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Xue J, Song Z, Zhao H, Yi Z, Li F, Yang C, Liu K, Zhang Y. A case of variant of GBS with positive serum ganglioside GD3 IgG antibody. Ital J Pediatr 2024; 50:109. [PMID: 38831339 PMCID: PMC11149178 DOI: 10.1186/s13052-024-01682-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 05/28/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Acute bulbar palsy-plus (ABPp) syndrome is an unusual variant of Guillain-Barré syndrome (GBS). Anti-GT1a and anti-GQ1b antibodies have been reported in patients with ABPp, but without reports related to GD3 antibodies. METHODS Clinical data of a patient diagnosed as ABPp syndrome were reviewed clinically. And we summarized the GBS patients with ABP and facial paralysis reported in the literature. RESULTS We reported a 13-year-old girl presented with asymmetric bifacial weakness, bulbar palsy and transient limb numbness, and had positive serum IgG anti-GD3 antibody. Through reviewing the GBS patients with ABP and facial paralysis reported previously, we found that facial palsy could be unilateral or bilateral. The bilateral facial palsy could present successively or simultaneously, and could be symmetrical or asymmetrical. Other common symptoms included ophthalmoplegia, sensory abnormality and ataxia. IgG anti-GT1a and IgG anti-GQ1b antibodies were the most frequent. Most of the patients had full recovery within two weeks to one year of follow-up. CONCLUSIONS We reported a patient with asymmetric bifacial palsy and bulbar palsy, which seemed to fit the diagnosis of ABPp syndrome. This was the first report of ABPp variant of GBS with positive serum ganglioside GD3 IgG antibody.
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Affiliation(s)
- Jiao Xue
- Department of Pediatric Neurology, The Affiliated Hospital of Qingdao University, No. 1677 Wutaishan Road, Qingdao, Shandong, 266000, China
| | - Zhenfeng Song
- Department of Pediatric Neurology, The Affiliated Hospital of Qingdao University, No. 1677 Wutaishan Road, Qingdao, Shandong, 266000, China
| | - Hongshan Zhao
- Department of Anesthesiology, the Affiliated Hospital of Qingdao University, No. 1677 Wutaishan Road, Qingdao, Shandong, 266000, China
| | - Zhi Yi
- Department of Pediatric Neurology, The Affiliated Hospital of Qingdao University, No. 1677 Wutaishan Road, Qingdao, Shandong, 266000, China
| | - Fei Li
- Department of Pediatric Neurology, The Affiliated Hospital of Qingdao University, No. 1677 Wutaishan Road, Qingdao, Shandong, 266000, China
| | - Chengqing Yang
- Department of Pediatric Neurology, The Affiliated Hospital of Qingdao University, No. 1677 Wutaishan Road, Qingdao, Shandong, 266000, China
| | - Kaixuan Liu
- Department of Pediatric Neurology, The Affiliated Hospital of Qingdao University, No. 1677 Wutaishan Road, Qingdao, Shandong, 266000, China
| | - Ying Zhang
- Department of Pediatric Neurology, The Affiliated Hospital of Qingdao University, No. 1677 Wutaishan Road, Qingdao, Shandong, 266000, China.
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Brun G, Graber M, Mohr S, Béjot Y. Acute Bulbar Palsy and Ophtalmoplegia Associated With Anti-GT1a IgG Antibodies. Neurologist 2022; 27:348-349. [PMID: 34967823 DOI: 10.1097/nrl.0000000000000407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Although several variants of Guillain-Barré syndrome (GBS) have been described, they are uncommon, and the atypical clinical presentation of patients makes the diagnosis challenging. This article reports a case of acute bulbar palsy plus (ABPp) syndrome. CASE REPORT A 18-year-old patient was admitted to our hospital because of difficulty swallowing, slurred speech, tingling of the extremities of the 4 limbs, and diplopia. He reported abdominal pain and diarrhea 2 weeks earlier. Physical examination showed a low-pitched voice, palsy elevation of the soft palate and complete palsy of the abduction of the left eye. Electromyography and cerebrospinal fluid examination were unremarkable, but Campylobacter jejuni serology was positive, and we found an isolated immunoglobulin G (IgG) anti-GT1a antibodies positivity. A diagnosis of ABPp was finally made, and the patient fully recovered early after receiving polyvalent immunoglobulins infusion. CONCLUSIONS ABPp is classified as subtype of GBS. The most frequent clinical signs of ABPp are ophthalmoplegia, facial palsy, and ataxia. IgG anti-GT1a and/or anti-GQ1b are positive in a majority of patients with ABPp; however, these antibodies are not specific and can found in other subtypes of GBS.
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Affiliation(s)
- Gaël Brun
- Department of Neurology, University Hospital of Dijon, University of Burgundy, Dijon, France
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Xue J, Song Z, Li F, Yi Z, Yang C, Liu K, Zhang Y. Guillain-Barré syndrome with unilateral peripheral facial paralysis in a Chinese child. Int J Dev Neurosci 2022; 82:548-553. [PMID: 35993140 DOI: 10.1002/jdn.10225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/05/2022] [Accepted: 08/15/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Guillain-Barré syndrome (GBS) is an immune-mediated polyradiculoneuropathy with the classic presentation of acute onset neurological symptoms preceded by an infective illness, followed by progressive limb weakness. Unilateral facial paralysis is rarely seen in GBS. CASE PRESENTATION We reported a child presented with unilateral facial paralysis, limited outward movement of one eye and unilateral lower limb weakness, who was later diagnosed to have GBS. Through reviewing the patients with similar presentation reported previously, we found that the onset time of unilateral facial weakness in relation to other presentations of GBS seemed to be variable, which could be later or earlier than other symptoms, or concomitant. Most of the patients had a relatively good outcome within two weeks to twelve months of follow-up. CONCLUSIONS Unilateral facial paralysis may be a feature of GBS, albeit a rare thing. Recognizing the clinical patterns of such atypical variants of GBS allows for more timely and accurate diagnosis, and for treatment to be initiated without delay.
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Affiliation(s)
- Jiao Xue
- Department of Pediatric Neurology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Zhenfeng Song
- Department of Pediatric Neurology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Fei Li
- Department of Pediatric Neurology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Zhi Yi
- Department of Pediatric Neurology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Chengqing Yang
- Department of Pediatric Neurology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Kaixuan Liu
- Department of Pediatric Neurology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Ying Zhang
- Department of Pediatric Neurology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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Ivan AP, Odajiu I, Popescu BO, Davidescu EI. COVID-19 Associated Guillain-Barré Syndrome: A Report of Nine New Cases and a Review of the Literature. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:977. [PMID: 35893091 PMCID: PMC9332472 DOI: 10.3390/medicina58080977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/18/2022] [Accepted: 07/20/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Guillain-Barré syndrome (GBS)-a rare condition characterized by acute-onset immune-mediated polyneuropathy-has been registered as a neurological manifestation of COVID-19, suggesting a possible link between these two conditions. METHODS We report a case series of patients with COVID-19-related GBS hospitalized in the Neurology Department of Colentina Clinical Hospital, Bucharest, Romania, between March 2020 and March 2021. Several variables were analyzed, such as the mean interval between the onset of COVID-19 symptoms and neurological ones, clinical features, treatment course, and outcome. Further on, we conducted a thorough literature review based on the PubMed and ScienceDirect scientific databases. RESULTS A total of 9 COVID-19 patients developed symptoms of GBS, out of which in 7, it manifested as an acute inflammatory demyelinating polyneuropathy (AIDP). Five patients presented respiratory failure, 2 requiring mechanical ventilation. All patients received a course of intravenous immunoglobulins, 2 additionally requiring plasma exchange. Upon discharge, all but 1 patient (who had not regained the ability to walk) had a positive outcome, and 1 died during admission. In the literature review, we analyzed the published sources at the time of writing. CONCLUSIONS A link between COVID-19 and GBS might be possible; therefore, increased vigilance is required in the early identification of these cases for prompt diagnosis and treatment. Some notable differences such as an earlier onset of GBS symptoms, higher respiratory dysfunction, and higher mortality rates in COVID-19 patients have been observed between the presentation of GBS in the context of COVID-19 and GBS of other causes.
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Affiliation(s)
- Andreea Paula Ivan
- Department of Neurology, Colentina Clinical Hospital, 020125 Bucharest, Romania; (A.P.I.); (I.O.); (E.I.D.)
| | - Irina Odajiu
- Department of Neurology, Colentina Clinical Hospital, 020125 Bucharest, Romania; (A.P.I.); (I.O.); (E.I.D.)
| | - Bogdan Ovidiu Popescu
- Department of Neurology, Colentina Clinical Hospital, 020125 Bucharest, Romania; (A.P.I.); (I.O.); (E.I.D.)
- Department of Clinical Neurosciences, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Cell Biology, Neurosciences and Experimental Myology, ”Victor Babeș” National Institute of Pathology, 050096 Bucharest, Romania
| | - Eugenia Irene Davidescu
- Department of Neurology, Colentina Clinical Hospital, 020125 Bucharest, Romania; (A.P.I.); (I.O.); (E.I.D.)
- Department of Clinical Neurosciences, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
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Dukkipati SS, Zhou DJ, Powers AM, Piccione EA, Koh S. Acute Bulbar Palsy-Plus Variant of Guillain-Barré Syndrome in a 3-Year-Old Girl. Child Neurol Open 2022; 9:2329048X221115476. [PMID: 35936111 PMCID: PMC9350509 DOI: 10.1177/2329048x221115476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 06/30/2022] [Indexed: 11/17/2022] Open
Abstract
We present a case of a 3-year-old girl who rapidly developed bilateral facial
palsy, dysphagia, dysphonia, areflexia, and ataxia soon after receiving an
influenza vaccine. Brain and spine Magnetic resonance imaging (MRI) scans with
and without contrast showed enhancement of cranial nerves III, V, VII, and X, as
well as the anterior and posterior cervical spinal and cauda equina roots.
cerebrospinal fluid (CSF) studies showed white blood cell count of 19
cells/cm2, glucose 81 mg/dL, and protein 116 mg/dL, with negative
infectious and autoimmune labs. Serum IgM and IgG antibodies against GM1, GD1a,
GD1b, GM2, GT1A, GQ1b were negative. The patient was treated with intravenous
immunoglobulin, which led to a full recovery. Upon three-month follow-up, her
neurologic examination demonstrated normal cranial nerves, reflexes, and gait.
Her presentation was most consistent with the acute bulbar palsy plus (ABPp)
variant of Guillain-Barré syndrome (GBS), a rare and challenging diagnosis
especially in her age group.
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Affiliation(s)
- Saihari S. Dukkipati
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Daniel J. Zhou
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Andria M. Powers
- Department of Radiology, Children's Hospital and Medical Center, Omaha, NE, USA
| | - Ezequiel A. Piccione
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Sookyong Koh
- Division of Neurology, Department of Pediatrics, Children's Hospital and Medical Center, Omaha, NE, USA
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Cao Q, Chu H, Fu X, Yao J, Xiao Z, Lu Z. Case Report: Acute Bulbar Palsy Plus Syndrome: A Guillain-Barré Syndrome Variant More Prone to Be a Subtype Than Overlap of Distinct Subtypes. Front Neurol 2020; 11:566480. [PMID: 33329308 PMCID: PMC7732419 DOI: 10.3389/fneur.2020.566480] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 10/22/2020] [Indexed: 11/24/2022] Open
Abstract
Objective: Acute bulbar palsy plus (ABPp) syndrome is a rare regional variant of Guillain-Barré syndrome (GBS) characterized by acute bulbar palsy combined with other cranial symptoms or ataxia without limb and neck weakness. We aim to investigate characteristics of ABPp syndrome and analyze its nosological position within the GBS spectrum. Methods: A patient with ABPp syndrome was reported, and previous case reports of patients who met the criteria for ABPp syndrome from the literature were reviewed. Results: A total of 28 patients were included in our study. Median age was 32 years. Most of the patients (78.6%) were from Asia, and 75.0% had preceding infection. The main accompanying symptoms were ophthalmoplegia (85.7%), facial palsy (60.7%), and ataxia (50.0%). There existed asymmetric weakness in the form of unilateral facial palsy (32.1%) and ptosis (3.6%). Approximately half of the patients had albuminocytological dissociation. All the tested patients were seropositive for antiganglioside antibodies, of which the two most common were immunoglobulin G (IgG) anti-GT1a (77.3%) and anti-GQ1b (59.1%) antibodies. Over one-third of the patients who underwent electrophysiological assessment showed subclinical neuropathy beyond cranial nerves. The outcome was generally favorable as 89.3% of patients made full recovery within 5 months. Conclusion: The hitherto largest case series of ABPp syndrome advances our understanding of this disease. Serologically, the presence of IgG anti-GT1a and anti-GQ1b antibodies predicts and contributes to the disease. Phenotypically, ABPp syndrome is more prone to be a separate subtype of GBS than overlap of distinct subtypes and has the potential to complement current diagnostic framework of GBS.
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Affiliation(s)
- Qian Cao
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Hong Chu
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xiujuan Fu
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jiajia Yao
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zheman Xiao
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zuneng Lu
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
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Yadav P, Dhaka S, Chaudhary R, Damke S, Lohiya S. A Rare Case Report of Guillain-Barré Syndrome Presenting as Unilateral Facial Palsy with Isolated acute Bulbar Palsy. J Pediatr Neurosci 2020; 15:157-159. [PMID: 33042253 PMCID: PMC7519738 DOI: 10.4103/jpn.jpn_129_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/16/2020] [Accepted: 01/30/2020] [Indexed: 11/26/2022] Open
Abstract
Guillain–Barré syndrome (GBS) is an immune-mediated acute inflammatory polyradiculoneuropathy and it is the most common cause of acute flaccid paralysis worldwide. There are some rare variants of GBS, which may be easily missed unless suspected. Here we present a case of GBS presenting as isolated acute bulbar palsy. A 10-month-old infant, known case of tricuspid atresia with pulmonary stenosis, presented with left-sided lower motor neuron type of facial palsy and palsy of bilateral glossopharyngeal and vagus nerve of 2 weeks’ duration. On detailed neurological examination, motor and sensory system were normal. Nerve conduction study showed demyelinating motor neuropathy and hence the diagnosis of GBS was made. To the best of our knowledge, no case of isolated bulbar palsy due to GBS in infancy has been reported.
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Affiliation(s)
- Prachi Yadav
- Department of Pediatrics, Jawaharlal Nehru Medical College (JNMC), Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
| | - Sahil Dhaka
- Department of Pediatrics, Jawaharlal Nehru Medical College (JNMC), Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
| | - Richa Chaudhary
- Department of Pediatrics, Jawaharlal Nehru Medical College (JNMC), Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
| | - Sachin Damke
- Department of Pediatrics, Jawaharlal Nehru Medical College (JNMC), Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
| | - Sham Lohiya
- Department of Pediatrics, Jawaharlal Nehru Medical College (JNMC), Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
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Sharma K, Tengsupakul S, Sanchez O, Phaltas R, Maertens P. Guillain-Barré syndrome with unilateral peripheral facial and bulbar palsy in a child: A case report. SAGE Open Med Case Rep 2019; 7:2050313X19838750. [PMID: 30915222 PMCID: PMC6429638 DOI: 10.1177/2050313x19838750] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 02/27/2019] [Indexed: 12/29/2022] Open
Abstract
Guillain-Barré syndrome is characterized by progressive motor weakness, sensory changes, dysautonomia, and areflexia. Cranial nerve palsies are frequent in Guillain-Barré syndrome. Among cranial nerve palsies in Guillain-Barré syndrome, facial nerve palsy is the most common affecting around half of the cases. Facial palsy in Guillain-Barré syndrome is usually bilateral. We describe a pediatric Guillain-Barré syndrome variant presenting with unilateral peripheral facial palsy and dysphagia. A 5-year-old boy had progressive lower extremity weakness and pain 3 days prior to onset of unilateral peripheral facial palsy. On presentation, diagnosis of Guillain-Barré syndrome was supported by areflexia and albuminocytologic dissociation. His condition deteriorated with a decline in his respiratory effort and inability to handle secretions. He was given non-invasive ventilation to prevent worsening of his acute respiratory failure. Brain and spine magnetic resonance imaging scans showed enhancement of the left bulbar nerve complex and anterior and posterior cervical nerve roots with gadolinium. Treatment with intravenous immunoglobulin led to an uneventful clinical course with partial recovery within 2 weeks. In summary, Guillain-Barré syndrome should be considered as a possible cause of unilateral peripheral facial palsy. Guillain-Barré syndrome patients with facial nerve and bulbar palsy require close monitoring as they are at risk of developing acute respiratory failure. Early intervention with intravenous immunoglobulin may benefit these patients. Magnetic resonance imaging findings may lend support to early intervention.
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Affiliation(s)
- Kamal Sharma
- Division of Pediatric Critical Care, Department of Pediatrics, College of Medicine, University of South Alabama, Mobile, AL, USA
| | - Supatida Tengsupakul
- Division of Pediatric Infectious Disease and Pediatric Hospitalist Service, College of Medicine, University of South Alabama, Mobile, AL, USA
| | - Omar Sanchez
- Division of Pediatric Critical Care, Department of Pediatrics, College of Medicine, University of South Alabama, Mobile, AL, USA
| | - Rozaleen Phaltas
- Department of Pediatrics, College of Medicine, University of South Alabama, Mobile, AL, USA
| | - Paul Maertens
- Department of Neurology, College of Medicine, University of South Alabama, Mobile, AL, USA
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