological dissociation with protein of 94 mg/dl. Telemetry showed diffuse T-wave inversion. He denied cardiac symptoms and prior EKG9s were normal. He didn9t have any past medical or family history of coronary artery disease. Physical examination: he was hypertensive (160/80-90), HR 40-50. Cardiovascular exam was normal. Neurological exam revealed mild dysarthria, weakness 4/5 in both proximal and distal muscles bilaterally. Reflexes were absent throughout. EKG showed sinus bradycardia, prolong QT interval and T-wave inversions in the inferior and anterolateral leads. An echocardiogram showed normal left ventricular systolic function. Cardiac enzymes were normal. Nerve conduction studies showed prolonged distal latencies, partial conduction block, temporal dispersion, absent F-waves and reduced recruitment on needle electromyography all consistent with an acquired demyelinating polyneuropathy i.e. GBS. He was treated with IVIG for 5 days. Neurosarcoidosis was ruled out after extensive evaluation including MRIs of brain, T-spine and L-spine; which were all unremarkable. He was discharge to acute rehab. At one month follow-up his dysarthria and extremity weakness had resolved. Conclusions: Cardiovascular abnormalities in GBS are attributed to autonomic neuropathy and can be seen in up to 2/3 of affected patients. Early recognition, close monitoring and immediate treatment may prevent these potentially fatal complications. Disclosure: Dr. Rivera-Lara has nothing to disclose. Dr. Salameh has nothing to disclose.

Guillain-Barre syndrome presenting as epiglottitis in a child

Guillain-Barre syndrome presenting as epiglottitis in a child

Atypical presentation of Guillain-Barre syndrome with acute hydrocephalus

A 32-year-old man was treated with a ventriculo-peritoneal shunt for acute panventricular hydrocephalus. On the third postoperative day, an ascending tetraparesis and subsequent respiratory failure developed. Based on the clinical findings, cerebrospinal fluid study and electrophysiological results, a diagnosis of Guillain-Barre syndrome (GBS) was made. Despite plasmaphoresis and immunoglobulin infusion, the patient was ventilator dependent and bed-bound for 4 months. One year later, he was able to walk without assistance and had only slightly wasting of the intrinsic hand muscles. This is the first report of acute hydrocephalus preceding the symptoms of GBS.

A case of Guillain–Barre syndrome presenting severe blood pressure fluctuations

Blood pressure fluctuations due to the autonomic disturbances in Guillain–Barre syndrome (GBS) have been described in previous reports and may develop to a life-threatening condition. We here report a GBS patient who presented severe blood pressure fluctuations and was successfully treated with intravenous immunoglobulin. A 75-year-old woman was admitted to the emergency department of our hospital for rapidly evolving weakness, preceded ten days by a respiratory infection. She had a history of hypertension with systolic blood pressure (SBP) of around 140 mm Hg, but her SBP on admission was above 200 mm Hg.

Acute Neuropathy Mimicking Guillain-Barr� Syndrome after Diabetic Ketoacidosis: A casereport

A 42 year-old woman was admitted in a comatose state after exhibiting polydipsia and progressive body weight loss of 4-week duration. Diabetic ketoacidosis was diagnosed due to an increased blood glucose level (956 mg/dl), metabolic acidosis, and positive urinary ketone bodies. On the fourth hospital day, despite recovery from the critical state of ketoacidosis, the patient suffered from progressively ascending paresthesia and weakness in the lower limbs. On the basis of clinical and electrophysiological findings, axonal Guillain-Barre syndrome presenting as a paraparesis variant, a very unusual neuropathy related to diabetic ketoacidosis, was diagnosed. The patient reached satisfactory functional outcome after eight weeks of outpatient rehabilitation program. This article discusses the differential diagnoses of acute onset of weakness in critically ill patients. Correlation of pathogenesis between Guillain-Barre syndrome and diabetes mellitus is briefly described. Management policies of Guillain-Barre syndrome, including rehabilitative treatment, are also delineated.

Guillain Barre Syndrome Presenting as Nausea and Vomiting

Guillain Barre Syndrome Presenting as Nausea and Vomiting

An Uncommon Manifestation of a Common Disease-Reply

—we appreciate Dr Smith's thoughtful comments concerning our case report, Herpes Simplex Virus and Recurrent Laryngeal Nerve Paralysis. The possibility that the patient's cranial nerve paralysis represented an atypical presentation of Guillain-Barre syndrome is interesting. Several aspects of the patient's clinical course were definitely unusual for Guillain-Barre syndrome, including high fever at the onset of the neuritis, asymmetry of the motor weakness, absence of universal areflexia, and rapid recovery of extremity strength (the patient was able to take a few steps three days after admission to the hospital). 1 Also, CSF obtained on day 8 of the hospitalization had a normal protein level of 14 mg/dL in contrast to 56 mg/dL on the day of admission. Such a rapid return to normal of the CSF protein value is uncommon in Guillain-Barre syndrome. 2 As Dr Smith indicates, there is evidence for an association between herpesvirus infection and Guillain-Barre syndrome. 3,4