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Ohashi T, Mano T, Iguchi N, Nanaura H, Kiriyama T, Sugie K. [A case of Guillain-Barré syndrome with unilateral diaphragmatic nerve palsy that was longitudinally evaluated using multiple examinations]. Rinsho Shinkeigaku 2022; 62:805-809. [PMID: 36184413 DOI: 10.5692/clinicalneurol.cn-001765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The patient, a 50-year-old woman, presented with fever and diarrhea in early July, X. One week later, she noticed muscle weakness in both lower extremities, which upon examination was found to be dominant in the distal muscles, with associated loss of tendon reflexes. We diagnosed the case as Guillain-Barré syndrome. After admission, the patient experienced decreased oxygenation, and a chest X-ray indicated elevation of the left hemidiaphragm. The phrenic nerve conduction studies revealed laterality of the amplitude of compound muscle action potential, and diaphragmatic ultrasonographic examination revealed decreased left diaphragmatic wall motion. We diagnosed the patient with unilateral diaphragmatic nerve palsy and initiated intravenous immunoglobulin and methylprednisolone treatment. After 2 weeks, the patient demonstrated good clinical recovery, increased diaphragmatic nerve amplitude, and improved diaphragmatic movement. We evaluated the longitudinal clinical course of unilateral diaphragmatic nerve palsy in the patient using nerve conduction tests and diaphragmatic echocardiography. The longitudinal evaluation allowed us to assess the pathological condition more sensitively so that the prognosis could be predicted accurately.
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Affiliation(s)
| | - Tomoo Mano
- Department of Neurology, Nara Medical University
- Department of Rehabilitation Medicine, Nara Medical University
| | | | | | | | - Kazuma Sugie
- Department of Neurology, Nara Medical University
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Xue J, Song Z, Li F, Yi Z, Yang C, Liu K, Zhang Y. Guillain-Barré syndrome with unilateral peripheral facial paralysis in a Chinese child. Int J Dev Neurosci 2022; 82:548-553. [PMID: 35993140 DOI: 10.1002/jdn.10225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/05/2022] [Accepted: 08/15/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Guillain-Barré syndrome (GBS) is an immune-mediated polyradiculoneuropathy with the classic presentation of acute onset neurological symptoms preceded by an infective illness, followed by progressive limb weakness. Unilateral facial paralysis is rarely seen in GBS. CASE PRESENTATION We reported a child presented with unilateral facial paralysis, limited outward movement of one eye and unilateral lower limb weakness, who was later diagnosed to have GBS. Through reviewing the patients with similar presentation reported previously, we found that the onset time of unilateral facial weakness in relation to other presentations of GBS seemed to be variable, which could be later or earlier than other symptoms, or concomitant. Most of the patients had a relatively good outcome within two weeks to twelve months of follow-up. CONCLUSIONS Unilateral facial paralysis may be a feature of GBS, albeit a rare thing. Recognizing the clinical patterns of such atypical variants of GBS allows for more timely and accurate diagnosis, and for treatment to be initiated without delay.
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Affiliation(s)
- Jiao Xue
- Department of Pediatric Neurology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Zhenfeng Song
- Department of Pediatric Neurology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Fei Li
- Department of Pediatric Neurology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Zhi Yi
- Department of Pediatric Neurology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Chengqing Yang
- Department of Pediatric Neurology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Kaixuan Liu
- Department of Pediatric Neurology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Ying Zhang
- Department of Pediatric Neurology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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Sharma S, Adhikari A, Ghimire N, Mainali G, Yadav SK, Rajkarnikar R. Guillain-Barré Syndrome associated with SARS-CoV-2 infection in Nepal: A case report. Ann Med Surg (Lond) 2022; 80:104214. [PMID: 35936572 PMCID: PMC9339100 DOI: 10.1016/j.amsu.2022.104214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 07/14/2022] [Accepted: 07/20/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Corona viruses may also affect the central nervous system, inducing various neurological problems. Guillain-Barré Syndrome (GBS) is a rare immune-mediated post-infectious neuropathy typically leading to ascending weakness. Herein, we present a case of the patient to show an association of GBS and SARS-CoV-2 infection in Nepal Case presentation Twenty-seven yrs old man show an association of GBS and SARS-CoV-2 infection in Nepal who presented with difficulty in walking, backache, tingling sensations over the bilateral wrist and ankle, and features of facial nerve palsy. The diagnosis of GBS was made. Following Intravenous Immunoglobulin (IVIg) administration, the patient started showing motor recovery within a week. Clinical discussion Patient who developed GBS as a likely post-infectious complication after the initial onset of infectious symptoms with persistent mild dry cough. Conclusion GBS has severe complications and early diagnosis is important to monitor for loss of ambulation and initiation of immunoglobulin treatment. GBS should be considered as a potential rare but serious complication due to COVID-19 Corona viruses may also affect the central nervous system, inducing various neurological problems. GBS is a rare immune-mediated post-infectious neuropathy typically leading to ascending weakness. There is association od GBS and SARS-CoV-2 infection. GBS should be considered as a potential rare but serious complication due to COVID-19.
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Gonçalves RAM, Costa GJV, Afonso MAL, Jerónimo LMMAL. Rehabilitation of unilateral peripheral facial paralysis in Guillain-Barré: a case study. REVISTA CEFAC 2021. [DOI: 10.1590/1982-0216/20212364021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Facial palsies have multiple etiologies, but have in common the negative impact not only on the functions of the stomatognathic system but also on the self-image and emotional expression. This article aimed to describe a case study of unilateral peripheral facial palsy caused by the Guillain-Barré Syndrome. Hence, it shares assessment and intervention experiences related to this type of change and presents its functional results. It also highlights the important role of the interdisciplinary team (which comprised a physiatrist, physical therapist, speech-language-hearing therapist, occupational therapist, and nurses) to catalyze the patient’s evolution and the management of possible complications. Moreover, it is rather important to integrate the patients as members of the rehabilitation team, empowering them and giving them responsibility for the success of the intervention.
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Ripellino P, Pons M, Izzo MGA, Gobbi C. Bilateral phrenic neuropathy responsive to intravenous immunoglobulin treatment. CLINICAL AND TRANSLATIONAL NEUROSCIENCE 2019. [DOI: 10.1177/2514183x19891606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The aetiology of phrenic neuropathy is often unknown, but immune mechanisms may play a role. In a typical case of bilateral phrenic neuropathy with paradoxical breathing (video), an inflammatory pathogenesis was suggested by prolonged distal latency of phrenic nerve compound muscle action potentials in nerve conduction studies and a clear-cut albumin-cytologic dissociation. This encouraged us to treat the patient with a standard dose of intravenous immunoglobulin. After obtaining a strong improvement at spirometry, we repeated the second cycle of intravenous immunoglobulin and observed normalization of symptoms within few weeks and no relapse after 3 years. This case suggests that lumbar puncture should be performed in the acute phase of phrenic neuropathies to detect potential responders to immunomodulatory treatment.
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Affiliation(s)
- Paolo Ripellino
- Department of Neurology, Neurocenter of Southern Switzerland, Lugano (CH), Switzerland
| | - Marco Pons
- Department of Internal Medicine, Ospedale Regionale di Lugano, Lugano (CH), Switzerland
| | | | - Claudio Gobbi
- Department of Neurology, Neurocenter of Southern Switzerland, Lugano (CH), Switzerland
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Sharma K, Tengsupakul S, Sanchez O, Phaltas R, Maertens P. Guillain-Barré syndrome with unilateral peripheral facial and bulbar palsy in a child: A case report. SAGE Open Med Case Rep 2019; 7:2050313X19838750. [PMID: 30915222 PMCID: PMC6429638 DOI: 10.1177/2050313x19838750] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 02/27/2019] [Indexed: 12/29/2022] Open
Abstract
Guillain-Barré syndrome is characterized by progressive motor weakness, sensory changes, dysautonomia, and areflexia. Cranial nerve palsies are frequent in Guillain-Barré syndrome. Among cranial nerve palsies in Guillain-Barré syndrome, facial nerve palsy is the most common affecting around half of the cases. Facial palsy in Guillain-Barré syndrome is usually bilateral. We describe a pediatric Guillain-Barré syndrome variant presenting with unilateral peripheral facial palsy and dysphagia. A 5-year-old boy had progressive lower extremity weakness and pain 3 days prior to onset of unilateral peripheral facial palsy. On presentation, diagnosis of Guillain-Barré syndrome was supported by areflexia and albuminocytologic dissociation. His condition deteriorated with a decline in his respiratory effort and inability to handle secretions. He was given non-invasive ventilation to prevent worsening of his acute respiratory failure. Brain and spine magnetic resonance imaging scans showed enhancement of the left bulbar nerve complex and anterior and posterior cervical nerve roots with gadolinium. Treatment with intravenous immunoglobulin led to an uneventful clinical course with partial recovery within 2 weeks. In summary, Guillain-Barré syndrome should be considered as a possible cause of unilateral peripheral facial palsy. Guillain-Barré syndrome patients with facial nerve and bulbar palsy require close monitoring as they are at risk of developing acute respiratory failure. Early intervention with intravenous immunoglobulin may benefit these patients. Magnetic resonance imaging findings may lend support to early intervention.
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Affiliation(s)
- Kamal Sharma
- Division of Pediatric Critical Care, Department of Pediatrics, College of Medicine, University of South Alabama, Mobile, AL, USA
| | - Supatida Tengsupakul
- Division of Pediatric Infectious Disease and Pediatric Hospitalist Service, College of Medicine, University of South Alabama, Mobile, AL, USA
| | - Omar Sanchez
- Division of Pediatric Critical Care, Department of Pediatrics, College of Medicine, University of South Alabama, Mobile, AL, USA
| | - Rozaleen Phaltas
- Department of Pediatrics, College of Medicine, University of South Alabama, Mobile, AL, USA
| | - Paul Maertens
- Department of Neurology, College of Medicine, University of South Alabama, Mobile, AL, USA
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Ohta Y, Kawahara Y, Tadokoro K, Sato K, Sasaki R, Takahashi Y, Takemoto M, Hishikawa N, Yamashita T, Asano T, Inomata T, Abe K. Asymmetrical and Isolated Hypoglossal Nerve Palsy Accompanied by a New Subset of Anti-ganglioside Antibodies in a Patient with Diffuse Large B Cell Lymphoma. Intern Med 2019; 58:283-286. [PMID: 30146587 PMCID: PMC6378144 DOI: 10.2169/internalmedicine.1269-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Malignant lymphoma sometimes involves peripheral nerves due to paraneoplastic syndrome associated with anti-ganglioside antibodies. We report a very rare case of malignant lymphoma accompanied by an asymmetrical and isolated hypoglossal nerve palsy associated with a new subset of anti-ganglioside antibodies. Magnetic resonance imaging and 18F-2-deoxy-2-fluoro-D-glucose position emission tomography showed no abnormalities of the hypoglossal nerve nucleus; however, the patient' s serum was positive for anti-sulfated glucuronyl paragloboside IgM antibodies as well as anti-GM1 IgM and anti-GQ1b IgM antibodies. The present case might suggest a paraneoplastic asymmetrical and isolated hypoglossal nerve palsy associated with a new subset of anti-ganglioside antibodies.
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Affiliation(s)
- Yasuyuki Ohta
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Yuko Kawahara
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Koh Tadokoro
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Kota Sato
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Ryo Sasaki
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Yoshiaki Takahashi
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Mami Takemoto
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Nozomi Hishikawa
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Toru Yamashita
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Takeru Asano
- Department of Hematology and Oncology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Tomoko Inomata
- Department of Hematology and Oncology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Koji Abe
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
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He B, Yu L, Li S, Xu F, Yang L, Ma S, Guo Y. Neuroprotective effect of lurasidone via antagonist activities on histamine in a rat model of cranial nerve involvement. Mol Med Rep 2018; 17:6002-6008. [PMID: 29436643 DOI: 10.3892/mmr.2018.8595] [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: 03/25/2016] [Accepted: 03/11/2017] [Indexed: 11/06/2022] Open
Abstract
Cranial nerve involvement frequently involves neuron damage and often leads to psychiatric disorder caused by multiple inducements. Lurasidone is a novel antipsychotic agent approved for the treatment of cranial nerve involvement and a number of mental health conditions in several countries. In the present study, the neuroprotective effect of lurasidone by antagonist activities on histamine was investigated in a rat model of cranial nerve involvement. The antagonist activities of lurasidone on serotonin 5‑HT7, serotonin 5‑HT2A, serotonin 5‑HT1A and serotonin 5‑HT6 were analyzed, and the preclinical therapeutic effects of lurasidone were examined in a rat model of cranial nerve involvement. The safety, maximum tolerated dose (MTD) and preliminary antitumor activity of lurasidone were also assessed in the cranial nerve involvement model. The therapeutic dose of lurasidone was 0.32 mg once daily, administered continuously in 14‑day cycles. The results of the present study found that the preclinical prescriptions induced positive behavioral responses following treatment with lurasidone. The MTD was identified as a once daily administration of 0.32 mg lurasidone. Long‑term treatment with lurasidone for cranial nerve involvement was shown to improve the therapeutic effects and reduce anxiety in the experimental rats. In addition, treatment with lurasidone did not affect body weight. The expression of the language competence protein, Forkhead‑BOX P2, was increased, and the levels of neuroprotective SxIP motif and microtubule end‑binding protein were increased in the hippocampal cells of rats with cranial nerve involvement treated with lurasidone. Lurasidone therapy reinforced memory capability and decreased anxiety. Taken together, lurasidone treatment appeared to protect against language disturbances associated with negative and cognitive impairment in the rat model of cranial nerve involvement, providing a basis for its use in the clinical treatment of patients with cranial nerve involvement.
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Affiliation(s)
- Baoming He
- Department of Neurology, Sichuan Academy of Medical Sciences, Sichuan People's Hospital, Chengdu, Sichuan 610072, P.R. China
| | - Liang Yu
- Department of Neurology, Sichuan Academy of Medical Sciences, Sichuan People's Hospital, Chengdu, Sichuan 610072, P.R. China
| | - Suping Li
- Department of Neurology, Sichuan Academy of Medical Sciences, Sichuan People's Hospital, Chengdu, Sichuan 610072, P.R. China
| | - Fei Xu
- Department of Neurology, Sichuan Academy of Medical Sciences, Sichuan People's Hospital, Chengdu, Sichuan 610072, P.R. China
| | - Lili Yang
- Department of Neurology, Sichuan Academy of Medical Sciences, Sichuan People's Hospital, Chengdu, Sichuan 610072, P.R. China
| | - Shuai Ma
- Department of Neurology, Sichuan Academy of Medical Sciences, Sichuan People's Hospital, Chengdu, Sichuan 610072, P.R. China
| | - Yi Guo
- Department of Neurology, Sichuan Academy of Medical Sciences, Sichuan People's Hospital, Chengdu, Sichuan 610072, P.R. China
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Asymmetric Acute Motor Axonal Neuropathy With Unilateral Tongue Swelling Mimicking Stroke. Neurologist 2017; 21:106-108. [PMID: 27801771 DOI: 10.1097/nrl.0000000000000102] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
A 60-year-old man presented with acute onset of left hemiparesis and left hypoglossal nerve palsy with ipsilateral tongue swelling. He then progressed to tetraparesis in a few days. Cerebrospinal fluid showed cell protein dissociation. A nerve conduction study showed motor axonal neuropathy with sensory sparing. A subsequent blood test revealed anti-GD1b IgG antibody positivity. He was diagnosed to have acute motor axonal neuropathy (AMAN) and treated with a course of intravenous immunoglobulin with slow improvement. This is probably the first AMAN with asymmetrical presentation mimicking stroke reported in the literature in detail. The anti-GD1b IgG antibody is also not commonly associated with AMAN.
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Iqbal M, Sharma P, Charadva C, Prasad M. Rare encounter of unilateral facial nerve palsy in an adolescent with Guillain-Barré syndrome. BMJ Case Rep 2016; 2016:bcr-2015-213394. [PMID: 26823357 DOI: 10.1136/bcr-2015-213394] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Unilateral facial nerve palsy is rarely encountered in Guillain-Barré syndrome (GBS). We report a case of an adolescent girl who presented with peripheral ascending weakness, preceded by Campylobacter jejuni infection. After treatment with intravenous immunoglobulin, the peripheral weakness improved. Electro-diagnostic testing confirmed axonal dysfunction and the patient was positive for antiganglioside antibodies. However, the patient developed unilateral left-sided facial weakness. She was managed with further intravenous immunoglobulin and intensive physiotherapy. The outcome for facial palsy was very good, with almost complete resolution after 2 weeks.
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Affiliation(s)
| | | | | | - Manish Prasad
- Department of Paediatric Neurology, University Hospitals of Leicester, Leicester, UK
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Cranial nerve involvement as presenting sign of multifocal motor neuropathy. J Clin Neurosci 2012; 19:1733-5. [DOI: 10.1016/j.jocn.2011.12.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 11/25/2011] [Accepted: 12/28/2011] [Indexed: 11/22/2022]
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Verma R, Chaudhari TS, Giri P. Unilateral facial palsy in Guillain-Barre syndrome (GBS): a rare occurrence. BMJ Case Rep 2012; 2012:bcr-2012-007077. [PMID: 23087283 DOI: 10.1136/bcr-2012-007077] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Guillain-Barre syndrome (GBS) is a postinfectious, autoimmune disorder which, apart from limb weakness, is characterised by cranial nerve involvement. Bilateral facial nerve palsy is the most common pattern of cranial nerve involvement in GBS. However, unilateral facial palsy, although uncommon, can be seen in GBS. We report a rare case of unilateral facial palsy in GBS and importance of electrophysiological tests including blink study in such cases has been emphasised.
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Affiliation(s)
- Rajesh Verma
- Department of Neurology, Chhatrapati Shahuji Maharaj Medical University, Lucknow, Uttar Pradesh, India.
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Galassi G, Girolami F. Acute-Onset Multifocal Motor Neuropathy (AMMN): How We Meet the Diagnosis. Int J Neurosci 2012; 122:413-22. [DOI: 10.3109/00207454.2012.677884] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Acute motor-sensory axonal Guillain-Barré syndrome with unilateral facial nerve paralysis after rotavirus gastroenteritis in a 2-year-old boy. J Infect Chemother 2011; 18:119-23. [PMID: 21915637 DOI: 10.1007/s10156-011-0300-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2011] [Accepted: 08/16/2011] [Indexed: 10/17/2022]
Abstract
Guillain-Barré syndrome (GBS) is well known as presenting with acute immune-mediated polyneuropathies, with strong associations with antecedent infections. Several variant forms of GBS have been described, including acute inflammatory demyelinating polyneuropathy, acute motor axonal neuropathy, acute motor-sensory axonal neuropathy, and sensory GBS. We present a rare case of 2-year-old boy with acute motor and sensory polyneuropathy and left-sided facial nerve paralysis after rotavirus infection. He received immunoglobulin i.v. with subsequent satisfactory recovery.
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Barabás J, Klenk G, Szabó G, Lukáts O, Bogdán S, Decker I, Huszár T. Modified Procedure for Secondary Facial Rehabilitation Following Total Bilateral Irreversible Peripheral Facial Palsy. J Craniofac Surg 2007; 18:169-76. [PMID: 17251859 DOI: 10.1097/01.scs.0000244914.82725.e2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We present the case of a middle-aged gentleman who developed total bilateral irreversible peripheral facial palsy over a period of 10 years, starting with palsy of the marginal mandibular and buccal branches of the facial nerve and progressing to the zygomatic and temporal branches. The patient did not develop any other neurological symptoms, and all neurological and other tests have remained negative over the last 10 years. Dripping of saliva and inability to close the mouth necessitated reanimation of the perioral region with the help of a fascia lata graft fixed to the fascia of the masseter muscles. The increasing lagophthalmos and associated eye problems were alleviated with a temporal muscle transposition combined with a lengthening procedure using the temporal fascia, passed through the upper and lower eyelids and hooked around the medial canthal ligament. The fascia strips were sutured not to the canthal ligament itself, but to each other, thereby placing equal self-adjusted tension on the upper and lower eyelids. Both operations were successful and improved eating and eye closure functions, allowing resolution of the eye symptoms.
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Affiliation(s)
- József Barabás
- Department of Oral and Maxillofacial Surgery, Semmelweis University, Mária u. 52, Budapest, Hungary.
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