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Ung H, Ferrey D. Neurosyphilis presenting with Guillain-Barre syndrome: a case report. BMC Neurol 2023; 23:421. [PMID: 38001427 PMCID: PMC10675934 DOI: 10.1186/s12883-023-03471-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 11/17/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Syphilis is associated with a wide variety of systemic presentations, earning it the moniker "The great mimicker". Neurosyphilis is classically associated with meningovasculitis in the acute-subacute stage and tabes dorsalis and dementia paralytica in later stages. However, one of the less well described presentations include Guillain-Barre Syndrome. This case presents a patient with an ascending polyneuropathy suspicious for Guillain-Barre Syndrome who also had other atypical findings including a truncal sensory loss, optic disc swelling, and rash ultimately found to have neurosyphilis. Electrodiagnostic testing was consistent with demyelination, supporting a diagnosis of neurosyphilis associated Guillain-Barre Syndrome. CASE PRESENTATION A 37-year-old female presented to the emergency department with a weakness and difficulty swallowing. She described a three-month history of symptoms, initially starting with a persistent headache followed by one month of a pruritic rash on her chest, palms, and soles. Two weeks prior to presentation, she developed progressive weakness in her arms, numbness in her arms and chest, and difficulty swallowing. Neurological exam was notable for multiple cranial neuropathies, distal predominant weakness in all extremities, length-dependent sensory loss, and hyporeflexia. Investigation revealed a positive Venereal Disease Research Laboratory in her cerebrospinal fluid without significant pleocytosis, contrast enhancement in cranial nerves V, VII, and VIII on MRI, and a demyelinating polyneuropathy on electrodiagnostic testing. She was diagnosed with Guillain-Barre syndrome, secondary to neurosyphilis. The patient acutely declined and required intubation, and ultimately made a full recovery after treatment with plasmapheresis and penicillin. CONCLUSIONS This case describes a clinical entity of syphilitic Guillain-Barre Syndrome and highlights the importance of including syphilis in the differential of any patient presenting with ascending polyradiculopathy, especially given the resurgence of syphilis.
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Affiliation(s)
- Hoameng Ung
- Department of Neurosciences, University of California San Diego, San Diego, California, USA.
| | - Dominic Ferrey
- Department of Neurosciences, University of California San Diego, San Diego, California, USA
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Uz FB, Uz C, Karaahmet OZ. Three-year follow-up outcomes of adult patients with Guillain-Barré Syndrome after rehabilitation. Malawi Med J 2023; 35:156-162. [PMID: 38362288 PMCID: PMC10865062 DOI: 10.4314/mmj.v35i3.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
Background Guillain-Barré syndrome (GBS), the most common cause of acute paralytic neuropathy, covers a number of recognizably different variants. We aimed to evaluate the clinical characteristics of the patients with GBS and the outcome results of the patients after rehabilitation. Methods We enrolled 24 adult patients with GBS and evaluated their demographic characteristics, signs, complications, functional levels, and residual symptoms at admission, discharge, and during the 1st and 3rd-year follow-up visits. Functional Independence Scale (FIM), Functional Ambulation Scale (FAS), Hughes functional grading scale, Six-Minute Walking Test (6MWT), and Fatigue Severity Scale (FSS) were used for patient evaluation. Results In this study, patients with a mean age of 47.29 ± 16.2 years (40% female) were hospitalized for an average of 28.91 ± 25.6 days. The predominant symptoms experienced by these patients were fatigue (100%), neuropathic pain (70.8%), joint pain (54.2%), and autonomic dysfunction (50%). Significant changes were observed in FIM, Hughes functional grading scale, FAS, 6MWT, and MRC score at admission, discharge, and 1st/3rd-year follow-ups (p=0.000, p=0.000, p=0.000, p=0.001, p=0.000, respectively). Fatigue and Hughes score increased significantly with age (p=0.019, r=0.475; p=0.041, r=0.419, respectively). Negative correlations were found between age and FAS, 6MWT, and MRC score at 1st-year follow-up (p=0.025, r=-0.456; p=0.027, r=-0.450; p=0.008, r=-0.528). FSS was above 4 before admission and in 53.1% at 3rd-year follow-up, correlating negatively with 6MWT and MRC sum score. GBS clinical types showed no significant differences. Conclusion Rehabilitation improves functional improvement in GBS patients, with long-term benefits observed. However, residual symptoms such as fatigue and neuropathic pain may persist despite functional improvement. These findings highlight the importance of incorporating rehabilitation into the management of GBS and addressing residual symptoms to improve patient outcomes.
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Affiliation(s)
- Fatma Ballı Uz
- Etlik City Hospital, Department of Physical Medicine and Rehabilitation, Ankara, Turkey
| | - Cuma Uz
- Etlik City Hospital, Department of Physical Medicine and Rehabilitation, Ankara, Turkey
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Bosello F, Marastoni D, Pizzini FB, Zaffalon C, Zuliani A, Turri G, Mariotto S, Bonacci E, Pedrotti E, Calabrese M. Atypical myelin oligodendrocyte glycoprotein antibody-associated optic neuritis and acute demyelinating polyneuropathy after SARS-CoV-2 infection: Case report and literature review. J Neuroimmunol 2023; 375:578011. [PMID: 36621074 DOI: 10.1016/j.jneuroim.2022.578011] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/11/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
Abstract
Post-infectious immune-mediated neurological complications of Sars-Cov-2 have been increasingly recognized since the novel pandemic emerged. We describe the case of a 74 years-old patient who developed a Myelin Oligodendrocyte Glycoprotein (MOG) antibody-associated unilateral retrobulbar optic neuritis a few weeks after paucisymptomatic COVID-19 disease and, subsequently, after the resolution of the optic neuritis, an acute inflammatory demyelinating polyneuropathy. So far, no cases of these two neurological manifestations have been reported in the same patient. We herein report a case characterized by both manifestations and review the accumulating literature regarding MOG antibody-associated disease following SarsCov-2 infection.
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Chiu ATG, Chan RWK, Yau MLY, Yuen ACL, Lam AKF, Lau SWY, Lau AMC, Fung STH, Ma KH, Lau CWL, Yau MM, Ko CH, Tsui KW, Ma CK, Tai SM, Yau EKC, Fung E, Wu SP, Kwong KL, Chan SHS. Guillain-Barré syndrome in children - High occurrence of Miller Fisher syndrome in East Asian region. Brain Dev 2022; 44:715-24. [PMID: 35906115 DOI: 10.1016/j.braindev.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 07/10/2022] [Accepted: 07/11/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND Guillain-Barré syndrome (GBS) is a rare acquired immune-mediated polyneuropathy. Updated population-based data concerning paediatric GBS is needed. METHODS Paediatric patients aged below 18 years diagnosed with GBS between 2009 and 2018 in all 11 paediatric departments in Hong Kong were identified from the Hong Kong Hospital Authority Clinical Data Analysis and Reporting System. The collected data from medical health records were reviewed by paediatric neurologist from each department. Estimated incidence of paediatric GBS was calculated. We also compared our findings with other paediatric GBS studies in Asia. RESULTS 63 subjects of paediatric GBS were identified, giving an estimated annual incidence of 0.62 per 100,000 population. Half of the subjects had acute inflammatory demyelinating polyneuropathy (AIDP) (n = 31; 49.2%), one quarter had Miller Fisher Syndrome (MFS) (n = 16; 25.4%), one-fifth had axonal types of GBS (n = 12; 19.0%), and four were unclassified. Paediatric subjects with axonal subtypes of GBS compared to the other 2 subtypes, had significantly higher intensive care unit (ICU) admission rates (p = 0.001) and longest length of stay (p = 0.009). With immunomodulating therapy, complete recovery was highest in those with MFS (100%), followed by AIDP (87.1%) and axonal GBS (75%). Our study also confirms a higher MFS rate for paediatric GBS in East Asia region and our study has the highest MFS rate (25.4%). CONCLUSION Our population-based 10-year paediatric GBS study provides updated evidence on estimated incidence, healthcare burden and motor outcome of each subtype of paediatric GBS and confirmed a higher occurrence of paediatric MFS in East Asia.
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Xu L, Gao TX, Chang SH, Jiang SM, Zhang LJ, Yang L. Role of lymphocyte-related immune-inflammatory biomarkers in detecting early progression of Guillain-Barré syndrome. J Clin Neurosci 2022; 105:31-36. [PMID: 36063751 DOI: 10.1016/j.jocn.2022.08.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/06/2022] [Accepted: 08/22/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study aimed to investigate the role of peripheral neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), and platelet to lymphocyte ratio (PLR) in the progression and severity of the Guillain-Barré syndrome (GBS). METHODS 47 GBS patients and 50 age and sex-matched healthy controls (HC) were retrospectively included. Demographic and clinical assessment data were reviewed and abstracted. NLR, MLR, and PLR were calculated based on the peripheral blood tests by reviewing clinical data. The relationship between the Hughes' score and NLR, MLR, PLR levels was investigated. RESULTS The GBS patients had higher NLR levels (P < 0.001), MLR levels (P = 0.001) and PLR levels (P < 0.001) than those in HC. And patients with severe disability score (Hughes' score ≥ 3) had significantly higher NLR (P = 0.007), MLR (P = 0.04), PLR (P = 0.013). Spearman correlation analysis indicated that NLR was positively associated with the Hughes' score (r = 0.331, P = 0.023). In the patients with acute inflammatory demyelinating polyneuropathy (AIDP), Spearman correlation analysis indicated that NLR, MLR and PLR were positively associated to the Hughes' score (r = 0.825, P = 0.001 for NLR, r = 0.727, P = 0.005 for MLR, and r = 0.723, P = 0.005 for PLR). CONCLUSIONS NLR, MLR, and PLR may be indicators of disease activity in patients with GBS or AIDP. These parameters may benefit the active treatment of GBS patients with a high degree of disability.
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Affiliation(s)
- Lu Xu
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Tian-Xiao Gao
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Sheng-Hui Chang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Shu-Min Jiang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Lin-Jie Zhang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Li Yang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China.
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Kasinathan A, Saini AG, Suthar R, Saini L, Sahu JK, Singhi P, Singhi S, Sankhyan N. Comparison of Five Different Electrophysiological Criteria for Childhood Guillain Barre Syndrome. Ann Indian Acad Neurol 2021; 24:542-546. [PMID: 34728948 PMCID: PMC8513960 DOI: 10.4103/aian.aian_721_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 09/30/2020] [Accepted: 11/19/2020] [Indexed: 11/29/2022] Open
Abstract
Background: Internationally approved electrodiagnostic criteria for Guillain Barre syndrome lack in children. We intended to compare the diagnostic accuracy of the currently available five electrophysiological criteria for childhood Guillain Barre Syndrome (GBS) at the time of sentinel assessment. Methodology: In this single-center study, data of children diagnosed with GBS between January 2013 to December 2017 were retrieved. Patient charts were reviewed for clinical features, electrophysiological recordings. The electrodiagnostic results (4 motor nerves and two sensory nerves in upper limbs and lower limbs) were reanalyzed and were classified based on Dutch group; Ho; Hadden; Hughes and Rajabally criteria for GBS. Results: During this study period, of the 205 children with clinical features of GBS, 15 children had incomplete electrophysiological data, and four children were excluded due to missing data. The mean age of onset of the 186 children enrolled was 77 months; the median duration from symptom onset to electrodiagnostic evaluation was seven days; pure motor and motor-sensory form of GBS was seen in 71 and 115 children. Based on the Hadden criteria, a demyelinating pattern was noted in 57 children; axonal in 37; Inexcitable in 84 and Equivocal in 8 children. The sensitivity of the various criteria ranged from 71% to 100% for demyelination, 97% to 100% for axonal. The degree of agreement using Hadden and Rajabally criteria for Equivocal subtypes was 0.93. Conclusions: The Rajabally criteria showed the best sensitivity, specificity and diagnostic accuracy for electrodiagnosis of GBS in children when compared against Hadden criteria.
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Affiliation(s)
- Ananthanarayanan Kasinathan
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Arushi G Saini
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Renu Suthar
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Lokesh Saini
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jitendra K Sahu
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pratibha Singhi
- Pediatric Neurology and Neurodevelopment, Medanta, The Medicity, Gurugram, Haryana, India
| | - Sunit Singhi
- Pediatrics Division, Medanta, The Medicity, Gurugram, Haryana, India
| | - Naveen Sankhyan
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Ohnari K, Okada K, Mafune K, Kusunoki S, Adachi H. Unclassified subtype of Guillain-Barré syndrome is associated with quick recovery. J Clin Neurosci 2021; 91:313-8. [PMID: 34373045 DOI: 10.1016/j.jocn.2021.07.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 06/27/2021] [Accepted: 07/17/2021] [Indexed: 11/21/2022]
Abstract
Electrophysiological classification of Guillain-Barré syndrome (GBS) is important for predicting its clinical course; however, few reports discuss GBS patients who do not conform to the acute inflammatory demyelinating polyneuropathy (AIDP) or acute motor axonal neuropathy (AMAN) classifications. Therefore, the present study assessed the features of unclassified types of GBS and compared them to those of AIDP and AMAN. We compared clinical symptoms, nerve conduction, and laboratory data among patients with AIDP, AMAN, and unclassified subtypes of GBS, according to criteria developed by Rajabally, Hadden, and Ho. According to the Rajabally criteria, the F wave frequency in the upper and lower extremities was higher in the unclassified subgroup than in the AIDP and AMAN subgroups; however, according to the Hadden and Ho criteria, the F wave frequency in only the lower extremities was higher in the unclassified subgroup than in the other subgroups. The unclassified subgroup showed better prognosis using the Rajabally criteria. Classification with the Rajabally criteria is useful for predicting prognosis and determining treatment in patients with GBS. Moreover, unclassified patients exhibit the quickest recovery.
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Ruiz-Sandoval JL, Salvatella-Gutiérrez AP, López-Valencia G, Chiquete E, Ruiz-Herrera V, Pérez-Gómez HR, Adrián MGL, Jiménez-Ruiz A, Rodríguez-Hinojosa J, Quintero-Reyes Á, González-Jaime JDJ, Villaseñor Cabrera TDJ. Clinical Characteristics and Predictors of Short-Term Outcome in Mexican Adult Patients with Guillain-Barré Syndrome. Neurol India 2021; 69:107-114. [PMID: 33642280 DOI: 10.4103/0028-3886.310063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Information regarding the clinical presentation and outcome of Guillain-Barré Syndrome (GBS) in adults from Latin America is limited. Objective To identify clinical characteristics and short-term outcome predictors in adult Mexican patients with GBS. Patients and Methods We included adult patients with clinical and electrophysiological data with confirmed GBS, admitted to a tertiary hospital in Western Mexico, from January 2002 to February 2011. A good outcome at hospital discharge was considered if patients had a Hughes score of 0-2 and at 3 and 6 months, a Hughes score of 0-1. Results A total of 115 patients were analyzed (68% men, mean age 44 years old, range 18-84). Previous infection occurred in 63% of cases. Descendent pattern of weakness was observed in 40 (35%) patients. GBS subtypes were: acute motor axonal neuropathy in 31%, acute inflammatory demyelinating polyneuropathy in 29%, sensory axonal neuropathy (AMSAN) in 18%, and equivocal in 22%. A total of 73 (63%) patients received induction therapy: 50 (68%) received plasmapheresis and 13 (18%) received intravenous immunoglobulin (IVIG). In-hospital mortality occurred in 14 (12%) patients. Early gait complaints and emergency room admission with mild Hughes score (0-2) were predictors for a good outcome at hospital discharge (P < 0.05); meanwhile, age >75 years; dysarthria and higher Hughes score were associated with a poor outcome(P < 0.05). Conclusions Axonal pattern, motor involvement, and the descendent pattern of presentation were the main clinical GBS findings in our cohort. Higher Hughes scale scores at hospital admission were a strong predictor for a bad outcome at hospital discharge and short-term follow-up, independently of treatment type or in-hospital management. GBS in Mexico still carries considerable mortality.
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Affiliation(s)
- Jose Luis Ruiz-Sandoval
- Department of Neurology, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara; Department of Neurosciences, Translational Neurosciences Institute, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Jalisco, México
| | | | - Germán López-Valencia
- Department of Neurology, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Jalisco, México
| | - Erwin Chiquete
- Department of Internal Medicine, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Jalisco, México
| | - Vida Ruiz-Herrera
- Department of Infectology, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Jalisco, México
| | - Héctor Raúl Pérez-Gómez
- Department of Infectology, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Jalisco, México
| | - Miranda-García Luis Adrián
- Department of Neurology, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara; Department of Neurosciences, Translational Neurosciences Institute, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Jalisco, México
| | - Amado Jiménez-Ruiz
- Department of Internal Medicine, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Jalisco, México
| | - Jorge Rodríguez-Hinojosa
- Department of Intensive Care Unit, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Jalisco, México
| | - Ángeles Quintero-Reyes
- Department of Blood Bank and Transfusional Center, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Jalisco, México
| | - José de Jesús González-Jaime
- Department of Physical Medicine and Rehabilitation, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Jalisco, México
| | - Teresita de Jesús Villaseñor Cabrera
- Department of Neurosciences, Translational Neurosciences Institute, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara; Department of Neuropsychology, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Jalisco, México
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Sheikh AB, Chourasia PK, Javed N, Chourasia MK, Suriya SS, Upadhyay S, Ijaz F, Pal S, Moghimi N, Shekhar R. Association of Guillain-Barre syndrome with COVID-19 infection: An updated systematic review. J Neuroimmunol 2021; 355:577577. [PMID: 33895700 PMCID: PMC8053360 DOI: 10.1016/j.jneuroim.2021.577577] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/14/2021] [Accepted: 04/13/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The systematic review aimed to determine demographic characteristics, clinical features, lab evaluation, management and complications of the studies focusing on Guillain-Barre syndrome (GBS) as a sequele of novel coronavirus (COVID-19) infection. METHODS After protocol registration, PubMed, Web of Science and Cumulative Index to Nursing & Allied Health Literature (CINHAL) databases were searched for relevant articles using MeSH key-words and imported into referencing/review softwares. The data, regarding demographic and clinical characteristics, diagnostic workup and management, was analyzed in International Business Machines (IBM) Statistics SPSS 21. Many statistical tests, such as t-test and the Mann-Whitney U test, were used. P < 0.05 was considered significant. RESULTS We identified 64 relevant articles. The mean age of the patients was 56 ± 16 years; the majority were males (64.9%). Among the neurological findings, paresthesia was the most typical symptom (48.9%). Most of the patients had been diagnosed by reverse transcriptase-polymerase chain reaction (RT-PCR) (69.2%). Two-third of the patients received immunoglobulins (IVIg) (77.7%). Although functions recovered in most patients, there were four patients with facial diplegia during follow-up (4.26%). Acute inflammatory demyelinating polyneuropathy (AIDP) was more likely to be associated with paresis of the lower extremity (p < 0.05) and higher levels of glucose on cerebrospinal fluid (CSF) analysis (p < 0.05). These patients were more likely to receive IVIg (p < 0.05) and develop respiratory insufficiency, subsequently (p < 0.05). CONCLUSIONS GBS is being recognized as one of the many presentations of the COVID-19 infection. Although the common form is AIDP that might lead to complications, other variants are possible as well, and more studies are needed to focus on those subvariants.
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Affiliation(s)
- Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, United States of America.
| | - Prabal Kumar Chourasia
- Department of Hospital Medicine, Mary Washington Hospital, Fredericksburg, VA, United States of America
| | - Nismat Javed
- Department of Internal Medicine, Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | | | - Sajid S Suriya
- Department of Neurology, University of New Mexico, Albuquerque, NM, United States of America
| | - Shubhra Upadhyay
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, United States of America
| | - Fatima Ijaz
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, United States of America
| | - Suman Pal
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, United States of America
| | - Narges Moghimi
- Department of Neurology, University of New Mexico, Albuquerque, NM, United States of America
| | - Rahul Shekhar
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, United States of America
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Freiha J, Zoghaib R, Makhoul K, Maalouf N, Riachi N, Chalah MA, Ayache SS, Ahdab R. The value of sensory nerve conduction studies in the diagnosis of Guillain-Barré syndrome. Clin Neurophysiol 2021; 132:1157-1162. [PMID: 33780722 DOI: 10.1016/j.clinph.2021.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/18/2021] [Accepted: 02/28/2021] [Indexed: 10/21/2022]
Abstract
Electrophysiology plays a determinant role in Guillain-Barré syndrome (GBS) diagnosis, classification, and prognostication. However, traditional electrodiagnostic (EDX) criteria for GBS rely on motor nerve conduction studies (NCS) and are suboptimal early in the course of the disease or in the setting of GBS variants. Sensory nerve conduction studies, including the sural-sparing pattern and the sensory ratio are not yet included in EDX criteria despite their well-established role in GBS diagnosis. The aim of this review is to discuss the diagnostic value of sensory NCS in GBS, their role in establishing the diagnosis and predicting the outcome according to the various subtypes of the disease.
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Affiliation(s)
- Joumana Freiha
- Gilbert and Rose Mary Chagoury School of Medicine, Lebanese American University, Byblos 4504, Lebanon; Neurology Department, Lebanese American University Medical Center Rizk Hospital, Beirut 113288, Lebanon
| | - Romy Zoghaib
- Gilbert and Rose Mary Chagoury School of Medicine, Lebanese American University, Byblos 4504, Lebanon; Neurology Department, Lebanese American University Medical Center Rizk Hospital, Beirut 113288, Lebanon
| | - Karim Makhoul
- Gilbert and Rose Mary Chagoury School of Medicine, Lebanese American University, Byblos 4504, Lebanon; Neurology Department, Lebanese American University Medical Center Rizk Hospital, Beirut 113288, Lebanon
| | - Nancy Maalouf
- Gilbert and Rose Mary Chagoury School of Medicine, Lebanese American University, Byblos 4504, Lebanon; Neurology Department, Lebanese American University Medical Center Rizk Hospital, Beirut 113288, Lebanon
| | - Naji Riachi
- Gilbert and Rose Mary Chagoury School of Medicine, Lebanese American University, Byblos 4504, Lebanon; Neurology Department, Lebanese American University Medical Center Rizk Hospital, Beirut 113288, Lebanon
| | - Moussa A Chalah
- Service de Physiologie-Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, 51 avenue de Lattre de Tassigny, 94010 Créteil, France; EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France
| | - Samar S Ayache
- Service de Physiologie-Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, 51 avenue de Lattre de Tassigny, 94010 Créteil, France; EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France
| | - Rechdi Ahdab
- Gilbert and Rose Mary Chagoury School of Medicine, Lebanese American University, Byblos 4504, Lebanon; Neurology Department, Lebanese American University Medical Center Rizk Hospital, Beirut 113288, Lebanon; Hamidy Medical Center, Tripoli 1300, Lebanon.
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Liu MQ, Wang J, Huang CN, Qi Y, Zhang LJ, Yi M, Chang SH, Sun LS, Yang L. Elevated cerebrospinal fluid levels of beta-2-microglobulin in patients with Guillain-Barré syndrome and their correlations with clinical features. Neurol Sci 2021; 42:4249-4255. [PMID: 33598798 DOI: 10.1007/s10072-021-05108-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 01/31/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUNDS Beta-2-microglobulin (β2-MG) levels vary in many infectious and autoimmune diseases. We investigated plasma and cerebrospinal fluid (CSF) β2-MG levels in patients with Guillain-Barré syndrome (GBS) and their correlations with clinical parameters. METHODS CSF samples from 50 patients with GBS including 19 acute inflammatory demyelinating polyneuropathy (AIDP), 6 acute motor axonal neuropathy (AMAN), 10 acute motor-sensory axonal neuropathy (AMSAN), 7 Miller-Fisher syndrome (MFS), and 8 unclassified patients were collected. Moreover, 23 CSF samples from patients with non-inflammatory neurological disorders (NIND) as controls were collected. Plasma samples from 42 enrolled patients and 29 healthy individuals were also collected. The β2-MG levels were measured by immunoturbidimetry on automatic biochemical analyser. Besides, clinical data were extracted from electronic patient documentation system. RESULTS CSF levels of β2-MG, lactate dehydrogenase (LDH), and lactate were significantly increased in patients with GBS (p = 0.004, p = 0.041, p = 0.040, respectively), particularly in patients with AIDP (p < 0.001, p = 0.001, p = 0.015, respectively), whereas no statistically significant difference was found in plasma levels of β2-MG. Furthermore, CSF levels of β2-MG were positively correlated with Hughes functional score (r = 0.493, p = 0.032), LDH (r = 0.796, p < 0.001), and lactate (r = 0.481, p = 0.037) but not with protein (r = - 0.090, p = 0.713) in AIDP patients. CONCLUSIONS CSF β2-MG levels may help identify AIDP and indicate clinical severity. CSF LDH and lactate levels correlate with CSF β2-MG levels; interaction among these biomarkers would need further investigation.
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Affiliation(s)
- Ming-Qi Liu
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Jing Wang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Chen-Na Huang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Yuan Qi
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Lin-Jie Zhang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Ming Yi
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Sheng-Hui Chang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Li-Sha Sun
- Department of Clinical Laboratory Center, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, China.
| | - Li Yang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, China.
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Moss KR, Bopp TS, Johnson AE, Höke A. New evidence for secondary axonal degeneration in demyelinating neuropathies. Neurosci Lett 2021; 744:135595. [PMID: 33359733 PMCID: PMC7852893 DOI: 10.1016/j.neulet.2020.135595] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 10/31/2020] [Accepted: 12/19/2020] [Indexed: 12/28/2022]
Abstract
Development of peripheral nervous system (PNS) myelin involves a coordinated series of events between growing axons and the Schwann cell (SC) progenitors that will eventually ensheath them. Myelin sheaths have evolved out of necessity to maintain rapid impulse propagation while accounting for body space constraints. However, myelinating SCs perform additional critical functions that are required to preserve axonal integrity including mitigating energy consumption by establishing the nodal architecture, regulating axon caliber by organizing axonal cytoskeleton networks, providing trophic and potentially metabolic support, possibly supplying genetic translation materials and protecting axons from toxic insults. The intermediate steps between the loss of these functions and the initiation of axon degeneration are unknown but the importance of these processes provides insightful clues. Prevalent demyelinating diseases of the PNS include the inherited neuropathies Charcot-Marie-Tooth Disease, Type 1 (CMT1) and Hereditary Neuropathy with Liability to Pressure Palsies (HNPP) and the inflammatory diseases Acute Inflammatory Demyelinating Polyneuropathy (AIDP) and Chronic Inflammatory Demyelinating Polyneuropathy (CIDP). Secondary axon degeneration is a common feature of demyelinating neuropathies and this process is often correlated with clinical deficits and long-lasting disability in patients. There is abundant electrophysiological and histological evidence for secondary axon degeneration in patients and rodent models of PNS demyelinating diseases. Fully understanding the involvement of secondary axon degeneration in these diseases is essential for expanding our knowledge of disease pathogenesis and prognosis, which will be essential for developing novel therapeutic strategies.
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Affiliation(s)
- Kathryn R Moss
- Department of Neurology, Neuromuscular Division, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Taylor S Bopp
- Department of Neurology, Neuromuscular Division, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Anna E Johnson
- Department of Neurology, Neuromuscular Division, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Ahmet Höke
- Department of Neurology, Neuromuscular Division, Johns Hopkins School of Medicine, Baltimore, MD, United States.
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Hess SR, Waligora AC, Jiranek WA, Golladay GJ. Inflammatory demyelinating polyneuropathy after total hip arthroplasty. Arthroplast Today 2019; 5:17-20. [PMID: 31020015 PMCID: PMC6470325 DOI: 10.1016/j.artd.2018.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 08/28/2018] [Accepted: 08/30/2018] [Indexed: 12/29/2022] Open
Abstract
Inflammatory demyelinating polyneuropathy is a rare but devastating condition. Guillain-Barré syndrome is the most common cause with acute inflammatory demyelinating polyneuropathy being the most common subtype that follows a monophasic course and does not recur. Chronic inflammatory demyelinating polyneuropathy occurs when symptoms persist for greater than 8 weeks. With many proposed etiologies, few reports have described acute inflammatory demyelinating polyneuropathy after total joint arthroplasty. To our knowledge, this is the first case report of chronic inflammatory demyelinating polyneuropathy developing after total hip arthroplasty that was further complicated by dislocation.
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Affiliation(s)
- Shane R Hess
- Department of Orthopedics, The CORE Institute, Phoenix, AZ, USA
| | | | | | - Gregory J Golladay
- Department of Orthopaedic Surgery, Virginia Commonwealth University Medical Center, Richmond, VA, USA
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Gupta PK, Singhi P, Singhi S, Kasinathan A, Sankhyan N. How Different is AMAN from AIDP in Childhood GBS? A Prospective Study from North India. Indian J Pediatr 2019; 86:329-334. [PMID: 30637680 DOI: 10.1007/s12098-018-2835-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 12/06/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To compare the clinical profile and short-term outcome of children with axonal and demyelinating subtypes of childhood Guillain Barré syndrome (GBS). METHODS This is a prospective observational study conducted in a tertiary care teaching hospital in North India. Consecutive children with Guillain Barré syndrome were recruited to compare the clinical profile and short term outcome among the subtypes. RESULTS Among 9847 children admitted to the emergency, 95 had acute flaccid paralysis; 57 of whom had GBS. Electrophysiological studies were completed in 57; of whom 20 had acute inflammatory demyelinating polyneuropathy (AIDP); 19 had acute motor axonal neuropathy (AMAN); 12 had non-reactive nerves; five were unclassifiable; 1 had acute motor sensory axonal neuropathy (AMSAN). More children in AMAN group had preceding gastroenteritis (4 vs. 2), while AIDP group had upper respiratory infections (12 vs. 7). Ataxia was only seen in AIDP subtype while wrist drop, foot drop and hyperreflexia were seen only with AMAN subtype. Respiratory muscle involvement (6 vs. 3) and artificial ventilation (5 vs. 2) was more in AMAN. At discharge, children with AIDP were less likely to be non-ambulant (12 vs. 6, p = 0.036). Mean disability scores at hospital discharge (4.9 ± 1.2 vs. 4 ± 0.9, p = 0.015) and at last follow-up (0.7 ± 1.01 vs. 0.05 ± 0.2, p = 0.016) were higher in AMAN. Children with AIDP were more likely to achieve normalcy on follow-up (19 vs. 12, p = 0.023). CONCLUSIONS Children with AMAN appear to have a more severe clinical course; higher short-term morbidity; and slower recovery than those with AIDP.
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Affiliation(s)
| | - Pratibha Singhi
- Pediatric Neurology and Neurodevelopment, Medanta, The Medicity, Gurugram, Haryana, India
| | - Sunit Singhi
- Division of Pediatrics, Medanta, The Medicity, Gurugram, Haryana, India
| | - Ananthanarayanan Kasinathan
- Department of Pediatrics, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth University, Puducherry, India
| | - Naveen Sankhyan
- Pediatric Neurology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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García A, Sedano MJ, Álvarez-Paradelo S, Berciano J. Reversible conduction failure on the deep tendon reflex response recording in early Guillain-Barré syndrome. Clin Neurophysiol Pract 2018; 3:159-163. [PMID: 30560219 PMCID: PMC6247394 DOI: 10.1016/j.cnp.2018.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 09/14/2018] [Accepted: 09/23/2018] [Indexed: 01/12/2023] Open
Abstract
Objective To describe the case of a patient with Guillain-Barré syndrome (GBS) showing early reversible conduction failure (RCF) detected by means of serial deep tendon reflex response (T-reflex) study. Methods A 36-year-old woman had a 5-day history of foot and hand paresthesias ascending to thighs and arms, throbbing interscapular and neck pain, mild to moderate tetraparesis, and areflexia. Nerve conduction studies (NCS) were performed on days 7 and 33 after onset. Results NCS showed an equivocal electrophysiologic pattern, just an isolated distal RCF being detected on the right radial nerve at initial examination. Motor latency on deltoid muscle after Erb's point stimulation was preserved. Sensory conduction velocities were normal or slightly slowed. Somatosensory evoked potentials from median and tibial nerves were normal. Initially, F-wave study demonstrated reversible abnormalities, consisting of multiple A waves and low F-wave persistence, minimal F-wave latencies being preserved. Biceps brachii T-reflex was normal, whereas Achilles T-reflex was absent bilaterally, appearing on the second study with normal T-wave morphology and latency, thus conforming to the requirements for RCF diagnosis. Soleus H-reflex was also initially absent. Conclusions Serial T-reflex study is a useful technique for detecting early RCF of proximal nerve trunks in early GBS. Significance T-reflex is useful tool for GBS in association with NCS.
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Key Words
- A waves
- ADM, abductor digiti minimi
- AH, abductor hallucis
- AIDP, acute inflammatory demyelinating polyneuropathy
- AMAN, acute motor axonal neuropathy
- AMSAN, acute motor sensory axonal neuropathy
- APB, abductor pollicis brevis
- Acute inflammatory demyelinating polyneuropathy
- Acute motor axonal neuropathy
- CIDP, chronic idiopathic demyelinating polyneuropathy
- CMAP, compound muscle action potential
- CMT1A, Charcot-Marie-Tooth disease type 1A
- DML, distal motor latency
- EDB, extensor digitorum brevis
- EDC, extensor digitorum communis
- EMG, electromyography
- Erb’s point
- F waves
- GBS, Guillain-Barré syndrome
- Guillain-Barré syndrome
- H reflex
- LLN, lower limit of normal
- MCV, motor conduction velocity
- MRC, Medical Research Council
- NCS, nerve conduction study
- Nerve conduction study
- RCF, reversible conduction failure
- Reversible conduction failure
- SCV, sensory conduction velocity
- SEP, somatosensory evoked potentials
- SNAP, sensory nerve action potential
- Somatosensory evoked potentials
- T reflex
- TA, tibialis anterior
- ULN, upper limit of normal
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Affiliation(s)
- Antonio García
- Service of Clinical Neurophysiology, University Hospital "Marqués de Valdecilla (IDIVAL)" and "Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED)", Santander, Spain
| | - María J Sedano
- Service of Neurology, University Hospital "Marqués de Valdecilla (IDIVAL)", University of Cantabria and "Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED)", Santander, Spain
| | - Silvia Álvarez-Paradelo
- Service of Clinical Neurophysiology, University Hospital "Marqués de Valdecilla (IDIVAL)" and "Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED)", Santander, Spain
| | - José Berciano
- Service of Neurology, University Hospital "Marqués de Valdecilla (IDIVAL)", University of Cantabria and "Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED)", Santander, Spain
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Ahdab R, Noureldine MHA, Mohammedi K, Nader M, Zouari HG, Nordine T, Créange A, Lefaucheur JP, Ayache SS. The ulnar ratio as a sensitive and specific marker of acute inflammatory demyelinating polyneuropathy. Clin Neurophysiol 2018; 129:1699-1703. [PMID: 29940481 DOI: 10.1016/j.clinph.2018.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 04/20/2018] [Accepted: 05/23/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVES To explore the value of a novel sensory criterion, the ulnar ratio - defined as the SNAP amplitude of the palmar cutaneous (pUN) over that of the dorsal branch (dUN) of the ulnar nerve - as a predictor of Acute Inflammatory Demyelinating Polyneuropathy (AIDP). METHODS We prospectively included 22 patients with AIDP, 20 patients with diabetic peripheral neuropathy (DPN), and 18 controls. Eligible subjects underwent nerve conduction studies including, among others, the dUN, pUN, and sural nerve. RESULTS A sural sparing pattern was found in 72% of AIDP cases. The ulnar ratio was significantly lower in patients with AIDP compared to those with DPN or controls. The ROC curve area to discriminate AIDP (versus controls and diabetics together) was higher with the ulnar ratio and pUN compared to dUN. An ulnar ratio ≥ 0.78 seems to be the best threshold to rule out the diagnosis of AIDP, with a specificity of 100% and a sensitivity of 87%. The ulnar ratio was equally reliable in the subgroup of patients presenting within a week of symptoms onset. CONCLUSION The ulnar ratio is a highly sensitive and specific marker of AIDP and can help confirm the diagnosis when direct signs of demyelination are lacking. SIGNIFICANCE Incorporating specific sensory abnormalities, such as the ulnar ratio, in the electrodiagnostic criteria of AIDP could enhance their reliability.
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Affiliation(s)
- Rechdi Ahdab
- Division of Neurology, Lebanese American University Medical Center, Beirut, Lebanon; Hamidy Charitable Medical Center, Tripoli, Lebanon.
| | | | - Kamel Mohammedi
- University Hospital and Faculty of Medicine of Bordeaux, France; The George Institute for Global Health, Sydney, Australia
| | - Manal Nader
- Division of Neurology, Lebanese American University Medical Center, Beirut, Lebanon
| | - Hela G Zouari
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France; Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, 51 avenue de Lattre de Tassigny, 94010, Créteil, France; Service d'Explorations Fonctionnelles, CHU Habib Bourguiba, Sfax, Tunisia
| | - Tarik Nordine
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France; Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, 51 avenue de Lattre de Tassigny, 94010, Créteil, France.
| | - Alain Créange
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France; Service de Neurologie, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, 51 avenue de Lattre de Tassigny, 94010, Créteil, France.
| | - Jean-Pascal Lefaucheur
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France; Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, 51 avenue de Lattre de Tassigny, 94010, Créteil, France.
| | - Samar S Ayache
- Division of Neurology, Lebanese American University Medical Center, Beirut, Lebanon; EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France; Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, 51 avenue de Lattre de Tassigny, 94010, Créteil, France.
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Fong CY, Aung HWW, Khairani A, Gan CS, Shahrizaila N, Goh KJ. Bickerstaff's brainstem encephalitis with overlapping Guillain-Barré syndrome: Usefulness of sequential nerve conduction studies. Brain Dev 2018; 40:507-11. [PMID: 29459060 DOI: 10.1016/j.braindev.2018.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/29/2018] [Accepted: 02/01/2018] [Indexed: 11/21/2022]
Abstract
Bickerstaff's brainstem encephalitis (BBE) is a rare immune-mediated disorder characterized by ophthalmoplegia, ataxia and disturbance of consciousness, which may overlap with Guillain-Barré syndrome (GBS) if there is additional limb weakness. We report a 7-month-old boy presented with ophthalmoplegia followed by a rapidly ascending paralysis of all four limbs and disturbance of consciousness. The initial impression was BBE with overlapping GBS. This was supported by sequential nerve conduction study (NCS) findings compatible with an acute inflammatory demyelinating polyneuropathy (AIDP). He received intravenous pulse methylprednisolone, intravenous immunoglobulin and plasmapharesis with complete clinical recovery after 6 weeks of illness and improved NCS findings from week 16. This is the first case of paediatric BBE with overlapping GBS with an AIDP subtype of GBS. It expands the clinical spectrum of this condition in children. Our case highlights the importance of sequential NCS in paediatric BBE with overlapping GBS for accurate electrophysiological diagnosis and prognosis particularly if the first NCS findings are not informative.
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Abstract
Introduction Immune-mediated peripheral neuropathy is the term applied to a spectrum of peripheral nerve disorders where immune dysregulation plays a role. Therefore, they are treatable. We analyzed the cases seen in the past 3 years by us and evaluated the clinical, laboratory, and outcome parameters in these patients. Patients and Methods Consecutive patients seen by the authors and diagnosed as immune-mediated neuropathy were analyzed for etiology, pathology, and outcome assessed. Results A total of sixty patients, 31 acute and 29 chronic neuropathies, were identified. Their subtypes treatment and outcome assessed. Males were significantly more in both acute and chronic cases. Miller Fisher 4, AMAN 1, paraplegic type 1, motor dominant type 19, Sensory-motor 1, MADSAM 3, Bifacial 2. Nonsystemic vasculitis was seen in 16 out of 29 chronic neuropathy and HIV, POEMS, and diabetes mellitus one each. Discussion There is a spectrum of immune-mediated neuropathy which varies in clinical course, response to treatment, etc., Small percentage of uncommon cases are seen. In this group, mortality was nil and morbidity was minimal. Conclusion Immune-mediated neuropathies are treatable and hence should be diagnosed early for good quality outcome.
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Affiliation(s)
| | - Venkata Raviteja Karru
- Department of Neurocentre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - M A Mukheem Mudabbir
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Subashree Ramakrishnan
- Department of Neurocentre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Anitha Mahadevan
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Österlund-Tauriala E, Partanen JV. Three cases of acute distal demyelinating neuropathy with recovery. Clin Case Rep 2017; 5:822-828. [PMID: 28588819 PMCID: PMC5457988 DOI: 10.1002/ccr3.943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 08/23/2016] [Accepted: 03/02/2017] [Indexed: 11/10/2022] Open
Abstract
Guillain–Barré syndrome (GBS) may present as distal acute inflammatory demyelinating polyradiculoneuropathy (AIDP), with severe distal demyelination of the peripheral nerves in the absence of radiculitis. Clinical course is benign, and prognosis seems favorable, but nerve conduction studies (NCS) findings at nadir may resemble some chronic forms of polyneuropathy, so close follow‐up during recovery is needed.
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Affiliation(s)
- Emilia Österlund-Tauriala
- Clinical Neurosciences, Neurology Helsinki University Hospital University of Helsinki Helsinki Finland
| | - Juhani V Partanen
- Clinical Neurosciences, Clinical Neurophysiology Helsinki University Hospital University of Helsinki Helsinki Finland
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Abstract
Neuromuscular diseases are syndromic disorders that affect nerve, muscle, and/or neuromuscular junction. Knowledge about the management of these diseases is required for anesthesiologists, because these may frequently be encountered in the intensive care unit, operating room, and other settings. The challenges and advances in management for some of the neuromuscular diseases most commonly encountered in the operating room and neurointensive care unit are reviewed.
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Affiliation(s)
- Veronica Crespo
- Department of Anesthesiology, Duke University, Erwin Road, Durham, NC 27710, USA
| | - Michael L Luke James
- Department of Anesthesiology, Duke University, Erwin Road, Durham, NC 27710, USA; Department of Neurology, Duke University, Erwin Road, Durham, NC 27710, USA.
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Voitenkov VV, Andrey K, Natalia S, Anastasia A. Transcranial Magnetic Stimulation as an Additional Diagnostic Tool in Children with Acute Inflammatory Demyelinating Polyneuropathy. J Pediatr Neurosci 2017; 12:144-148. [PMID: 28904571 PMCID: PMC5588638 DOI: 10.4103/jpn.jpn_128_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CONTEXT The diagnosis of polyneuropathy may be challenging at the early stages of the disease. Despite electromyography (EMG) efficacy in the establishment of polyneuropathy diagnosis, in some cases, results are dubious and neurophysiologists may implement additional techniques to ensure that conduction is affected. AIMS The aim of the study was to evaluate motor-evoked potential (MEP) characteristics in children with acute inflammatory demyelinating polyneuropathy (AIDP). SETTINGS AND DESIGN The study was conducted at a pediatric research and clinical center for infectious diseases. SUBJECTS AND METHODS Twenty healthy children (7-14 years old) without signs of neurological disorders were enrolled as controls. Thirty-seven patients (8-13 years old) with AIDP were enrolled as the main group. EMG and transcranial magnetic stimulation (TMS) were performed on the 3rd-7th days from the onset of the first symptoms. STATISTICAL ANALYSIS USED Descriptive statistics and Student's t-test were used. Bonferroni method was applied to implement appropriate corrections for multiple comparisons. RESULTS Significant differences between children with AIDP and controls on latencies of both cortical and lumbar MEPs were registered. Cortical MEP shapes were disperse in 100% of the cases and lumbar MEPs were disperse in 57% of the cases. CONCLUSIONS Diagnostic TMS on the early stage of the AIDP in children may be implemented as the additional tool. The main finding in this population is lengthening of the latency of cortical and lumbar MEPs. Disperse shape of the lumbar MEPs may be used as the early sign of the acute demyelization.
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Affiliation(s)
- Voitenkov Vladislav Voitenkov
- Department of Functional Diagnostics, Pediatric Research and Clinical Center for Infectious Diseases, Saint Petersburg, Russia
| | - Klimkin Andrey
- Department of Functional Diagnostics, Pediatric Research and Clinical Center for Infectious Diseases, Saint Petersburg, Russia
| | - Skripchenko Natalia
- Department of Functional Diagnostics, Pediatric Research and Clinical Center for Infectious Diseases, Saint Petersburg, Russia
| | - Aksenova Anastasia
- Department of Functional Diagnostics, Pediatric Research and Clinical Center for Infectious Diseases, Saint Petersburg, Russia
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Gunatilake SSC, Gamlath R, Wimalaratna H. An unusual case of recurrent Guillain-Barré syndrome with normal cerebrospinal fluid protein levels: a case report. BMC Neurol 2016; 16:161. [PMID: 27596231 PMCID: PMC5011863 DOI: 10.1186/s12883-016-0687-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 08/29/2016] [Indexed: 11/20/2022] Open
Abstract
Background Guillain-Barré syndrome is an acquired polyradiculo-neuropathy, often preceded by an antecedent event. It is a monophasic disease but a recurrence rate of 1–6 % is documented in a subset group of patients. Patients with Guillain-Barré syndrome show cerebrospinal fluid albuminocytologic dissociation. Normal cerebrospinal fluid protein levels during both initial and recurrent episodes of Guillain-Barré syndrome is a rare occurrence and has not been described earlier in the literature. Case presentation Twenty-five-year-old Sri Lankan female with past history of complete recovery following an acute inflammatory demyelinating polyneuropathy (AIDP) variant of Guillain-Barré syndrome 12 years back presented with acute, ascending symmetrical flaccid quadriparasis extending to bulbar muscles, bilateral VII cranial nerves and respiratory compromise needing mechanical ventilation. Nerve conduction study revealed AIDP variant of Guillain-Barré syndrome. Cerebrospinal fluid analysis done after 2 weeks were normal during both episodes without albuminocytologic dissociation. She was treated with intravenous immunoglobulin resulting in a remarkable recovery. Both episodes had a complete clinical recovery in three and four months’ time respectively, rather a faster recovery than usually expected. Conclusion Recurrence of Guillain-Barré syndrome can occur in a subset of patients with Guillain-Barré syndrome even after many years of asymptomatic period. Normal cerebrospinal fluid profile does not exclude Guillain-Barré syndrome and may occur in subsequent recurrences of Guillain-Barré syndrome arising the need for further studies to identify the pathophysiology and the possibility of a different subtype of Guillain-Barré syndrome.
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Yoshida T, Ueki Y, Suzuki T, Kawagashira Y, Koike H, Kusumoto S, Ida S, Oguri T, Omura M, Sobue, Matsukawa N. Guillain-Barré syndrome after allogeneic bone marrow transplantation: Case report and literature review. eNeurologicalSci 2016; 4:52-55. [PMID: 29430549 PMCID: PMC5803090 DOI: 10.1016/j.ensci.2016.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 08/03/2016] [Accepted: 08/03/2016] [Indexed: 12/20/2022] Open
Abstract
A 50-year-old man with acute myelogenous leukemia underwent allogeneic bone-marrow transplantation (BMT). He presented with severe diarrhoea 86 days post BMT and was diagnosed with graft-versus-host disease (GVHD) based on skin and rectal biopsies. He complained of numbness and weakness in the distal extremities at 114 days after BMT. His symptoms rapidly deteriorated and he required mechanical ventilation for respiratory failure. His clinical course and the findings of a nerve conduction study fulfilled the criteria for diagnosis of Guillain-Barré syndrome (GBS). Sural nerve biopsy revealed active demyelination and infiltration of macrophages and CD8+ T-cells. After three cycles of intravenous immunoglobulin therapy, his symptoms gradually improved, and he could eventually walk unassisted. Although GBS has been known to develop after allogeneic BMT, the pathogenesis remains unclear, and specific treatment regimens have not been well established. Here, we report a case of GBS, caused by an immune-mediated mechanism related to GVHD, which was successfully treated using intravenous immunoglobulin therapy.
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Affiliation(s)
- Tomoko Yoshida
- Department of Neurology and Neuroscience, Nagoya City University Graduate School of Medical Science, Kawasumi, Mizuho-ku, Nagoya 467-8601, Japan
| | - Yoshino Ueki
- Department of Neurology and Neuroscience, Nagoya City University Graduate School of Medical Science, Kawasumi, Mizuho-ku, Nagoya 467-8601, Japan
| | - Tomotaka Suzuki
- Department of Medical Oncology and Immunology, Nagoya City University Graduate School of Medical Science, Kawasumi, Mizuho-ku, Nagoya 467-8601, Japan
| | - Yuichi Kawagashira
- Department of Neurology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-Ku, Nagoya 466-8550, Japan
| | - Haruki Koike
- Department of Neurology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-Ku, Nagoya 466-8550, Japan
| | - Shigeru Kusumoto
- Department of Medical Oncology and Immunology, Nagoya City University Graduate School of Medical Science, Kawasumi, Mizuho-ku, Nagoya 467-8601, Japan
| | - Shinsuke Ida
- Department of Medical Oncology and Immunology, Nagoya City University Graduate School of Medical Science, Kawasumi, Mizuho-ku, Nagoya 467-8601, Japan
| | - Takuya Oguri
- Department of Neurology and Neuroscience, Nagoya City University Graduate School of Medical Science, Kawasumi, Mizuho-ku, Nagoya 467-8601, Japan
| | - Masahiro Omura
- Department of Neurology and Neuroscience, Nagoya City University Graduate School of Medical Science, Kawasumi, Mizuho-ku, Nagoya 467-8601, Japan
| | - Sobue
- Department of Neurology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-Ku, Nagoya 466-8550, Japan
| | - Noriyuki Matsukawa
- Department of Neurology and Neuroscience, Nagoya City University Graduate School of Medical Science, Kawasumi, Mizuho-ku, Nagoya 467-8601, Japan
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Li X, Wang Y. Systemic Lupus Erythematosus With Acute Inflammatory Demyelinating Polyneuropathy: A Case Report and Review of the Literature. J Clin Med Res 2016; 8:555-9. [PMID: 27298667 PMCID: PMC4894028 DOI: 10.14740/jocmr2550w] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2016] [Indexed: 11/26/2022] Open
Abstract
We recently encountered a patient with acute inflammatory demyelinating polyneuropathy (AIDP) that was associated with systemic lupus erythematosus (SLE). A 34-year-old Chinese female with a 3-year history of SLE presented with acute bilateral leg weakness and paraparesis, and lost the ability to walk 1 day after noticing bilateral leg numbness and pain for 12 days. Physical examination revealed bilateral facial muscle paralysis, muscle strength in the legs with graded 1/5 proximally and 2/5 distally bilaterally and absence of deep tendon reflex in both knees and ankles. Paresthesia was observed in distal limbs with glove and stocking distribution. Cerebrospinal fluid analysis demonstrated albuminocytologic dissociation. Electrophysiologic survey also indicated sensory-motor demyelinating polyneuropathy. The diagnosis of SLE was established based on her initial symptoms including intermittent fevers, hair loss, oral ulcers, malar rash and arthritis affecting the elbow, wrist and hand joints; positive immunologic findings for antinuclear antibody (ANA), anti-DNA antibody, anti-Smith (anti-Sm) antibody, low serum complement levels, and the kidney biopsy specimen showed glomerular mesangial proliferation with focal endothelial cell proliferation (ISN/PPS 2004 classification lupus nephritis, class III). Treatment with intravenous immunoglobulin, methylprednisolone and cyclophosphamide resulted in clinical and electrophysiological improvement.
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Affiliation(s)
- Xiangling Li
- Department of Nephrology, The Affiliated Hospital of Weifang Medical University, 2428 Yuhe Road, Weifang 261031, China
| | - Yanqiang Wang
- Department of Neurology, The Affiliated Hospital of Weifang Medical University, Weifang 261031, China
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Notturno F, Kokubun N, Sekiguki Y, Nagashima T, De Lauretis A, Yuki N, Kuwabara S, Uncini A. Demyelinating Guillain-Barré syndrome recurs more frequently than axonal subtypes. J Neurol Sci 2016; 365:132-6. [PMID: 27206890 DOI: 10.1016/j.jns.2016.02.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 01/26/2016] [Accepted: 02/19/2016] [Indexed: 11/23/2022]
Abstract
Guillain-Barré syndrome (GBS) is considered a monophasic disorder yet recurrences occur in up to 6% of patients. We retrospectively studied an Italian-Japanese population of 236 GBS and 73 Miller Fisher syndrome (MFS) patients and searched for factors which may be associated with recurrence. A recurrent patient was defined as having at least two episodes that fulfilled the diagnostic criteria for GBS and MFS with an identifiable recovery after each episode and a minimum of 2months between episodes. Preceding Campylobacter jejuni (C. jejuni) infection and antiganglioside antibodies were also assessed. Seven (3%) recurrent GBS and one (1.4%) recurrent MFS patients were identified. In the individual patient the clinical features during episodes were usually similar varying in severity whereas the preceding infection differed. None of the patients had GBS in one episode and MFS in the recurrence or vice versa. Recurrent GBS patients, compared with monophasic GBS, did not have preceding diarrhea at the first episode and considering the electrophysiological subtypes, acute inflammatory demyelinating polyneuropathies recurred more frequently than axonal GBS (6.5% vs 0.9%, p=0.04). In conclusion in a GBS population with a balanced number of demyelinating and axonal subtypes less frequent diarrhea and demyelination at electrophysiology were associated with recurrence.
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Scarpino M, Lolli F, Carrai R, Lanzo G, Spalletti M, Barilaro A, Fattapposta F, Amantini A, Grippo A. Diagnostic accuracy of neurophysiological criteria for early diagnosis of AIDP: A prospective study. Neurophysiol Clin 2016; 46:35-42. [PMID: 26906685 DOI: 10.1016/j.neucli.2015.12.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 12/29/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To assess the diagnostic accuracy of electrodiagnostic (EDX) criteria for the early detection and characterization of Guillain-Barré syndrome (GBS) in clinical practice. METHODS We conducted a prospective study in patients referred for an EDX exam with clinical suspicion of GBS. We evaluated four sets of neurophysiological criteria and four neurophysiological tests among those recently proposed for the early diagnosis of GBS. RESULTS We recruited 84 patients. Acute inflammatory demyelinating polyneuropathy (AIDP) was the final diagnosis in 23 patients. No axonal forms were found. The best sensitivity was obtained using Rajabally et al.'s criteria (82.1%), whereas the specificity was 90.0% for Ho et al.'s and Hadden et al.'s criteria and 100% for the Dutch GBS study group and Rajabally's criteria. Regarding the neurophysiological tests proposed for early diagnosis, the sensitivity ranged from 16.6 to 100%, whereas specificity ranged from 73.1 to 98.3%. CONCLUSION The Dutch GBS study group and Rajabally et al.'s criteria showed an optimal combination of sensitivity and specificity for clinical practice, although with a slightly higher sensitivity for Rajabally et al.'s criteria. None of the neurophysiological parameters recently proposed for early diagnosis have good diagnostic accuracy for clinical application. SIGNIFICANCE In a real clinical setting with patients referred by neurologists and emergency doctors, an EDX study performed within a week of symptom onset supports the diagnosis of AIDP in 82% of cases.
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Affiliation(s)
- Maenia Scarpino
- Neuromuscolar Department, AOU Careggi, Florence, Italy; IRCCS Don Carlo Gnocchi, Florence, Italy
| | - Francesco Lolli
- Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy
| | - Riccardo Carrai
- Neuromuscolar Department, AOU Careggi, Florence, Italy; IRCCS Don Carlo Gnocchi, Florence, Italy
| | | | | | | | | | - Aldo Amantini
- Neuromuscolar Department, AOU Careggi, Florence, Italy; IRCCS Don Carlo Gnocchi, Florence, Italy
| | - Antonello Grippo
- Neuromuscolar Department, AOU Careggi, Florence, Italy; IRCCS Don Carlo Gnocchi, Florence, Italy.
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Ashikari Y, Kobayashi S, Tago A, Yoneyama M, Ito M, Fukuda K, Mizuno Y, Tsunoda Y, Shimizu S, Yokoi K, Kamioka N, Hamajima N, Suzuki S. A case of Guillain-Barré syndrome with meningeal irritation. Brain Dev 2016; 38:163-6. [PMID: 26403311 DOI: 10.1016/j.braindev.2015.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 05/26/2015] [Accepted: 06/01/2015] [Indexed: 11/22/2022]
Abstract
Here, we report a 5-year-old girl with Guillain-Barré syndrome who presented with a chief complaint of pain in the extremities, which was followed by neck stiffness. Bladder dysfunction was found, which required catheterization. Magnetic resonance imaging revealed marked enhancement of the nerve roots in the cauda equina on T1-weighted imaging after gadolinium injection, and nerve conduction studies led to a diagnosis of Guillain-Barré syndrome. Her symptoms improved after intravenous immunoglobulin therapy, but her neck stiffness remained 16 days after admission. Four weeks after admission, she could walk without support. As patients with signs of meningeal irritation may be diagnosed with other diseases, such as meningitis, it is important to recognize atypical cases of pediatric Guillain-Barré syndrome to achieve early diagnosis and treatment.
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Miyaji K, Paul F, Shahrizaila N, Umapathi T, Yuki N. Complement regulatory proteins (CD46, 55 and 59) expressed on Schwann cells: immune targets in demyelinating neuropathies? J Neuroimmunol 2014; 276:172-4. [PMID: 25156074 DOI: 10.1016/j.jneuroim.2014.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 07/28/2014] [Accepted: 08/01/2014] [Indexed: 12/20/2022]
Abstract
Given their localization and important role in regulating complement, complement regulatory proteins may act as target antigens and their antibodies as biomarkers in demyelinating neuropathies. We investigated the binding of autoantibodies to complement regulatory proteins (CD46, 55 and 59) in demyelinating diseases. In 42 acute inflammatory demyelinating polyneuropathy, 23 chronic inflammatory demyelinating polyneuropathy, 13 acute motor axonal neuropathy, 71 multiple sclerosis, and 19 neuromyelitis optica patients as well as 55 healthy controls, we were unable to detect significant titers of antibodies to CD46, CD55 and CD59. These autoantibodies are unlikely to be biomarkers in acute and chronic inflammatory demyelinating polyneuropathies.
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Affiliation(s)
- Kazuki Miyaji
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité University Medicine, Berlin, Germany; Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Charité University Medicine, Berlin, Germany
| | - Nortina Shahrizaila
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Nobuhiro Yuki
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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30
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Berkowitz AL, Thakur KT. Acute inflammatory demyelinating polyradiculoneuropathy following malaria. J Clin Neurosci 2013; 21:704-6. [PMID: 24417794 DOI: 10.1016/j.jocn.2013.07.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 07/15/2013] [Indexed: 11/15/2022]
Abstract
Among the neurologic complications of malaria, acute inflammatory demyelinating polyradiculoneuropathy is a rarely reported phenomenon. We describe a patient with acute inflammatory demyelinating polyradiculoneuropathy following malaria in a 26-year-old traveler to an endemic area and review the clinical features of all 23 previously reported patients. Malarial infection should be considered as a potential preceding trigger in patients residing in or travelers returning from malaria-endemic areas presenting with the clinical features of acute inflammatory demyelinating polyradiculoneuropathy in the setting of a recent or ongoing febrile illness.
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Affiliation(s)
- Aaron L Berkowitz
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
| | - Kiran T Thakur
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
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31
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Kerasnoudis A, Pitarokoili K, Behrendt V, Gold R, Yoon MS. Nerve ultrasound score in distinguishing chronic from acute inflammatory demyelinating polyneuropathy. Clin Neurophysiol 2013; 125:635-41. [PMID: 24070674 DOI: 10.1016/j.clinph.2013.08.014] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 08/04/2013] [Accepted: 08/08/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Aim of this study was to develop and evaluate the applicability of an ultrasound score (Bochum ultrasound score - BUS) in distinguishing chronic (CIDP) from acute inflammatory demyelinating polyneuropathy (AIDP). METHODS Step 1: For the development of BUS 75 healthy-controls, 20 CIDP, 20 AIDP patients underwent US 4.55 ± 3.5 and 3.4 ± 2.91 years, respectively after onset. After comparing the distribution pattern and frequency of pathological US changes between the two study groups, we developed BUS, summarizing the cross sectional area (CSA) of: (1) the ulnar nerve in Guyons' canal, (2) the ulnar nerve in upper-arm, (3) the radial nerve in spiral groove, (4) the sural nerve between the gastrocnemius muscle. Step 2: The BUS underwent blinded evaluation in further 10 CIDP, 21 AIDP patients 3.8 ± 2.7 and 2.3 ± 1.5 years, respectively after onset. Step 3: The BUS underwent blinded, prospective evaluation in 8 patients with acute/subacute polyradiculoneuropathy (5 CIDP, 3 AIDP) 2.6 ± 1.8 weeks after onset. RESULTS The BUS showed a sensitivity of 90% and specificity of 90.4% (positive predictive value, PPV=81.8%; negative predictive value, NPV=95%) in distinguishing CIDP from AIDP, when they showed no differences in disease duration (p=0.0551).In addition, the BUS distinguished subacute-CIDP from AIDP with a sensitivity of 80%, specificity of 100% (PPV=100%, NPV=75%). CONCLUSION The BUS seems to allow a reliable distinction of CIDP from AIDP. SIGNIFICANCE The BUS may be helpful in distinguishing subacute-CIDP from AIDP.
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Affiliation(s)
- A Kerasnoudis
- Department of Neurology, St. Josef Hospital, Ruhr University of Bochum, Germany.
| | - K Pitarokoili
- Department of Neurology, St. Josef Hospital, Ruhr University of Bochum, Germany.
| | - V Behrendt
- Department of Neurology, St. Josef Hospital, Ruhr University of Bochum, Germany.
| | - R Gold
- Department of Neurology, St. Josef Hospital, Ruhr University of Bochum, Germany.
| | - M-S Yoon
- Department of Neurology, St. Josef Hospital, Ruhr University of Bochum, Germany.
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Kokubun N, Shahrizaila N, Koga M, Hirata K, Yuki N. The demyelination neurophysiological criteria can be misleading in Campylobacter jejuni-related Guillain-Barré syndrome. Clin Neurophysiol 2013; 124:1671-9. [PMID: 23514735 DOI: 10.1016/j.clinph.2013.02.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Revised: 02/08/2013] [Accepted: 02/18/2013] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The exclusive association of Campylobacter jejuni infection with the axonal variant of Guillain-Barré syndrome (GBS) is debatable. The current study aims to elucidate the GBS subtypes of patients with an antecedent C. jejuni infection. METHODS Nerve conduction study results of 73 patients with GBS were reviewed. Patients were defined as having a recent C. jejuni infection when there was a positive stool culture or serological evidence of C. jejuni in the presence of preceding diarrhea. RESULTS A total of 23 patients had evidence of a recent C. jejuni infection. At the early stage, patients were classified as AMAN (n=9; 39%), AIDP (n=3; 13%) or equivocal (n=9) using existing electrophysiological criteria. Prolonged distal latencies and conduction slowing that were seen in 11 patients rapidly normalized within 3 weeks in seven, whereas four had minor abnormalities throughout the course. Subsequently, all patients showed either acute motor axonal neuropathy pattern or reversible conduction failure. CONCLUSION Serial neurophysiology suggests that C. jejuni infections are exclusive to axonal GBS. SIGNIFICANCE Our findings suggest that AMAN can demonstrate the full complement of demyelinating features at the early stages of disease.
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Affiliation(s)
- Norito Kokubun
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan.
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Aygul R, Deniz O, Guzelcik M, Kotan D. Guillain-barré syndrome during active brucellosis. Eurasian J Med 2010; 42:157-9. [PMID: 25610149 DOI: 10.5152/eajm.2010.43] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Accepted: 10/14/2010] [Indexed: 11/22/2022] Open
Abstract
It has been reported that approximately two thirds of patients diagnosed with Guillain-Barré syndrome (GBS) have had a prodromal illness within a four-week period preceding the onset of GBS. This prodromal illness is most commonly an upper respiratory tract illness or, secondly, gastroenteritis. However, specific infectious agents, such as mycoplasma, cytomegalovirus, Ebstein-Barr virus, vaccinia, variola, campylobacter, varicella-zoster, measles, mumps, hepatitis A and B viruses, rubella, influenza A and B viruses, coxackie and echoviruses, have also been reported to be certain or probable etiologic antecedent agents of GBS. In contrast, GBS during active brucellosis has rarely been reported. This article presents the case of a 28 year-old male patient with GBS during active brucellosis who responded fully to treatment directed to brucellosis. and it is stressed that brucellosis should be considered as a probable etiologic agent in patients with GBS who live in areas where brucellosis is endemic.
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Affiliation(s)
- Recep Aygul
- Department of Neurology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Orhan Deniz
- Department of Neurology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Metin Guzelcik
- Department of Neurology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Dilcan Kotan
- Department of Neurology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
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