151
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Abstract
Zika virus (ZIKV) infection has been associated with Guillain-Barré Syndrome (GBS). Roughly 60% of people in countries such as the U.S. live in areas at risk for seasonal spread of ZIKV. ZIKV belongs to a class of diseases that is not typically seen in hospital settings across the U.S. and Europe. We describe the case presentation, management, and treatment of ZIKV infection complicated by GBS. A 64-year-old woman with recent travel to the Dominican Republic presented with rash followed by an acute, ascending polyneuropathy consistent with GBS. She was confirmed to have an acute ZIKV infection by detection of ZIKV nucleic acid by reverse transcription-polymerase chain reaction. She met Brighton Collaboration criteria level 1 evidence for GBS. She received two courses of intravenous immunoglobulin and slowly improved, though still had weakness at discharge. More research is needed to identify the pathophysiology behind ZIKV-associated GBS and its optimal treatment. Prevention is fundamental to limiting infection and spread of ZIKV.
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152
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An Unusual Presentation of Acute Weakness: Acute Inflammatory Demyelinating Polyneuropathy in a Patient with Psychiatric Illness. Case Rep Emerg Med 2018; 2018:4065342. [PMID: 30345121 PMCID: PMC6174749 DOI: 10.1155/2018/4065342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 04/25/2018] [Accepted: 07/31/2018] [Indexed: 11/24/2022] Open
Abstract
We report an unusual presentation of Guillain-Barré wherein a patient with an extensive history of psychiatric illness had a dream that his legs were crushed in an earthquake and awoke from the dream with paresthesias and rapid paralysis of bilateral lower extremities. This article discusses an atypical presentation of pathology and diagnostic evaluation for a form of Guillain-Barré called Acute Inflammatory Demyelinating Polyneuropathy (AIDP).
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153
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Debnath M, Nagappa M, Subbanna M, Sundaravadivel P, Talukdar PM, Shivakumar V, Wahatule R, Dutta D, Binukumar B, Sinha S, Bindu PS, Periyavan S, Umamaheswara Rao G, Taly AB. Th17 pathway signatures in a large Indian cohort of Guillain Barré syndrome. J Neuroimmunol 2018; 323:125-130. [DOI: 10.1016/j.jneuroim.2018.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 07/28/2018] [Accepted: 08/02/2018] [Indexed: 12/19/2022]
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154
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Durcan R, Murphy O, Reid V, Lynch T. Guillain-Barré syndrome mimicking botulism in early disease course. Pract Neurol 2018; 18:501-504. [PMID: 30061335 DOI: 10.1136/practneurol-2018-001891] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2018] [Indexed: 11/03/2022]
Abstract
A 42-year-old man, returning to Europe after a 2-month stay in China, reported cough and runny nose. Five days later, he developed neck discomfort and rapidly evolving weakness, spreading from his arms to the facial, bulbar and neck muscles, and then the legs. He developed dysphagia and breathlessness, and was intubated in the emergency department. Cerebrospinal fluid showed mildly elevated protein. On day 2 he had fixed dilated pupils, with absent oculocephalic reflexes, and a flaccid upper limb paralysis. MR scans of the brain and spinal cord were normal. The early features of descending weakness, bulbar involvement and fixed dilated pupils made it difficult to distinguish between Guillain-Barré syndrome and botulism, and early investigations were inconclusive. We initially gave both botulinum antitoxin and intravenous immunoglobulin, but initially delayed plasma exchange as this would have removed the botulinum antitoxin. Diagnostic testing for botulism has low sensitivity, so we urge pre-emptive treatment if it is clinically suspected.
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Affiliation(s)
- Robert Durcan
- Department of Neurology, Mater Misericordiae University Hospital, Dublin, Ireland.,Dublin Neurological Institute, Dublin, Ireland
| | - Olwen Murphy
- Department of Neurology, Mater Misericordiae University Hospital, Dublin, Ireland.,Dublin Neurological Institute, Dublin, Ireland.,Johns Hopkins University, Baltimore, Maryland, USA
| | - Valerie Reid
- Department of Neurology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Tim Lynch
- Department of Neurology, Mater Misericordiae University Hospital, Dublin, Ireland.,Dublin Neurological Institute, Dublin, Ireland
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155
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Azevedo MBD, Coutinho MSC, Silva MAD, Arduini DB, Lima JDV, Monteiro R, Mendes BNB, Lemos MCF, Noronha CP, Saraceni V. Neurologic manifestations in emerging arboviral diseases in Rio de Janeiro City, Brazil, 2015-2016. Rev Soc Bras Med Trop 2018; 51:347-351. [PMID: 29972566 DOI: 10.1590/0037-8682-0327-2017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 11/17/2017] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Dengue has affected Rio de Janeiro City since the 1980s. The sequential Zika and chikungunya virus introductions during 2015 aggravated the health scenario, with 97,241 cases of arboviral diseases reported in 2015-2016, some with neurological disorders. METHODS Arbovirus-related neurologic cases were descriptively analyzed, including neurological syndromes and laboratory results. RESULTS In total, 112 cases with non-congenital neurologic manifestations (Guillain-Barré syndrome, 64.3%; meningoencephalitis, 24.1%; acute demyelinating encephalomyelitis, 8%) were arbovirus-related; 43.7% were laboratory-confirmed, of which 57.1% were chikungunya-positive. CONCLUSIONS Emerging arbovirus infections brought opportunities to study atypical, severe manifestations. Surveillance responses optimized case identification and better clinical approaches.
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Affiliation(s)
| | | | | | | | | | - Rosangela Monteiro
- Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | | | | | | | - Valéria Saraceni
- Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
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156
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Acute motor and sensory axonal neuropathy related to treatment with MEK inhibitors in a patient with advanced melanoma. Melanoma Res 2018; 27:632-634. [PMID: 28872488 DOI: 10.1097/cmr.0000000000000390] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Approximately one-half of advanced cutaneous melanomas have a V600 mutation in the BRAF gene that activates the mitogen-activated protein kinase pathway. The combination of BRAF plus MEK inhibitors is one of the most effective treatments for these patients. Severe neurological toxicities have been reported in the literature. However, these toxicities are very rare. Here, we present one patient with acute motor and sensory axonal neuropathy, which is a subtype of Guillain-Barre syndrome, secondary to treatment with MEK inhibitors. This side effect had never been described as related to these agents. However, the mitogen-activated protein kinase pathway can be involved in Guillain-Barre syndrome, and awareness of early neurological injury signs is important in patients treated with MEK inhibitors.
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157
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Chae CS, Kwon KM, Lee JS, Kim YH. A Case Report of Overlapping Miller Fisher Syndrome, Guillain-Barré Syndrome, and the Bickerstaff Brainstem Encephalitis. Neurologist 2018; 23:128-130. [DOI: 10.1097/nrl.0000000000000183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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158
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Zhao PP, Ji QK, Sui RB, Zhang R, Zhang LJ, Xu ZX, Li Q, Ji SB, Zhao JH. Increased intracranial pressure in Guillain-Barré syndrome: A case report. Medicine (Baltimore) 2018; 97:e11584. [PMID: 30045288 PMCID: PMC6078745 DOI: 10.1097/md.0000000000011584] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Guillain-Barré syndrome (GBS) is an inflammatory autoimmune demyelinating polyneuropathy that affects most of the peripheral nervous system. Papilledema and raised intracranial pressure (ICP) are seen in some patients, and are thought to be associated with elevated cerebrospinal fluid (CSF) protein-though CSF protein levels are normal in some patients, thus the specific mechanisms remain unclear. Interleukin (IL)-17 levels are elevated in the CSF and plasma in GBS patients, and elevated IL-17 in the CSF of patients with idiopathic intracranial hypertension has been reported. Intravenous immunoglobulin (IVIG) exerts therapeutic effects by downregulating IL-17 in GBS patients. PATIENT CONCERNS Herein we describe a case of a 14-year-old girl who initially presented with relapsing limb weakness. DIAGNOSES Magnetic resonance imaging revealed an enlarged ventricle, electromyography, and nerve conduction studies were suggestive of polyradiculopathy, and lumbar puncture revealed elevated ICP with normal cells and elevated protein values. INTERVENTIONS She was treated with IVIG 0.4 g/kg per day for 5 days. OUTCOMES At a 6-month follow-up there had been no recurrence. LESSONS SUBSECTIONS In GBS patients who have a relapsing course and develop papilledema with possible immunological disturbance, an accurate early diagnosis in conjunction with the prompt initiation of immunotherapy may improve clinical symptoms and the prognosis.
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Affiliation(s)
- Pan-Pan Zhao
- Department of Neurology, First Affiliated Hospital of Xinxiang Medical University
- Henan Key Laboratory of Neural Regeneration
| | - Qian-Kun Ji
- Henan Key Laboratory of Neural Regeneration
- Department of Neurosurgery, First Affiliated Hospital of Xinxiang Medical University, Weihui, China
| | - Rui-Bin Sui
- Department of Neurology, First Affiliated Hospital of Xinxiang Medical University
- Henan Key Laboratory of Neural Regeneration
| | - Rong Zhang
- Department of Neurology, First Affiliated Hospital of Xinxiang Medical University
- Henan Key Laboratory of Neural Regeneration
| | - Li-Jun Zhang
- Department of Neurology, First Affiliated Hospital of Xinxiang Medical University
- Henan Key Laboratory of Neural Regeneration
| | - Zhi-xiu Xu
- Department of Neurology, First Affiliated Hospital of Xinxiang Medical University
- Henan Key Laboratory of Neural Regeneration
| | - Qing Li
- Department of Neurology, First Affiliated Hospital of Xinxiang Medical University
- Henan Key Laboratory of Neural Regeneration
| | - Si-Bei Ji
- Department of Neurology, First Affiliated Hospital of Xinxiang Medical University
- Henan Key Laboratory of Neural Regeneration
| | - Jian-Hua Zhao
- Department of Neurology, First Affiliated Hospital of Xinxiang Medical University
- Henan Key Laboratory of Neural Regeneration
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159
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Ancona P, Bailey M, Bellomo R. Characteristics, incidence and outcome of patients admitted to intensive care unit with Guillain-Barre syndrome in Australia and New Zealand. J Crit Care 2018; 45:58-64. [DOI: 10.1016/j.jcrc.2018.01.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 01/14/2018] [Accepted: 01/17/2018] [Indexed: 01/09/2023]
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160
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Bido-Medina R, Wirsich J, Rodríguez M, Oviedo J, Miches I, Bido P, Tusen L, Stoeter P, Sadaghiani S. Impact of Zika Virus on adult human brain structure and functional organization. Ann Clin Transl Neurol 2018; 5:752-762. [PMID: 29928658 PMCID: PMC5989769 DOI: 10.1002/acn3.575] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 04/12/2018] [Accepted: 04/13/2018] [Indexed: 01/11/2023] Open
Abstract
Objective To determine the impact of Zika virus (ZIKV) infection on brain structure and functional organization of severely affected adult patients with neurological complications that extend beyond Guillain–Barré Syndrome (GBS)‐like manifestations and include symptoms of the central nervous system (CNS). Methods In this first case–control neuroimaging study, we obtained structural and functional magnetic resonance images in nine rare adult patients in the subacute phase, and healthy age‐ and sex‐matched controls. ZIKV patients showed atypical descending and rapidly progressing peripheral nervous system (PNS) manifestations, and importantly, additional CNS presentations such as perceptual deficits. Voxel‐based morphometry was utilized to evaluate gray matter volume, and resting state functional connectivity and Network Based Statistics were applied to assess the functional organization of the brain. Results Gray matter volume was decreased bilaterally in motor areas (supplementary motor cortex, specifically Frontal Eye Fields) and beyond (left inferior frontal sulcus). Additionally, gray matter volume increased in right middle frontal gyrus. Functional connectivity increased in a widespread network within and across temporal lobes. Interpretation We provide preliminary evidence for a link between ZIKV neurological complications and changes in adult human brain structure and functional organization, comprising both motor‐related regions potentially secondary to prolonged PNS weakness, and nonsomatomotor regions indicative of PNS‐independent alternations. The latter included the temporal lobes, particularly vulnerable in a range of neurological conditions. While future studies into the ZIKV‐related neuroinflammatory mechanisms in adults are urgently needed, this study indicates that ZIKV infection can lead to an impact on the brain.
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Affiliation(s)
- Richard Bido-Medina
- Beckman Institute for Advanced Science and Technology University of Illinois at Urbana-Champaign Urbana Illinois 61801.,Neuroscience Program University of Illinois at Urbana-Champaign Urbana Illinois 61801
| | - Jonathan Wirsich
- Beckman Institute for Advanced Science and Technology University of Illinois at Urbana-Champaign Urbana Illinois 61801
| | | | - Jairo Oviedo
- Centro Diagnostico de Medicina Avanzada y Telemedicina (CEDIMAT) Santo Domingo Dominican Republic
| | - Isidro Miches
- Neuroscience Program University of Illinois at Urbana-Champaign Urbana Illinois 61801
| | - Pamela Bido
- Hospital Salvador B. Gautier Santo Domingo Dominican Republic
| | - Luis Tusen
- Hospital Salvador B. Gautier Santo Domingo Dominican Republic
| | - Peter Stoeter
- Centro Diagnostico de Medicina Avanzada y Telemedicina (CEDIMAT) Santo Domingo Dominican Republic
| | - Sepideh Sadaghiani
- Beckman Institute for Advanced Science and Technology University of Illinois at Urbana-Champaign Urbana Illinois 61801.,Psychology Department University of Illinois at Urbana-Champaign Urbana Illinois 61801
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161
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Abstract
AbstractA majority of patients with Guillain-Barré syndrome (GBS) have tendency of a good recovery. Our aim was to evaluate the outcome of the disease 1 and 3 years after GBS symptom onset. Methods: During 2014, GBS was diagnosed in 82 patients in seven tertiary healthcare centers. Neurological follow-up was conducted in 57 (70%) patients after 1 year, and in 54 (66%) after 3 years. Functional disability was estimated according to the GBS disability scale (GDS), with a score of 0-3 indicating mild disability and a score of 4-6 indicating severe disability during acute phase, whereas a score >1 indicated poor recovery on follow-ups. Visual analog scale was used to assess sensory symptoms and musculoskelatal pain, and Krupp’s Fatigue Severity Scale was used to asses fatigue. Results: Poor functional outcome was found in 39% of GBS patients at year 1 and 30% at year 3. Paresthesias/dysesthesias were detected in 60% of patients after 1 year and 43% after 3 years. Musculoskeletal pain was present in 40% of patients at year 1 and 33% at year 3. Significant fatigue after 1 year was found in 21% of subjects and after 3 years in 7%. Parameters associated with poor functional outcome after 1 year were age >55 years (p=0.05), severe disability at admission (p<0.05), and on discharge (p<0.01). Poor functional outcome after 3 years was associated with male gender (p<0.05) and severe disability on discharge (p=0.06). Conclusion: One and even three years after GBS onset, a substantial number of patients had neurological sequelae, including functional disability, sensory symptoms, pain, and fatigue.
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162
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Restrepo-Jiménez P, Rodríguez Y, González P, Chang C, Gershwin ME, Anaya JM. The immunotherapy of Guillain-Barré syndrome. Expert Opin Biol Ther 2018; 18:619-631. [DOI: 10.1080/14712598.2018.1468885] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Paula Restrepo-Jiménez
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Yhojan Rodríguez
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Paulina González
- Neurology Service, Clínica Universitaria Bolivariana, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Christopher Chang
- Division of Rheumatology, Allergy and Clinical Immunology, University of California Davis, School of Medicine, Davis, CA, USA
| | - M. Eric Gershwin
- Division of Rheumatology, Allergy and Clinical Immunology, University of California Davis, School of Medicine, Davis, CA, USA
| | - Juan-Manuel Anaya
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
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163
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Silva CAM, Belisle JT. Host Lipid Mediators in Leprosy: The Hypothesized Contributions to Pathogenesis. Front Immunol 2018; 9:134. [PMID: 29472920 PMCID: PMC5810268 DOI: 10.3389/fimmu.2018.00134] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 01/16/2018] [Indexed: 12/12/2022] Open
Abstract
The spectrum of clinical forms observed in leprosy and its pathogenesis are dictated by the host's immune response against Mycobacterium leprae, the etiological agent of leprosy. Previous results, based on metabolomics studies, demonstrated a strong relationship between clinical manifestations of leprosy and alterations in the metabolism of ω3 and ω6 polyunsaturated fatty acids (PUFAs), and the diverse set of lipid mediators derived from PUFAs. PUFA-derived lipid mediators provide multiple functions during acute inflammation, and some lipid mediators are able to induce both pro- and anti-inflammatory responses as determined by the cell surface receptors being expressed, as well as the cell type expressing the receptors. However, little is known about how these compounds influence cellular immune activities during chronic granulomatous infectious diseases, such as leprosy. Current evidence suggests that specialized pro-resolving lipid mediators (SPMs) are involved in the down-modulation of the innate and adaptive immune response against M. leprae and that alteration in the homeostasis of pro-inflammatory lipid mediators versus SPMs is associated with dramatic shifts in the pathogenesis of leprosy. In this review, we discuss the possible consequences and present new hypotheses for the involvement of ω3 and ω6 PUFA metabolism in the pathogenesis of leprosy. A specific emphasis is placed on developing models of lipid mediator interactions with the innate and adaptive immune responses and the influence of these interactions on the outcome of leprosy.
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Affiliation(s)
- Carlos A. M. Silva
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO, United States
| | - John T. Belisle
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO, United States
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164
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Pérez Sánchez S, Pérez Noguera R, Sánchez Sánchez V, López Domínguez JM. Anti-Hu associated paraneoplastic neuropathy simulating an axonal variant of Guillain-Barré syndrome. Neurologia 2017; 35:346-347. [PMID: 29169808 DOI: 10.1016/j.nrl.2017.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 08/19/2017] [Accepted: 09/12/2017] [Indexed: 10/18/2022] Open
Affiliation(s)
- S Pérez Sánchez
- Servicio de Neurología, Hospital Universitario Virgen Macarena, Sevilla, España.
| | - R Pérez Noguera
- Servicio de Neurología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - V Sánchez Sánchez
- Servicio de Neurología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - J M López Domínguez
- Servicio de Neurología, Hospital Universitario Virgen Macarena, Sevilla, España
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165
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Vasconcelos MM, Vasconcelos LG, Brito AR. Assessment of acute motor deficit in the pediatric emergency room. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2017. [DOI: 10.1016/j.jpedp.2017.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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166
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Vasconcelos MM, Vasconcelos LGA, Brito AR. Assessment of acute motor deficit in the pediatric emergency room. J Pediatr (Rio J) 2017; 93 Suppl 1:26-35. [PMID: 28756061 DOI: 10.1016/j.jped.2017.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 05/28/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES This review article aimed to present a clinical approach, emphasizing the diagnostic investigation, to children and adolescents who present in the emergency room with acute-onset muscle weakness. SOURCES A systematic search was performed in PubMed database during April and May 2017, using the following search terms in various combinations: "acute," "weakness," "motor deficit," "flaccid paralysis," "child," "pediatric," and "emergency". The articles chosen for this review were published over the past ten years, from 1997 through 2017. This study assessed the pediatric age range, from 0 to 18 years. SUMMARY OF THE DATA Acute motor deficit is a fairly common presentation in the pediatric emergency room. Patients may be categorized as having localized or diffuse motor impairment, and a precise description of clinical features is essential in order to allow a complete differential diagnosis. The two most common causes of acute flaccid paralysis in the pediatric emergency room are Guillain-Barré syndrome and transverse myelitis; notwithstanding, other etiologies should be considered, such as acute disseminated encephalomyelitis, infectious myelitis, myasthenia gravis, stroke, alternating hemiplegia of childhood, periodic paralyses, brainstem encephalitis, and functional muscle weakness. Algorithms for acute localized or diffuse weakness investigation in the emergency setting are also presented. CONCLUSIONS The clinical skills to obtain a complete history and to perform a detailed physical examination are emphasized. An organized, logical, and stepwise diagnostic and therapeutic management is essential to eventually restore patient's well-being and full health.
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Affiliation(s)
- Marcio Moacyr Vasconcelos
- Universidade Federal Fluminense (UFF), Hospital Universitário Antônio Pedro, Departamento Materno Infantil, Niterói, RJ, Brazil.
| | - Luciana G A Vasconcelos
- Associação Brasileira Beneficente de Reabilitação (ABBR), Divisão de Pediatria, Rio de Janeiro, RJ, Brazil
| | - Adriana Rocha Brito
- Universidade Federal Fluminense (UFF), Hospital Universitário Antônio Pedro, Departamento Materno Infantil, Niterói, RJ, Brazil
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167
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168
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Panosyan FB. Bilateral Ptosis due to Sympathetic Dysfunction as a Feature of Guillain-Barre Syndrome. J Clin Neuromuscul Dis 2017; 19:38-42. [PMID: 28827488 DOI: 10.1097/cnd.0000000000000163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This case-control study demonstrates that bilateral ptosis due to ocular sympathetic dysfunction is a characteristic feature of Guillain-Barre syndrome (GBS) and apraclonidine can be helpful in unmasking this clinical feature. Five patients with GBS and 9 healthy controls were assessed for ocular sympathetic dysfunction through application of topical apraclonidine to 1 eye. Changes resulting from reversal of ptosis or miosis due to apraclonidine were compared with the eye on the other side with no apraclonidine using photographs. Ocular sympathetic dysfunction in the form of mild bilateral ptosis was found in all 5 patients with GBS recruited in this study. Consistent with previous reports, healthy subjects had no significant response to apraclonidine. Although there was evidence of concomitant pupillary dysfunction in the form of bilateral Horner syndrome in 2 of the patients with GBS with more severe GBS phenotype, this study did not have the statistical power to reach conclusions regarding pupillary dysfunction and disease severity in GBS.
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Affiliation(s)
- Francis B Panosyan
- Department of Neurology, University of Rochester Medical Center, Rochester, NY
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169
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Immune Gamma Globulin Therapeutic Indications in Immune Deficiency and Autoimmunity. Curr Allergy Asthma Rep 2017; 16:55. [PMID: 27401913 DOI: 10.1007/s11882-016-0632-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Immune gamma globulin (IgG) has a long history in the treatment of both primary immune deficiency and autoimmune disorders. Disease indications continue to expand and new-generation products increase the versatility of delivery. This review encompasses a historical perspective as well as current and future implications of human immune globulin for the treatment of immune-mediated illness.
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170
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Nayak R. Practical approach to the patient with acute neuromuscular weakness. World J Clin Cases 2017; 5:270-279. [PMID: 28798922 PMCID: PMC5535318 DOI: 10.12998/wjcc.v5.i7.270] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 04/12/2017] [Accepted: 05/15/2017] [Indexed: 02/05/2023] Open
Abstract
Acute neuromuscular paralysis (ANMP) is a clinical syndrome characterized by rapid onset muscle weakness progressing to maximum severity within several days to weeks (less than 4 wk). Bulbar and respiratory muscle weakness may or may not be present. It is a common neurological emergency which requires immediate and careful investigations to determine the etiology because accurate diagnosis has significant impact on therapy and prognosis. Respiratory failure caused by neuromuscular weakness is considered as more critical than lung disease because its development may be insidious or subtle until sudden decompensation leads to life threatening hypoxia. Also, the arterial blood gas finding of severe hypoxemia, hypercapnia, and acidosis may not be apparent until respiratory failure is profound. Hence, the requirement for respiratory assistance should also be intensively and promptly investigated in all patients with neuromuscular disease. The disorder is classified based on the site of defect in motor unit pathway, i.e., anterior horn cells, nerve root, peripheral nerve, neuromuscular junction or muscle. Identification of the cause is primarily based on a good medical history and detailed clinical examination supplemented with neurophysiologic investigations and sometimes few specific laboratory tests. Medical history and neurological examination should be focused on the onset, progression, pattern and severity of muscle weakness as well as cranial nerves testing and tests for autonomic dysfunction. Associated non neurological features like fever, rash or other skin lesions etc. should also be noted. Globally, Guillain-Barré syndrome is the most frequent cause of ANMP and accounts for the majority of cases of respiratory muscles weakness associated with neuromuscular disorders. Newly acquired neuromuscular weakness in intensive care unit patients consist of critical illness polyneuropathy, critical illness myopathy and drug induced neuromuscular weakness which may arise as a consequence of sepsis, multi-organ failure, and exposure to certain medications like intravenous corticosteroids and neuromuscular blocking agents.
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171
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Patwala K, Crump N, De Cruz P. Guillain-Barré syndrome in association with antitumour necrosis factor therapy: a case of mistaken identity. BMJ Case Rep 2017; 2017:bcr-2017-219481. [PMID: 28679512 PMCID: PMC5534643 DOI: 10.1136/bcr-2017-219481] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2017] [Indexed: 11/04/2022] Open
Abstract
Guillain-Barré syndrome (GBS) is an immune-mediated disease characterised by evolving ascending limb weakness, sensory loss and areflexia. Two-thirds of GBS cases are associated with preceding infection. However, GBS has also been described in association with antitumour necrosis factor (TNF) therapies including infliximab and adalimumab for chronic inflammatory disorders such as rheumatoid arthritis, ankylosing spondylitis and inflammatory bowel disease. We present the case of a patient who developed GBS while undergoing treatment with adalimumab in combination with azathioprine for severe fistulising Crohn's disease, and review the literature on neurological adverse events that occur in association with anti-TNF therapy. We also propose an approach to the optimal management of patients who develop debilitating neurological sequelae in the setting of anti-TNF therapy.
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Affiliation(s)
- Kurvi Patwala
- Department of Gastroenterology, Austin Health, Heidelberg, Australia
| | - Nicholas Crump
- Department of Neurology, Austin Health, Heidelberg, Australia
| | - Peter De Cruz
- Department of Gastroenterology, Austin Health, Heidelberg, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Australia
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172
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Lomaglio M, Canale B. Differential diagnosis and recovery of acute bilateral foot drop in a patient with a history of low back pain: A case report. Physiother Theory Pract 2017; 33:508-514. [PMID: 28509608 DOI: 10.1080/09593985.2017.1323358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND PURPOSE Acute bilateral foot drop is rare and may be due to peripheral or central lesions. The purpose of this case report was to describe the differential diagnosis and recovery of a patient with low back pain (LBP) that awoke with bilateral foot drop. CASE DESCRIPTION A 39-year-old man with a history of LBP awoke with a steppage gait pattern. Spinal imaging and tapping were negative for sinister pathologies. A subsequent history taken by the physical therapist uncovered that the patient had previously taken a narcotic and slept in a kneeling position to relieve his LBP. Strength and sensory testing revealed isolated impairments in the fibular nerve distribution, and bilateral fibular palsy was suspected and later confirmed with electrophysiological studies. Surgical fibular nerve decompression was performed, and the patient underwent physical therapy. OUTCOMES Five months later the patient demonstrated antigravity strength and a partial return of sensation. By 17 months, his Lower Extremity Functional Scale had improved from 17/80 to 78/80, revealing a near complete recovery. DISCUSSION The patient's history of LBP was a "red herring" that delayed the diagnosis and caused undue stress to the patient. This case stresses the importance of a thorough history and clinical examination.
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Affiliation(s)
- Melanie Lomaglio
- a Department of Rehabilitative Sciences , University of St. Augustine for Health Sciences , St. Augustine , FL , USA
| | - Bob Canale
- b Department of Physical Therapy , St. Vincent's Medical Center Riverside , Jacksonville , FL , USA
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173
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Duffy SS, Keating BA, Perera CJ, Moalem-Taylor G. The role of regulatory T cells in nervous system pathologies. J Neurosci Res 2017; 96:951-968. [DOI: 10.1002/jnr.24073] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 03/28/2017] [Accepted: 04/06/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Samuel S. Duffy
- School of Medical Sciences; University of New South Wales UNSW; Sydney Australia
| | - Brooke A. Keating
- School of Medical Sciences; University of New South Wales UNSW; Sydney Australia
| | - Chamini J. Perera
- School of Medical Sciences; University of New South Wales UNSW; Sydney Australia
| | - Gila Moalem-Taylor
- School of Medical Sciences; University of New South Wales UNSW; Sydney Australia
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174
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Zhang LJ, Guo HY, Zhang DQ, Wang R, Li T, Li LM, Suo DM, Yang L. Analysis of serum interleukin-27 and interleukin-35 concentrations in patients with Guillain-Barré syndrome. Clin Chim Acta 2017; 468:5-9. [DOI: 10.1016/j.cca.2017.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 12/25/2016] [Accepted: 02/02/2017] [Indexed: 01/27/2023]
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175
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[Polyneuropathy in the elderly]. Z Gerontol Geriatr 2017; 50:347-361. [PMID: 28455594 DOI: 10.1007/s00391-017-1233-3] [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: 01/13/2017] [Revised: 02/27/2017] [Accepted: 03/30/2017] [Indexed: 10/19/2022]
Abstract
The peripheral nervous system is subject to changes during the ageing process, e. g. deep tendon reflexes decrease, as does proprioception. Polyneuropathies, on the other hand, need to be distinguished from age-related changes as independent diseases with etiologies similar to those at younger ages. Etiologies includes metabolic disorders, primary inflammatory polyneuropathies, and systemic disorders. Neuropathies associated with diabetes, malignancy, and monoclonal gammopathies appear to be more common in older patients. Using a systematic approach, it is possible to establish a specific diagnosis in the majority of cases. Since polyneuropathies contribute to reduced mobility in the elderly, an assessment of functional skills is mandatory. Polyneuropathy therapy is primarily based on the treatment of underlying conditions and neuropathic pain management. Physiotherapy and rehabilitation target pain relief and maintaining activities of daily living.
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176
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Slingerland AE, Schwabkey Z, Wiesnoski DH, Jenq RR. Clinical Evidence for the Microbiome in Inflammatory Diseases. Front Immunol 2017; 8:400. [PMID: 28446909 PMCID: PMC5388779 DOI: 10.3389/fimmu.2017.00400] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 03/21/2017] [Indexed: 12/11/2022] Open
Abstract
Clinical evidence is accumulating for a role of the microbiome in contributing to or modulating severity of inflammatory diseases. These studies can be organized by various organ systems involved, as well as type of study approach utilized, whether investigators compared the microbiome of cases versus controls, followed patients longitudinally, or intervened with antibiotics, prebiotics, or bacterial introduction. In this review, we summarize the clinical evidence supporting the microbiome as an important mechanism in the onset and maintenance of inflammation.
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Affiliation(s)
- Ann E Slingerland
- Immunology Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Zaker Schwabkey
- Department of Genomic Medicine, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Diana H Wiesnoski
- Department of Genomic Medicine, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Robert R Jenq
- Department of Genomic Medicine, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Stem Cell Transplantation Cellular Therapy, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Abstract
The approach to clinical conundrums by an expert clinician is revealed through the presentation of an actual patient's case in an approach typical of a morning report. Similarly to patient care, sequential pieces of information are provided to the clinician, who is unfamiliar with the case. The focus is on the thought processes of both the clinical team caring for the patient and the discussant. This icon represents the patient's case. Each paragraph that follows represents the discussant's thoughts.
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Affiliation(s)
- Zafia Anklesaria
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Daniel Hunt
- Department of Medicine, Emory University, Atlanta, GA, USA
| | - Maulik Shah
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Bradley Sharpe
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Bradley Monash
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
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178
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Pinto-Díaz CA, Rodríguez Y, Monsalve DM, Acosta-Ampudia Y, Molano-González N, Anaya JM, Ramírez-Santana C. Autoimmunity in Guillain-Barré syndrome associated with Zika virus infection and beyond. Autoimmun Rev 2017; 16:327-334. [PMID: 28216074 DOI: 10.1016/j.autrev.2017.02.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 12/05/2016] [Indexed: 12/15/2022]
Abstract
Autoimmune diseases share common immunopathogenic mechanisms (i.e., the autoimmune tautology), which explain the clinical similarities among them as well as their familial clustering. Guillain-Barré syndrome (GBS), an autoimmune peripheral neuropathy, has been recently associated with Zika virus (ZIKV) infection. Based on a series of cases, this review article provides a comparative analysis of GBS associated with ZIKV infection, contrasted with the general characteristics of GBS in light of the autoimmune tautology, including gender differences in prevalence, subphenotypes, polyautoimmunity, familial autoimmunity, age at onset, pathophysiology, ecology, genetics, ancestry, and treatment.
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Affiliation(s)
- Carlos A Pinto-Díaz
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 No. 63-C-69, Bogotá, Colombia
| | - Yhojan Rodríguez
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 No. 63-C-69, Bogotá, Colombia
| | - Diana M Monsalve
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 No. 63-C-69, Bogotá, Colombia
| | - Yeny Acosta-Ampudia
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 No. 63-C-69, Bogotá, Colombia
| | - Nicolás Molano-González
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 No. 63-C-69, Bogotá, Colombia
| | - Juan-Manuel Anaya
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 No. 63-C-69, Bogotá, Colombia
| | - Carolina Ramírez-Santana
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 No. 63-C-69, Bogotá, Colombia.
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179
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Shin SK, Kim KO, Kim EJ, Kim SY, Kim JH, Kim YJ, Chung JW, Kwon KA, Park DK. Peroral endoscopic myotomy for treatment of Guillain-Barre syndrome-associated achalasia: A rare case. World J Gastroenterol 2017; 23:926-930. [PMID: 28223738 PMCID: PMC5296210 DOI: 10.3748/wjg.v23.i5.926] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 10/06/2016] [Accepted: 10/19/2016] [Indexed: 02/06/2023] Open
Abstract
Guillain-Barre syndrome (GBS)-associated achalasia is a very rare disease of uncertain cause. We report the case of a patient diagnosed with GBS-associated type I achalasia who was successfully treated with peroral endoscopic myotomy (POEM). A 30-year-old man who was diagnosed with GBS 3 mo before was referred to our department with dysphagia and meal-related regurgitation. The results of esophagography, endoscopy, and high-resolution manometry (HRM) revealed type I achalasia. POEM that utilized a submucosal tunneling technique was performed to treat the GBS-associated type I achalasia. After POEM, smooth passage of a contrast agent into the stomach was shown in follow-up esophagography, and follow-up HRM revealed a decrease in the mean integrated relaxation pressure 22.9 mmHg to 9.6 mmHg. The patient remained without dysphagia for 7 mo, even though the patient’s neurological problems were not fully resolved. POEM may be a safe and effective treatment for GBS-associated type I achalasia.
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180
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Abstract
Differentiating Guillain-Barré syndrome (GBS) from inherited neuropathies and other acquired peripheral neuropathies requires understanding the atypical presentations of GBS and its variant forms, as well as historical and physical features suggestive of inherited neuropathies. GBS is typically characterized by the acute onset of ascending flaccid paralysis, areflexia, and dysesthesia secondary to peripheral nerve fiber demyelination. The disorder usually arises following a benign gastrointestinal or respiratory illness, is monophasic, reaches a nadir with several weeks, and responds to immunomodulatory therapy. Inherited neuropathies with onset before adulthood, whose presentation may mimic Guillain-Barré syndrome, are reviewed.
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Affiliation(s)
- Brett J Bordini
- Department of Pediatrics, Section of Hospital Medicine, Nelson Service for Undiagnosed and Rare Diseases, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Priya Monrad
- Department of Child and Adolescent Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
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181
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Shubhakaran K. Cranial nerve involvement in Guillain–Barre syndrome: Revisited. J Pediatr Neurosci 2017; 12:398-399. [PMID: 29675091 PMCID: PMC5890572 DOI: 10.4103/jpn.jpn_18_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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182
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Han TH, Kim DY, Park DW, Moon JH. Transient Isolated Lower Bulbar Palsy With Elevated Serum Anti-GM1 and Anti-GD1b Antibodies During Aripiprazole Treatment. Pediatr Neurol 2017; 66:96-99. [PMID: 28341090 DOI: 10.1016/j.pediatrneurol.2016.07.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 07/19/2016] [Accepted: 07/21/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND Transient bulbar palsy without involvement of the facial or extraocular muscles is a rare presentation. It is considered a form of cranial polyneuropathy, a variant of Guillain-Barré syndrome that is related to the autoimmune mechanisms induced by preceding infections or vaccinations. However, drug-induced cranial polyneuropathy has not previously been reported. We describe a boy with isolated bulbar palsy and positive serum antiganglioside antibodies during aripiprazole treatment. PATIENT DESCRIPTION This 12-year-old boy was admitted with a seven-day history of dysarthria, tongue discomfort, and tinnitus. Three weeks before symptom onset, aripiprazole was added to the patient's medications for attention-deficit hyperactivity disorder. On examination, he showed curtaining of the pharyngeal wall, tongue fasciculation and deviation, and a weak gag reflex. Cranial magnetic resonance imaging suggested lower cranial nerve involvement. Serum anti-GM1 IgG and anti-GD1b IgG antibodies were positive. After stopping aripiprazole, his bulbar symptoms improved. However, on readministration of aripiprazole seven weeks later, dysarthria recurred and again resolved after stopping the drug. CONCLUSION We describe the first patient with anti-GM1 IgG and anti-GD1b IgG antibodies-associated transient cranial polyneuropathy presenting as isolated bulbar palsy. These findings could be an adverse effect of aripiprazole treatment.
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Affiliation(s)
- Tae Hwan Han
- Department of Pediatric Neurology, Hanyang University Guri Hospital, Guri-si, Gyeonggi-do, Republic of Korea
| | - Do Yeon Kim
- Department of Pediatric Neurology, Hanyang University Guri Hospital, Guri-si, Gyeonggi-do, Republic of Korea
| | - Dong Woo Park
- Department of Radiology, Hanyang University Guri Hospital, Guri-si, Gyeonggi-do, Republic of Korea
| | - Jin-Hwa Moon
- Department of Pediatric Neurology, Hanyang University Guri Hospital, Guri-si, Gyeonggi-do, Republic of Korea.
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183
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Patel P, Kearney JF. Immunological Outcomes of Antibody Binding to Glycans Shared between Microorganisms and Mammals. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2016; 197:4201-4209. [PMID: 27864551 PMCID: PMC5119654 DOI: 10.4049/jimmunol.1600872] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 08/04/2016] [Indexed: 02/07/2023]
Abstract
Glycans constitute basic cellular components of living organisms across biological kingdoms, and glycan-binding Abs participate in many cellular interactions during immune defense against pathogenic organisms. Glycan epitopes are expressed as carbohydrate-only entities or as oligomers or polymers on proteins and lipids. Such epitopes on glycoproteins may be formed by posttranslational modifications or neoepitopes resulting from metabolic-catabolic processes and can be altered during inflammation. Pathogenic organisms can display host-like glycans to evade the host immune response. However, Abs to glycans, shared between microorganisms and the host, exist naturally. These Abs are able to not only protect against infectious disease, but also are involved in host housekeeping functions and can suppress allergic disease. Despite the reactivity of these Abs to glycans shared between microorganisms and host, diverse tolerance-inducing mechanisms permit the B cell precursors of these Ab-secreting cells to exist within the normal B cell repertoire.
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Affiliation(s)
- Preeyam Patel
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, AL 35294
| | - John F Kearney
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, AL 35294
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184
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Acute flaccid weakness with myelopathy and peripheral nerve involvement in 2 children: Recent characterization of a previously observed phenomenon. Eur J Paediatr Neurol 2016; 20:948-952. [PMID: 27452920 DOI: 10.1016/j.ejpn.2016.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/29/2016] [Accepted: 07/04/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Acute flaccid weakness may be the first presentation of acute transverse myelitis (ATM), an immune-mediated central nervous system disorder or may be the first presentation of anterior horn cell syndrome or peripheral nervous system disease. CASE REPORTS We describe two previously healthy female infants who presented with acute flaccid paralysis and encephalopathy. Neuroimaging revealed central cord signal changes in both cases and surprisingly electrophysiological studies performed revealed a generalized axonal motor neuropathy as well. CONCLUSION Clinical, radiological and neurophysiological assessment are important to aid in the diagnosis and subsequent management of children with overlapping inflammatory peripheral and central nervous system syndromes.
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185
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Gross S, Fischer A, Rosati M, Matiasek L, Corlazzoli D, Cappello R, Porcarelli L, Harcourt-Brown T, Jurina K, Garosi L, Flegel T, Quitt P, Molin J, Huelsmeyer VI, Schenk H, Gandini G, Gnirs K, Blot S, Jeandel A, Baroni M, Loderstedt S, Abbiati G, Leithaeuser C, Schulze S, Kornberg M, Lowrie M, Matiasek K. Nodo-paranodopathy, internodopathy and cleftopathy: Target-based reclassification of Guillain-Barré-like immune-mediated polyradiculoneuropathies in dogs and cats. Neuromuscul Disord 2016; 26:825-836. [PMID: 27743643 DOI: 10.1016/j.nmd.2016.08.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 07/14/2016] [Accepted: 08/29/2016] [Indexed: 01/23/2023]
Abstract
Recent views on Guillain-Barré syndrome (GBS) question the accuracy of classification into axonal and demyelinating subtypes that represent convergent neurophysiological phenotypes rather than immunological targets. Instead it has been proposed to clarify the primarily affected fibre subunit in nerve biopsies. As nerve biopsies rarely are part of routine work-up in human patients we evaluated tissues taken from companion animals affected by GBS-like polyradiculoneuropathy to screen for distribution of immune cells, targeted fibre components and segregating non-inflammatory lesions. We identified that immune responses were directed either at Schmidt-Lanterman clefts, the paranode-node complex or both. Based on infiltrative and non-inflammatory changes, four subtypes and/or stages were distinguished, some of which indicate localisation of primary target antigens while others represent convergent late stage pictures, as a consequence to epitope spreading. The impact of histological subtyping onto clinical management and prognosis remains to be evaluated in future clinical trials. Natural development and clinical manifestation of large animal dysimmune neuropathy may reflect human Guillain-Barré syndrome more accurately than experimental models and therefore provide complementary clues for translational research.
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Affiliation(s)
- Simone Gross
- Section of Clinical & Comparative Neuropathology, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Andrea Fischer
- Section of Neurology, Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität, München, Munich, Germany
| | - Marco Rosati
- Section of Clinical & Comparative Neuropathology, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Lara Matiasek
- Neurology Referral Service, Tierklinik Haar, Haar, Germany
| | | | | | | | - Tom Harcourt-Brown
- Section of Neurology, Langford Veterinary Services, University of Bristol, Bristol, UK
| | - Konrad Jurina
- Section of Neurology, Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität, München, Munich, Germany
| | - Laurent Garosi
- Neurology Referral Service, Davies Veterinary Specialists, Manor Farm Business Park, Higham Gobion, UK
| | - Thomas Flegel
- Neurology Unit, Department of Small Animal Medicine, University of Leipzig, Leipzig, Germany
| | - Pia Quitt
- Section of Neurology, Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität, München, Munich, Germany
| | - Jessica Molin
- Section of Clinical & Comparative Neuropathology, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Velia-Isabel Huelsmeyer
- Section of Neurology, Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität, München, Munich, Germany
| | - Henning Schenk
- Neurology Service, Tierklinik Lueneburg, Lueneburg, Germany
| | - Gualtiero Gandini
- Department of Veterinary Medical Science, University of Bologna, Italy
| | - Kirsten Gnirs
- Section of Neurology & Neurosurgery, Advetia Clinic for Small Animal Medicine, Paris, France
| | - Stéphane Blot
- Section of Neurologie, Ecole Nationale Vétérinaire d'Alfort, University of Paris Est, Maisons Alfort, France
| | - Aurélien Jeandel
- Section of Neurologie, Ecole Nationale Vétérinaire d'Alfort, University of Paris Est, Maisons Alfort, France
| | - Massimo Baroni
- Section of Neurology, Clinica Veterinaria Valdinievole, Monsummano, Italy
| | - Shenja Loderstedt
- Section of Neurology, Clinic of Small Animal Medicine, University of Berlin, Berlin, Germany
| | | | | | | | | | - Mark Lowrie
- Dovecote Veterinary Hospital, Castle Donington, UK
| | - Kaspar Matiasek
- Section of Clinical & Comparative Neuropathology, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität München, Munich, Germany.
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186
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Pastula DM, Khan AS, Sharp TM, Biaukula VL, Naivalu TK, Rafai E, Ermias Belay, Staples JE, Fischer M, Kosoy OI, Laven JJ, Bennett EJ, Jenney AWJ, Naidu RN, Lanciotti RS, Galloway RL, Nilles EJ, Sejvar JJ, Kama M. Investigation of a Guillain-Barré syndrome cluster in the Republic of Fiji. J Neurol Sci 2016; 372:350-355. [PMID: 27842986 DOI: 10.1016/j.jns.2016.08.064] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 08/05/2016] [Accepted: 08/31/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND In 2014, we investigated a cluster of Guillain-Barre syndrome (GBS) in Fiji that occurred during a dengue epidemic. We designed a case-control study to determine the etiology. METHODS Cases were patients meeting Brighton Collaboration criteria for GBS with onset from February 2014 to May 2014. Controls were persons without symptoms of GBS who were matched by age group and location. We collected information on demographics and potential exposures. Serum samples were tested for evidence of recent arboviral or Leptospira spp. infections. RESULTS Nine cases of GBS were identified for an incidence of five cases per 100,000 population/year. Median age of cases was 27years (range: 0.8-52); five (56%) were male. Six (67%) reported an acute illness prior to GBS onset. Among the 9 cases and 28 controls enrolled, odds ratios for reported exposures or antibodies against various arboviruses or Leptospira spp. were not statistically significant. CONCLUSIONS No clear etiologies were identified for this unusual GBS cluster. There was a temporal association between the GBS cluster and a dengue epidemic, but we were unable to substantiate an epidemiologic or laboratory association. Further study is needed to explore potential associations between arboviral infections and GBS.
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Affiliation(s)
- Daniel M Pastula
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, United States; Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, United States; Department of Neurology, University of Colorado Denver, Aurora, CO, United States
| | | | - Tyler M Sharp
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, United States
| | | | | | - Eric Rafai
- Fiji Ministry of Health and Medical Services, Suva, Fiji
| | - Ermias Belay
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - J Erin Staples
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, United States
| | - Marc Fischer
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, United States
| | - Olga I Kosoy
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, United States
| | - Janeen J Laven
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, United States
| | | | | | | | - Robert S Lanciotti
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, United States
| | - Renee L Galloway
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Eric J Nilles
- Western Pacific Region, World Health Organization, Suva, Fiji
| | - James J Sejvar
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Mike Kama
- Fiji Ministry of Health and Medical Services, Suva, Fiji
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187
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Sinmaz N, Nguyen T, Tea F, Dale RC, Brilot F. Mapping autoantigen epitopes: molecular insights into autoantibody-associated disorders of the nervous system. J Neuroinflammation 2016; 13:219. [PMID: 27577085 PMCID: PMC5006540 DOI: 10.1186/s12974-016-0678-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 08/17/2016] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Our knowledge of autoantibody-associated diseases of the central (CNS) and peripheral (PNS) nervous systems has expanded greatly over the recent years. A number of extracellular and intracellular autoantigens have been identified, and there is no doubt that this field will continue to expand as more autoantigens are discovered as a result of improved clinical awareness and methodological practice. In recent years, interest has shifted to uncover the target epitopes of these autoantibodies. MAIN BODY The purpose of this review is to discuss the mapping of the epitope targets of autoantibodies in CNS and PNS antibody-mediated disorders, such as N-methyl-D-aspartate receptor (NMDAR), α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR), leucine-rich glioma-inactivated protein 1 (Lgi1), contactin-associated protein-like 2 (Caspr2), myelin oligodendrocyte glycoprotein (MOG), aquaporin-4 (AQP4), 65 kDa glutamic acid decarboxylase (GAD65), acetylcholine receptor (AChR), muscle-specific kinase (MuSK), voltage-gated calcium channel (VGCC), neurofascin (NF), and contactin. We also address the methods used to analyze these epitopes, the relevance of their determination, and how this knowledge can inform studies on autoantibody pathogenicity. Furthermore, we discuss triggers of autoimmunity, such as molecular mimicry, ectopic antigen expression, epitope spreading, and potential mechanisms for the rising number of double autoantibody-positive patients. CONCLUSIONS Molecular insights into specificity and role of autoantibodies will likely improve diagnosis and treatment of CNS and PNS neuroimmune diseases.
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Affiliation(s)
- Nese Sinmaz
- Brain Autoimmunity Group, Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital at Westmead, University of Sydney, Locked Bag 4001, Westmead, NSW, 2145, Australia
| | - Tina Nguyen
- Brain Autoimmunity Group, Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital at Westmead, University of Sydney, Locked Bag 4001, Westmead, NSW, 2145, Australia
| | - Fiona Tea
- Brain Autoimmunity Group, Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital at Westmead, University of Sydney, Locked Bag 4001, Westmead, NSW, 2145, Australia
| | - Russell C Dale
- Brain Autoimmunity Group, Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital at Westmead, University of Sydney, Locked Bag 4001, Westmead, NSW, 2145, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Fabienne Brilot
- Brain Autoimmunity Group, Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital at Westmead, University of Sydney, Locked Bag 4001, Westmead, NSW, 2145, Australia.
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, Australia.
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Divecha C, Tullu MS, Gandhi A, Deshmukh CT. Acute intermittent porphyria: A critical diagnosis for favorable outcome. Indian J Crit Care Med 2016; 20:428-31. [PMID: 27555700 PMCID: PMC4968068 DOI: 10.4103/0972-5229.186262] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Acute intermittent porphyria (AIP) is an inherited metabolic disorder characterized by the accumulation of toxic metabolites of the heme pathway. It rarely presents in the prepubertal age group. AIP often presents with nonspecific and nonlocalizing symptoms. Moreover, several commonly used medications and stress states are known to precipitate an attack. We present the case of a previously healthy 5 years female who was diagnosed as acute central nervous system infection/inflammation at admission. It was the presence of red flags that led to a correct diagnosis. Besides supportive management, a dedicated search for intravenous hemin (chemically heme arginate, aminolevulinic acid synthase inhibitor, and drug of choice) was attempted. Unexpected help was rendered by doctors from a medical college in Gujarat, and two ampoules could be obtained. The patient received three doses of intravenous hemin; however, she succumbed later. This case is presented for the diagnostic and therapeutic challenges faced in developing countries.
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Affiliation(s)
- Chhaya Divecha
- Department of Pediatrics, Pediatric Intensive Care Unit, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Milind S Tullu
- Department of Pediatrics, Pediatric Intensive Care Unit, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Akanksha Gandhi
- Department of Pediatrics, Pediatric Intensive Care Unit, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Chandrahas T Deshmukh
- Department of Pediatrics, Pediatric Intensive Care Unit, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
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189
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Affiliation(s)
| | | | - Philippe Saiag
- Université Versailles Saint-Quentin-en-Yvelines, Versailles, France
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190
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Dima A, Dumitrescu L, Berza I, Balea MI, Mujdaba-Elmi A, Popescu BO, Baicus C. Acute Bilateral Phrenic Neuropathy: from Diabetes Mellitus to Focal Guillain-Barré Syndrome. MAEDICA 2016; 11:61-63. [PMID: 28465753 PMCID: PMC5394497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Bilateral phrenic neuropathy is a rare cause of acute ventilatory failure posing both diagnostic and therapeutic difficulties. We report the case of a 55-years-old diabetic male presenting with acute onset orthopnea. Clinical and radioscopic evaluations suggested bilateral diaphragmatic paralysis, electroneuromyographic studies revealed bilateral acute phrenic neuropathy, and cerebrospinal fluid examination found albuminocytologic dissociation. The administration of high-dose intravenous immunoglobulin was followed by prompt improvement. During the next months the symptoms continued to regress. There were no recurrences. We consider the patient had a spatially limited form of acute inflammatory demyelinating polyradiculoneuropathy. The case underlies the importance of considering an immune mediated etiology in patients with acute bilateral phrenic neuropathy. To the best of our knowledge no similar case has been reported.
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Affiliation(s)
- Alina Dima
- Second Department of Internal Medicine, Colentina Clinical Hospital, Bucharest, Romania
| | - Laura Dumitrescu
- Second Department of Neurology, Colentina Clinical Hospital, Bucharest, Romania
| | - Ioana Berza
- Second Department of Internal Medicine, Colentina Clinical Hospital, Bucharest, Romania
| | - Marius Ioan Balea
- Department of Pneumology, Colentina Clinical Hospital, Bucharest, Romania
| | | | | | - Cristian Baicus
- Second Department of Internal Medicine, Colentina Clinical Hospital, Bucharest, Romania
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191
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Saxena A. Probiotics as a Potential Alternative for Relieving Peripheral Neuropathies: a Case for Guillain-Barré Syndrome. Front Microbiol 2016; 6:1497. [PMID: 26779152 PMCID: PMC4703756 DOI: 10.3389/fmicb.2015.01497] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 12/11/2015] [Indexed: 01/29/2023] Open
Affiliation(s)
- Abhishek Saxena
- Department of Biotechnology, TERI University New Delhi, India
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192
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Liao B, Kamiya-Matsuoka C, Fang X, Smith RG, Shanina E. Alternating ptosis associated with asialo-GM1 and GD1b antibodies. Int J Neurosci 2015; 126:1139-41. [PMID: 26710925 DOI: 10.3109/00207454.2015.1136825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Miller Fisher syndrome (MFS), variant of acute inflammatory demyelinating polyradiculoneuropathy, is recognized as clinical triad (ophthalmoplegia-ataxia-areflexia). Ganglioside antibodies play an important role in the pathogenesis of acute polyradiculoneuropathy including MFS. To our knowledge, there has been no report of MFS presenting with atypical alternating ptosis or with concurrent elevation of serum GD1 and asialo-GM1 antibody titers, and negative titers of GQ1b antibody such as our patient. Our objective is to report MFS with unusual symptoms and to share our diagnostic approach. We report a rare case of MFS presenting with alternating eyelid ptosis, paresthesia, and ataxia after a respiratory infection. Initial neurological examination revealed left eyelid ptosis, hyporeflexia, positive Romberg sign, and ataxia. The ice pack test was negative. Three days later, contralateral ptosis was observed, associated with areflexia and worsened ataxia. However, there was significant improvement of the previous left eyelid ptosis. Serology revealed elevated asialo-GM1 and GD1b antibodies. Acetylcholine receptor antibodies were negative. Cerebral spinal fluid revealed elevated IgG index. Nerve conduction studies (NCS) performed four days after the onset of symptoms showed normal nerve conduction velocities and F-waves, and absent bilateral H-reflexes. Repetitive nerve stimulation (3 Hz) showed no decrement of compound muscle action potentials. Trial with a single dose of pyridostigmine showed no clinical improvement. The symptoms resolved without intervention. NCS 18 days after onset of symptoms showed mildly prolonged F-waves and absent H-reflexes. This case highlights an atypical presentation of MFS and raises the awareness of a rare autoantibody associated with it.
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Affiliation(s)
- Bing Liao
- a 1 Department of Neurology , The University of Texas Medical Branch , Galveston , TX , USA.,b 2 Department of Neurology , Mayo Clinic , Rochester , MN , USA
| | - Carlos Kamiya-Matsuoka
- c 3 Department of Neuro-Oncology , The University of Texas MD Anderson Cancer Center , Houston , TX , United States
| | - Xiang Fang
- a 1 Department of Neurology , The University of Texas Medical Branch , Galveston , TX , USA
| | - Robert G Smith
- a 1 Department of Neurology , The University of Texas Medical Branch , Galveston , TX , USA
| | - Elena Shanina
- a 1 Department of Neurology , The University of Texas Medical Branch , Galveston , TX , USA
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194
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Dubey D, Kapotic M, Freeman M, Sawhney A, Rojas JC, Warnack W, Vernino S. Factors contributing to delay in diagnosis of Guillain-Barré syndrome and impact on clinical outcome. Muscle Nerve 2015; 53:384-7. [PMID: 26185107 DOI: 10.1002/mus.24772] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2015] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Heterogeneity of presenting symptoms makes the initial clinical diagnosis of Guillain-Barré syndrome (GBS) challenging. METHODS Observational retrospective study from 2 teaching hospitals (Parkland Memorial Hospital and University of Texas Southwestern University Hospital) between 2008 and 2013. RESULTS Sixty-nine GBS patients were identified. GBS was suspected on initial emergency department visit in only 49%. During first hospital encounter, 58% were evaluated by a neurologist. Neuropathic pain and presence of intact deep tendon reflexes were associated with delayed GBS diagnosis (P < 0.05). There was significantly better clinical outcome among patients who were evaluated by a neurologist during the initial visit (P < 0.005). Among these patients there was also significant difference in discharge destination; 71.2% of patients evaluated by a neurologist were discharged home (P < 0.01). Patients in whom GBS was not suspected at the time of initial Neurology evaluation were more likely to require intubation and to have residual weakness at the time of discharge (P < 0.05). CONCLUSIONS Atypical clinical signs and symptoms may lead to delayed diagnosis of GBS. Early neurological evaluation is associated with improved clinical diagnosis and discharge disposition.
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Affiliation(s)
- Divyanshu Dubey
- UT Southwestern Medical Center, Department of Neurology and Neurotherapeutics, 5323 Harry Hines Blvd, Dallas, Texas, 75235, USA
| | - Marissa Kapotic
- UT Southwestern Medical Center, Department of Neurology and Neurotherapeutics, 5323 Harry Hines Blvd, Dallas, Texas, 75235, USA
| | - Matthew Freeman
- UT Southwestern Medical Center, Department of Neurology and Neurotherapeutics, 5323 Harry Hines Blvd, Dallas, Texas, 75235, USA
| | - Anshudha Sawhney
- UT Southwestern Medical Center, Department of Neurology and Neurotherapeutics, 5323 Harry Hines Blvd, Dallas, Texas, 75235, USA
| | - Julio C Rojas
- UT Southwestern Medical Center, Department of Neurology and Neurotherapeutics, 5323 Harry Hines Blvd, Dallas, Texas, 75235, USA
| | - Worthy Warnack
- UT Southwestern Medical Center, Department of Neurology and Neurotherapeutics, 5323 Harry Hines Blvd, Dallas, Texas, 75235, USA
| | - Steven Vernino
- UT Southwestern Medical Center, Department of Neurology and Neurotherapeutics, 5323 Harry Hines Blvd, Dallas, Texas, 75235, USA
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Abstract
PURPOSE OF REVIEW Acquired immune demyelinating neuropathies refer to a group of disorders that share overlapping sensory, motor, and autonomic clinical, laboratory, and electrodiagnostic features. It is important to recognize acquired immune demyelinating neuropathies as they are generally responsive to immunosuppressive or immunomodulatory therapies. RECENT FINDINGS This article reviews recently developed early prognostic tools in Guillain-Barré syndrome and discusses the evolving understanding of chronic demyelinating phenotypes with differing treatment responsiveness. SUMMARY While weakness and numbness progress over 2 to 4 weeks in Guillain-Barré syndrome, they continue to evolve beyond 8 weeks in chronic inflammatory demyelinating polyradiculoneuropathy and over 4 to 8 weeks in subacute inflammatory demyelinating polyradiculoneuropathy. Acquired immune demyelinating neuropathies present uncommonly as variants with predominance of ocular, bulbar, sensory, autonomic, or motor manifestations in addition to regional variants, such as paraparetic acquired immune demyelinating neuropathies. Establishing the correct diagnosis is important as these immune disorders differ in response to corticosteroids and other immunosuppressive therapies.
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197
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Stoll SS, Rakocevic G. Severe acute inflammatory demyelinating polyradiculoneuropathy with persistent weakness associated with tumor-like nerve root enlargement. J Clin Neuromuscul Dis 2015; 16:220-222. [PMID: 25996968 DOI: 10.1097/cnd.0000000000000076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We report a 23-year-old woman with rapid onset of proximal and distal limb weakness and areflexia, associated with tumor-like spinal nerve root enlargement and markedly elevated cerebrospinal fluid protein. Our patient developed the inability to walk within days, without preceding illness. Within two weeks, she had near-complete bilateral wrist and foot drop. Her cranial nerves and respiratory function remained intact. She received intravenous immunoglobulin early on for suspected Guillain-barre syndrome but remained wheelchair-bound until 6 Plasma exchange sessions were completed. After that, she continued to improve with intravenous immunoglobulin dosed every 3-4 weeks. Prominent demyelinating features were found on NCS, with cerebrospinal fluid protein of 415 mg/dL. Comprehensive infectious work-up was negative. Magnetic resonance imaging of lumbosacral and cervical spine showed tumor-like masses mistaken for neurofibromatosis (axial diameter, 7.5-10 mm). Repeated magnetic resonance imaging 6 months later showed persistent nerve root enlargement, despite the patient's improved functional status.
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Affiliation(s)
- Sharon S Stoll
- *Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, PA; and †Department of Neurology, Thomas Jefferson University, Philadelphia, PA
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Albiol-Pérez S, Forcano-García M, Muñoz-Tomás MT, Manzano-Fernández P, Solsona-Hernández S, Mashat MA, Gil-Gómez JA. A novel virtual motor rehabilitation system for Guillain-Barré syndrome. Two single case studies. Methods Inf Med 2015; 54:127-34. [PMID: 25609504 DOI: 10.3414/me14-02-0002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 11/02/2014] [Indexed: 11/09/2022]
Abstract
INTRODUCTION This article is part of the Focus Theme of Methods of Information in Medicine on "New Methodologies for Patients Rehabilitation". OBJECTIVES For Guillain-Barré patients, motor rehabilitation programs are helpful at the onset to prevent the complications of paralysis and in cases of persistent motor impairment. Traditional motor rehabilitation programs may be tedious and monotonous, resulting in low adherence to the treatments. A Virtual Motor Rehabilitation system has been tested in Guillain-Barré patients to increase patient adherence and to improve clinical results. METHODS Two people with Guillain-Barré performed 20 rehabilitation sessions. We tested a novel system based on Motor Virtual Rehabilitation in three periods of time (baseline evaluation, final evaluation, and follow-up. In the training program, the participants carried out a specific treatment using the Active Balance Rehabilitation system (ABAR). The system is composed of customizable virtual games to perform static and dynamic balance rehabilitation. RESULTS Significant improvements in clinical results were obtained by both participants, with significant results in the static balance clinical test of the Anterior Reach test in the standing position and unipedal stance time. Other significant results were found in dynamic balance clinical tests in the Berg Balance Scale test and the 30-second Sit-to-Stand test. With regard to acceptance of the system, both patients enjoyed the experience, and both patients thought that this system was helpful for their rehabilitation. CONCLUSIONS The results show that Virtual Motor Rehabilitation for Guillain-Barré patients provides clinical improvements in an entertaining way.
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Affiliation(s)
- S Albiol-Pérez
- Sergio Albiol-Pérez, Dpto. de Informática e Ingeniería de Sistemas, Universidad de Zaragoza, Ciudad Escolar s/n, 44003, Teruel, Spain, E-mail:
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Abstract
Bee venom acupuncture has been widely used in Oriental medicine with limited evidence of effectiveness. Most of the complications due to bee venom acupuncture are local or systemic allergic reactions. However, serious medical and neurological complications have also been reported. We herein describe the treatment of a 68-year-old woman who developed progressive quadriplegia 10 days after receiving multiple honeybee venom sting acupuncture treatments. The electrophysiological findings were consistent with Guillain-Barré syndrome (GBS). The temporal relationship between the development of GBS and honeybee venom sting acupuncture is suggestive of a cause-and-effect relationship, although the precise pathophysiology and causative components in honeybee venom need to be verified.
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Affiliation(s)
- Hyun Jo Lee
- Department of Neurology, College of Medicine, The Catholic University of Korea, Korea
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Ye Y, Li SL, Li YJ. Comparison on therapeutic effect of plasma exchange and intravenous immunoglobulin for Guillian-Barre syndrome. Transfus Med 2014; 25:79-84. [PMID: 25515056 DOI: 10.1111/tme.12169] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 10/19/2014] [Accepted: 11/24/2014] [Indexed: 01/20/2023]
Affiliation(s)
- Y. Ye
- Department of Blood Transfusion; The Affiliated Hospital of Xi'an Medical University; Xi'an Shaanxi 710077 China
| | - S.-L. Li
- Department of Blood Transfusion; The Affiliated Hospital of Xi'an Medical University; Xi'an Shaanxi 710077 China
| | - Y.-J. Li
- Department of Neurology; The Affiliated Hospital of Xi'an Medical University; Xi'an Shaanxi 710077 China
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