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Elendu C, Osamuyi EI, Afolayan IA, Opara NC, Chinedu-Anunaso NA, Okoro CB, Nwankwo AU, Ezidiegwu DO, Anunaso CA, Ogbu CC, Aghahowa SO, Atuchukwu CS, Akpa EU, Peterson JC. Clinical presentation and symptomatology of Guillain-Barré syndrome: A literature review. Medicine (Baltimore) 2024; 103:e38890. [PMID: 39058828 PMCID: PMC11272278 DOI: 10.1097/md.0000000000038890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 06/20/2024] [Indexed: 07/28/2024] Open
Abstract
Guillain-Barré Syndrome (GBS) is a rare but potentially life-threatening neurological disorder characterized by acute onset ascending paralysis and sensory abnormalities. This article provides a comprehensive overview of GBS, covering its epidemiology, etiology, clinical presentation, diagnostic evaluation, management and treatment, prognosis, psychosocial impact, recent advances in research, public health implications, and ethical considerations. Epidemiological data reveal variations in GBS prevalence, incidence rates, and geographical distribution influenced by climate, infectious disease prevalence, and genetic susceptibility. Etiological factors include preceding infections, vaccinations, and autoimmune mechanisms, although the precise pathophysiology remains incomplete. Clinical presentation encompasses prodromal symptoms, motor deficits, sensory abnormalities, autonomic dysfunction, and variants such as Miller-Fisher Syndrome and Bickerstaff brainstem encephalitis. Neurological examination findings include weakness, paralysis, sensory deficits, and reflex changes, while autonomic dysfunction manifests as cardiovascular, respiratory, and gastrointestinal symptoms. Diagnostic evaluation relies on clinical criteria, laboratory tests (e.g., cerebrospinal fluid analysis, nerve conduction studies), and consideration of differential diagnoses. Management strategies encompass supportive care, immunomodulatory therapies (e.g., intravenous immunoglobulin, plasma exchange), and rehabilitation interventions to optimize functional outcomes and promote recovery. Prognosis varies depending on clinical features, treatment response, and complications such as respiratory failure and autonomic instability. Psychosocial impact encompasses psychological effects on patients and caregivers, highlighting the importance of coping strategies and support systems. Recent advances in research focus on emerging treatments, genetic predisposition, and biomarker discovery, offering promise for improving GBS outcomes. Public health implications include vaccination safety concerns and healthcare system considerations for GBS management. Ethical considerations encompass patient autonomy, resource allocation, and end-of-life decision-making.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Collins C. Ogbu
- University of Port Harcourt Teaching Hospital, Choba, Nigeria
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Wang M, Luo X, Xiao X, Zhang L, Wang Q, Wang S, Wang X, Xue H, Zhang L, Chen Y, Lei J, Štupnik T, Scarci M, Fiorelli A, Laisaar T, Fruscio R, Elkhayat H, Novoa NM, Davoli F, Waseda R, Estill J, Norris SL, Riley DS, Tian J. CARE-radiology statement explanation and elaboration: reporting guideline for radiological case reports. BMJ Evid Based Med 2024:bmjebm-2023-112695. [PMID: 38458654 DOI: 10.1136/bmjebm-2023-112695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/12/2024] [Indexed: 03/10/2024]
Abstract
Despite the increasing number of radiological case reports, the majority lack a standardised methodology of writing and reporting. We therefore develop a reporting guideline for radiological case reports based on the CAse REport (CARE) statement. We established a multidisciplinary group of experts, comprising 40 radiologists, methodologists, journal editors and researchers, to develop a reporting guideline for radiological case reports according to the methodology recommended by the Enhancing the QUAlity and Transparency Of health Research network. The Delphi panel was requested to evaluate the significance of a list of elements for potential inclusion in a guideline for reporting mediation analyses. By reviewing the reporting guidelines and through discussion, we initially drafted 46 potential items. Following a Delphi survey and discussion, the final CARE-radiology checklist is comprised of 38 items in 16 domains. CARE-radiology is a comprehensive reporting guideline for radiological case reports developed using a rigorous methodology. We hope that compliance with CARE-radiology will help in the future to improve the completeness and quality of case reports in radiology.
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Affiliation(s)
- Mengshu Wang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Department of Radiology, The First Hospital of Lanzhou University, Lanzhou, China
| | - Xufei Luo
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Research Unit of Evidence-Based Evaluation and Guidelines, Chinese Academy of Medical Sciences (2021RU017), School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Xiaojuan Xiao
- Department of Radiology, The Eighth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Shenzhen, China
| | - Linlin Zhang
- Editorial Office of Chinese Journal of Radiology, Beijing, China
| | - Qi Wang
- Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada
- McMaster Health Forum, McMaster University, Hamilton, ON, Canada
| | - Shiyu Wang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ximing Wang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Huadan Xue
- Department of Radiology, Translational Medicine Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Longjiang Zhang
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, General Hospital of Eastern Theater Command, Nanjing, China
| | - Yaolong Chen
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Research Unit of Evidence-Based Evaluation and Guidelines, Chinese Academy of Medical Sciences (2021RU017), School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence Based Medicine of Gansu Province, Lanzhou, China
- Institute of Health Data Science, Lanzhou University, Lanzhou, China
- World Health Organization Collaboration Center for Guideline Implementation and Knowledge Translation, Lanzhou, China
| | - Junqiang Lei
- Department of Radiology, The First Hospital of Lanzhou University, Lanzhou, China
- Intelligent Imaging Medical Engineering Research Center of Gansu Province, Lanzhou, China
- Accurate Image Collaborative Innovation International Science and Technology Cooperation Base of Gansu Province, Lanzhou, China
| | - Tomaž Štupnik
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Marco Scarci
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Alfonso Fiorelli
- Thoracic Surgery Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Tanel Laisaar
- Department of Thoracic Surgery and Lung Transplantation, Lung Clinic, Tartu University Hospital, Tartu, Estonia
- Lung Clinic, Institute of Clinical Medicine, Medical Faculty, University of Tartu, Tartu, Estonia
| | - Robert Fruscio
- Clinic of Obstetrics and Gynecology, University of Milan-Bicocca, IRCCS San Gerardo, Monza, Italy
| | - Hussein Elkhayat
- Cardiothoracic Surgery Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Nuria M Novoa
- Thoracic Surgery, Puerta de Hierro University Hospital-Majadahonda, Madrid, Spain
- Biomedical Institute of Salamanca, Salamanca, Spain
| | - Fabio Davoli
- General & Thoracic Surgery Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Ryuichi Waseda
- Department of General Thoracic, Breast and Pediatric Surgery, Fukuoka University, Fukuoka, Japan
| | - Janne Estill
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Susan L Norris
- Oregon Health & Science University, Portland, Oregon, USA
| | - David S Riley
- University of New Mexico Medical School, Santa Fe, New Mexico, USA
| | - Jinhui Tian
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence Based Medicine of Gansu Province, Lanzhou, China
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Javankiani S, Nasrollahizadeh A, Gharib B, Heidari M, Memarian S. The characteristics of Guillain-Barre syndrome in children in pre-COVID-19 and during the COVID-19 pandemic: A cross-sectional study. Health Sci Rep 2023; 6:e1782. [PMID: 38143455 PMCID: PMC10739064 DOI: 10.1002/hsr2.1782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/29/2023] [Accepted: 12/08/2023] [Indexed: 12/26/2023] Open
Abstract
Background and Aims In the pathophysiology of Guillain-Barre syndrome (GBS), inflammation and immunity are believed to play a key role. The neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), and platelet-lymphocyte ratio (PLR) have been recently identified as potential markers of inflammation or immunity. This study aimed to investigate whether NLR, MLR, and PLR are associated with GBS characteristics in children. We also assessed the impact of the COVID-19 pandemic on the characteristics of GBS in Iran. Methods In this retrospective cross-sectional study, we reviewed the records of all 150 children diagnosed with GBS in the Children's Medical Center hospital affiliated with Tehran University of Medical Sciences (TUMS) from March 2017 until March 2022. The TUMS research ethics committee approved the study (Ethics code: IR.TUMS.CHMC.REC.1399.125). Patients' data including gender, age, clinical symptoms, laboratory findings, and electrodiagnostic study results were collected and analyzed. Results This study involved 150 children, comprising 93 boys and 57 girls, with an average age of 7.53 ± 3.75 years. The analysis demonstrated that the number of hospitalization days increased with an increase in NLR (p = 0.025). Moreover, patients with abnormal electrodiagnostic study patterns had a higher risk of intensive care unit (ICU) admission (p: 0.027), although according to binary logistic regression, respiratory failure at admission time was the only significant factor increasing the risk of ICU admission (p = 0.035). The study also found that the pandemic has resulted in a shift from acute inflammatory demyelinating polyneuropathy to acute motor axonal neuropathy as the most common EMG-NCV pattern in our patients (p < 0.001). Conclusion We found that higher NLR was associated with a longer hospitalization duration and could potentially distinguish between severe and mild cases of GBS. We have also shown that the COVID-19 pandemic has changed our patients' most frequent electromyography and nerve conduction velocity (EMG-NCV) patterns.
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Affiliation(s)
- Sepide Javankiani
- Children's Medical CenterTehran University of Medical SciencesTehranIran
| | | | - Behdad Gharib
- Children's Medical CenterTehran University of Medical SciencesTehranIran
| | - Morteza Heidari
- Children's Medical CenterTehran University of Medical SciencesTehranIran
| | - Sara Memarian
- Children's Medical CenterTehran University of Medical SciencesTehranIran
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