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Li X, Zhang C. Guillain-Barré syndrome after surgery: a literature review. Front Neurol 2024; 15:1368706. [PMID: 38638310 PMCID: PMC11024248 DOI: 10.3389/fneur.2024.1368706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 02/26/2024] [Indexed: 04/20/2024] Open
Abstract
Guillain-Barré syndrome (GBS) is a rare postoperative complication that is sometimes characterized by serious motor weakness and prolonged weaning from mechanical ventilation. Although the exact nature of the relationship between GBS and the surgical procedure is still unclear, there is a clear increased incidence of GBS in post-surgical patients compared to non-surgical patients. GBS after surgery is unique in several ways. The course of post-surgical GBS unfolds more rapidly than in other situations where GBS develops, the condition is often more severe, and respiratory muscles are more commonly involved. Prompt diagnosis and appropriate treatment are essential, and the condition can worsen if treated inappropriately. Postoperative sedation, intubation, and restraint use make the diagnosis of GBS difficult, as the onset of symptoms of weakness or numbness in those contexts are not obvious. GBS is often misdiagnosed, being attributed to other postoperative complications, and subsequently mishandled. The lack of relevant information further obscures the clinical picture. We sought to better understand post-surgical GBS by performing an analysis of the relevant literature, focusing on clearly documenting the clinical characteristics, diagnosis, and management of GBS that emerges following surgery. We underscore the importance of physicians being aware of the possibility of GBS after major surgery and of performing a variety of laboratory clinical investigations early on in suspected cases.
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Affiliation(s)
| | - Chao Zhang
- Department of Neurology and Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
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2
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Komlakh K, Manafi-Rasi A, Mirbolook A, Baroutkoub M, Salimi S, Athari M. Acute Onset of Guillain-Barré Syndrome after Multiple Spine Surgeries: A Rare Case Report. Adv Biomed Res 2022; 11:113. [PMID: 36798916 PMCID: PMC9926031 DOI: 10.4103/abr.abr_311_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 04/29/2022] [Accepted: 04/30/2022] [Indexed: 12/28/2022] Open
Abstract
Guillain-Barré syndrome is an autoimmune disorder presented by ascending paralysis and areflexia. The condition has been reported after many infections, but Guillain-Barré syndrome after spine surgery is rare. We, herein, present a case of Guillain-Barré syndrome after multiple spine surgeries for degenerative lumbar scoliosis. A 60-year-old woman with degenerative scoliosis underwent surgery for the third time and developed Guillain-Barré syndrome 3 weeks after the final operation. The patient received intravenous immune globulin therapy and needed mechanical ventilation and intensive care. She was discharged in good condition after 5 weeks.
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Affiliation(s)
- Khalil Komlakh
- Department of Neurosurgery, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Manafi-Rasi
- Department of Orthopedic Surgery, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ahmadreza Mirbolook
- Department of Orthopedic Surgery, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mojtaba Baroutkoub
- Department of Orthopedic Surgery, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sohrab Salimi
- Department of Anesthesiology, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - MirBahador Athari
- Department of Orthopedic Surgery, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Address for correspondence: Dr. MirBahador Athari, Department of Orthopedic Surgery, Imam Hossein Medical Center, Madani St., Tehran, Iran. E-mail:
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3
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Tesoriero P, Feng JE, Anoushiravani AA, Kiprovski K, Marwin S, Wiznia D. Diagnosis of Guillain-Barré Syndrome After Total Hip Arthroplasty: A Case Report. JBJS Case Connect 2021; 11:01709767-202106000-00092. [PMID: 34038913 DOI: 10.2106/jbjs.cc.20.00848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE REPORT A 67-year-old man presented with signs of acute periprosthetic infection after total hip arthroplasty (THA). Surgical debridement, antibiotics, and a head and liner exchange were performed. After showing no improvement, a single-stage revision was conducted. Postoperatively, he developed back pain and lower extremity weakness. Electrodiagnostic studies showed a Guillain-Barré syndrome (GBS) variant. Intravenous immunoglobulin was administered to halt disease progression. After 1 year, he still demonstrated neuromuscular deficits and required a cane for ambulation. CONCLUSION This case highlights GBS after THA. A high degree of clinical suspicion is essential to prevent misinterpretation as a postsurgical complication. LEVEL OF EVIDENCE V, case report.
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Affiliation(s)
- Paul Tesoriero
- NYU Langone Long Island Hospital, NYU Langone Health, Mineola, New York
| | - James E Feng
- Beaumont Orthopaedic Hospital, Beaumont Health, Royal Oak, Michigan
| | | | - Kiril Kiprovski
- NYU Langone Orthopaedic Hospital, NYU Langone Health, New York, New York
| | - Scott Marwin
- NYU Langone Orthopaedic Hospital, NYU Langone Health, New York, New York
| | - Daniel Wiznia
- Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut
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4
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Asthana P, Zhang G, Sheikh KA, Him Eddie Ma C. Heat shock protein is a key therapeutic target for nerve repair in autoimmune peripheral neuropathy and severe peripheral nerve injury. Brain Behav Immun 2021; 91:48-64. [PMID: 32858161 DOI: 10.1016/j.bbi.2020.08.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/18/2020] [Accepted: 08/18/2020] [Indexed: 12/27/2022] Open
Abstract
Guillain-Barré syndrome (GBS) is an autoimmune peripheral neuropathy and a common cause of neuromuscular paralysis. Preceding infection induces the production of anti-ganglioside (GD) antibodies attacking its own peripheral nerves. In severe proximal peripheral nerve injuries that require long-distance axon regeneration, motor functional recovery is virtually nonexistent. Damaged axons fail to regrow and reinnervate target muscles. In mice, regenerating axons must reach the target muscle within 35 days (critical period) to reform functional neuromuscular junctions and regain motor function. Successful functional recovery depends on the rate of axon regeneration and debris removal (Wallerian degeneration) after nerve injury. The innate-immune response of the peripheral nervous system to nerve injury such as timing and magnitude of cytokine production is crucial for Wallerian degeneration. In the current study, forced expression of human heat shock protein (hHsp) 27 completely reversed anti-GD-induced inhibitory effects on nerve repair assessed by animal behavioral assays, electrophysiology and histology studies, and the beneficial effect was validated in a second mouse line of hHsp27. The protective effect of hHsp27 on prolonged muscle denervation was examined by performing repeated sciatic nerve crushes to delay regenerating axons from reaching distal muscle from 37 days up to 55 days. Strikingly, hHsp27 was able to extend the critical period of motor functional recovery for up to 55 days and preserve the integrity of axons and mitochondria in distal nerves. Cytokine array analysis demonstrated that a number of key cytokines which are heavily involved in the early phase of innate-immune response of Wallerian degeneration, were found to be upregulated in the sciatic nerve lysates of hHsp27 Tg mice at 1 day postinjury. However, persistent hyperinflammatory mediator changes were found after chronic denervation in sciatic nerves of littermate mice, but remained unchanged in hHsp27 Tg mice. Taken together, the current study provides insight into the development of therapeutic strategies to enhance muscle receptiveness (reinnervation) by accelerating axon regeneration and Wallerian degeneration.
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Affiliation(s)
- Pallavi Asthana
- Department of Neuroscience, City University of Hong Kong, Tat Chee Avenue, Hong Kong Special Administrative Region
| | - Gang Zhang
- Department of Neurology, University of Texas Medical School at Houston, 6431 Fannin Street, Houston TX 77030, USA
| | - Kazim A Sheikh
- Department of Neurology, University of Texas Medical School at Houston, 6431 Fannin Street, Houston TX 77030, USA
| | - Chi Him Eddie Ma
- Department of Neuroscience, City University of Hong Kong, Tat Chee Avenue, Hong Kong Special Administrative Region; City University of Hong Kong Shenzhen Research Institute, Shenzhen, China.
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Huang C, Zhang Y, Deng S, Ren Y, Lu W. Trauma-Related Guillain-Barré Syndrome: Systematic Review of an Emerging Concept. Front Neurol 2020; 11:588290. [PMID: 33240210 PMCID: PMC7681248 DOI: 10.3389/fneur.2020.588290] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/02/2020] [Indexed: 02/05/2023] Open
Abstract
Guillain-Barré syndrome (GBS) is mainly associated with preceding exposure to an infectious agent, although the precise pathogenic mechanisms and causes remain unknown. Increasing evidence indicates an association between trauma-related factors and GBS. Here, we performed a systematic review, summarized the current scientific literature related to the onset of GBS associated with trauma, and explored the possible pathogenesis. A literature search of various electronic databases was performed up to May 2020 to identify studies reporting diverse trauma-related triggers of GBS. Data were extracted, summarized descriptively, and evaluated with respect to possible mechanisms. In total, 100 publications, including 136 cases and 6 case series involving GBS triggered by injury, surgery, intracranial hemorrhage, and heatstroke, met our eligibility criteria. The median age of the patients was 53 [interquartile range (IQR) 45-63] years, and 72.1% of the patients were male. The median number of days between the trigger to onset of GBS symptoms was 9 (IQR 6.5-13). Overall, 121 patients (89.0%) developed post-injury/surgical GBS, whereas 13 (9.6%) and 2 (1.5%) patients had preexisting spontaneous intracranial hemorrhage and heatstroke, respectively. The main locations of injury or surgeries preceding GBS were the spine and brain. Based on available evidence, we highlight possible mechanisms of GBS induced by these triggers. Moreover, we propose the concept of "trauma-related GBS" as a new research direction, which may help uncover more pathogenic mechanisms than previously considered for typical GBS triggered by infection or vaccination.
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Affiliation(s)
- Chuxin Huang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yiliu Zhang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shuwen Deng
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yijun Ren
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Wei Lu
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
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Nadia B, Nouha F, Salma S, Mariem D, Salah BM, Chokri M. Acute motor axonal neuropathy form of the Guillain Barre syndrome two months after bariatric surgery. Presse Med 2019; 48:725-727. [PMID: 31133339 DOI: 10.1016/j.lpm.2019.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 03/30/2019] [Accepted: 05/07/2019] [Indexed: 12/22/2022] Open
Affiliation(s)
- Bouattour Nadia
- Habib Bourguiba hospital, neurology's department, 3072 Sfax, Tunisia.
| | - Farhat Nouha
- Habib Bourguiba hospital, neurology's department, 3072 Sfax, Tunisia
| | - Sakka Salma
- Habib Bourguiba hospital, neurology's department, 3072 Sfax, Tunisia
| | - Dammak Mariem
- Habib Bourguiba hospital, neurology's department, 3072 Sfax, Tunisia
| | | | - Mhiri Chokri
- Habib Bourguiba hospital, neurology's department, 3072 Sfax, Tunisia
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Zhong YX, Lu GF, Chen XL, Cao F. Postoperative Guillain-Barré Syndrome, a Neurologic Complication that Must Not Be Overlooked: A Literature Review. World Neurosurg 2019; 128:347-353. [PMID: 31059858 DOI: 10.1016/j.wneu.2019.04.239] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 04/27/2019] [Accepted: 04/29/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Guillain-Barré syndrome (GBS) is an uncommon, yet life-threatening postoperative neuropathic complication that is easily neglected, and hence, timely treatment is not provided in the clinics. This review aims to summarize the clinical features of postoperative GBS, and thus, improve the understanding of postoperative GBS. METHODS We reviewed the literature on postoperative GBS and assessed the demographic information, clinical manifestation, operation, time of onset of postoperative GBS, and prognosis. RESULTS A total of 33 cases of postoperative GBS were included in this study. The average age of patients with postoperative GBS was 46.9 years, and there was a peak in occurrence of GBS between ages 50 and 70 years. Men seemed more likely to have postoperative GBS than did women, with a ratio of 2.67:1. Progressive muscular weakness, present in 31 of the cases, was the most common presentation. Patients with spinal surgery were at further increased risk for GBS, and 84.8% of the patients with GBS had a good prognosis after prompt treatment. CONCLUSIONS Surgery is probably a potential risk factor for the occurrence of GBS. Early diagnosis and prompt treatment are imperative to reduce mortality.
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Affiliation(s)
- Yu-Xin Zhong
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Guan-Feng Lu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Xiao-Lu Chen
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Fei Cao
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
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8
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Hess SR, Waligora AC, Jiranek WA, Golladay GJ. Inflammatory demyelinating polyneuropathy after total hip arthroplasty. Arthroplast Today 2019; 5:17-20. [PMID: 31020015 PMCID: PMC6470325 DOI: 10.1016/j.artd.2018.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 08/28/2018] [Accepted: 08/30/2018] [Indexed: 12/29/2022] Open
Abstract
Inflammatory demyelinating polyneuropathy is a rare but devastating condition. Guillain-Barré syndrome is the most common cause with acute inflammatory demyelinating polyneuropathy being the most common subtype that follows a monophasic course and does not recur. Chronic inflammatory demyelinating polyneuropathy occurs when symptoms persist for greater than 8 weeks. With many proposed etiologies, few reports have described acute inflammatory demyelinating polyneuropathy after total joint arthroplasty. To our knowledge, this is the first case report of chronic inflammatory demyelinating polyneuropathy developing after total hip arthroplasty that was further complicated by dislocation.
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Affiliation(s)
- Shane R Hess
- Department of Orthopedics, The CORE Institute, Phoenix, AZ, USA
| | | | | | - Gregory J Golladay
- Department of Orthopaedic Surgery, Virginia Commonwealth University Medical Center, Richmond, VA, USA
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9
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Rudant J, Dupont A, Mikaeloff Y, Bolgert F, Coste J, Weill A. Surgery and risk of Guillain-Barré syndrome: A French nationwide epidemiologic study. Neurology 2018; 91:e1220-e1227. [PMID: 30143563 DOI: 10.1212/wnl.0000000000006246] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 06/28/2018] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To assess the association between Guillain-Barré syndrome (GBS) and recent surgery based on French nationwide data. METHODS Data were extracted from the French health administrative databases (SNIIRAM/PMSI). All patients hospitalized for GBS between 2009 and 2014 were identified by ICD-10 code G61.0 as main diagnosis. Patients previously hospitalized for GBS in 2006, 2007, and 2008 were excluded. Surgical procedures were identified from the hospital database. Hospitalizations for surgery with no infection diagnosis code entered during the hospital stay were also identified. The association between GBS and a recent surgical procedure was estimated using a case-crossover design. Case and referent windows were defined as 1-60 days and 366-425 days before GBS hospitalization, respectively. Analyses were adjusted for previous episodes of gastroenteritis and respiratory tract infection, identified by drug dispensing data. RESULTS Of the 8,364 GBS cases included, 175 and 257 patients had undergone a surgical procedure in the referent and case windows, respectively (adjusted odds ratio [OR] = 1.53, 95% confidence interval [CI]: 1.25-1.88). A slightly weaker association was observed for surgical procedures with no identified infection during the hospitalization (OR = 1.40, 95% CI: 1.12-1.73). Regarding the type of surgery, only surgical procedures on bones and digestive organs were significantly associated with GBS (OR and 95% CI = 2.78 [1.68-4.60] and 2.36 [1.32-4.21], respectively). CONCLUSION In this large nationwide epidemiologic study, GBS was moderately associated with any type of recent surgery and was more strongly associated with bone and digestive organ surgery.
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Affiliation(s)
- Jérémie Rudant
- From Caisse Nationale de l'Assurance Maladie (J.R., A.D., J.C., A.W.), Direction de la Stratégie des Études et des Statistiques, Département Études en Santé Publique, Paris; Assistance Publique-Hôpitaux de Paris (Y.M.), Hôpital Bicêtre, Unité de Rééducation Neurologique Infantile, Bicêtre; Université Paris-Saclay (Y.M.), Université Paris-Sud, CESP, Inserm, Villejuif; and Assistance Publique-Hôpitaux de Paris (F.B.), Hôpital Pitié-Salpêtrière, Réanimation Neurologique, Neurologie 1, Paris, France.
| | - Axelle Dupont
- From Caisse Nationale de l'Assurance Maladie (J.R., A.D., J.C., A.W.), Direction de la Stratégie des Études et des Statistiques, Département Études en Santé Publique, Paris; Assistance Publique-Hôpitaux de Paris (Y.M.), Hôpital Bicêtre, Unité de Rééducation Neurologique Infantile, Bicêtre; Université Paris-Saclay (Y.M.), Université Paris-Sud, CESP, Inserm, Villejuif; and Assistance Publique-Hôpitaux de Paris (F.B.), Hôpital Pitié-Salpêtrière, Réanimation Neurologique, Neurologie 1, Paris, France
| | - Yann Mikaeloff
- From Caisse Nationale de l'Assurance Maladie (J.R., A.D., J.C., A.W.), Direction de la Stratégie des Études et des Statistiques, Département Études en Santé Publique, Paris; Assistance Publique-Hôpitaux de Paris (Y.M.), Hôpital Bicêtre, Unité de Rééducation Neurologique Infantile, Bicêtre; Université Paris-Saclay (Y.M.), Université Paris-Sud, CESP, Inserm, Villejuif; and Assistance Publique-Hôpitaux de Paris (F.B.), Hôpital Pitié-Salpêtrière, Réanimation Neurologique, Neurologie 1, Paris, France
| | - Francis Bolgert
- From Caisse Nationale de l'Assurance Maladie (J.R., A.D., J.C., A.W.), Direction de la Stratégie des Études et des Statistiques, Département Études en Santé Publique, Paris; Assistance Publique-Hôpitaux de Paris (Y.M.), Hôpital Bicêtre, Unité de Rééducation Neurologique Infantile, Bicêtre; Université Paris-Saclay (Y.M.), Université Paris-Sud, CESP, Inserm, Villejuif; and Assistance Publique-Hôpitaux de Paris (F.B.), Hôpital Pitié-Salpêtrière, Réanimation Neurologique, Neurologie 1, Paris, France
| | - Joël Coste
- From Caisse Nationale de l'Assurance Maladie (J.R., A.D., J.C., A.W.), Direction de la Stratégie des Études et des Statistiques, Département Études en Santé Publique, Paris; Assistance Publique-Hôpitaux de Paris (Y.M.), Hôpital Bicêtre, Unité de Rééducation Neurologique Infantile, Bicêtre; Université Paris-Saclay (Y.M.), Université Paris-Sud, CESP, Inserm, Villejuif; and Assistance Publique-Hôpitaux de Paris (F.B.), Hôpital Pitié-Salpêtrière, Réanimation Neurologique, Neurologie 1, Paris, France
| | - Alain Weill
- From Caisse Nationale de l'Assurance Maladie (J.R., A.D., J.C., A.W.), Direction de la Stratégie des Études et des Statistiques, Département Études en Santé Publique, Paris; Assistance Publique-Hôpitaux de Paris (Y.M.), Hôpital Bicêtre, Unité de Rééducation Neurologique Infantile, Bicêtre; Université Paris-Saclay (Y.M.), Université Paris-Sud, CESP, Inserm, Villejuif; and Assistance Publique-Hôpitaux de Paris (F.B.), Hôpital Pitié-Salpêtrière, Réanimation Neurologique, Neurologie 1, Paris, France
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Abstract
Guillain-Barré syndrome is a rare autoimmune condition characterized by ascending motor weakness of the extremities that can ascend to the diaphragm, causing substantial morbidity and mortality. This case report describes a 57-year-old man who exhibited characteristics of Guillain-Barré syndrome 9 days after undergoing lumbar fusion at L3-S1. The diagnosis was based on the patient's ascending motor weakness and areflexia and was confirmed with electromyography. The patient progressed to respiratory failure, requiring mechanical ventilation. He regained motor function and ambulation within 6 months. Although the syndrome typically manifests initially as ascending paralysis, this patient's initial symptom was new-onset atrial fibrillation, a sign of autonomic dysfunction. Because it can cause paralysis and respiratory failure, Guillain-Barré syndrome should be included in the differential diagnosis whenever motor weakness is observed after lumbar surgery. The timing of symptoms, imaging results, and the development of atypical symptoms can help distinguish this rare possibility from other postoperative spinal complications.
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Abstract
Guillain-Barré syndrome (GBS) is a term that is used to describe a group of immune-mediated peripheral neuropathies, with the most common feature being rapid polyradiculoneuropathy. The exact etiology of this syndrome is unknown. In the field of orthopedics, GBS has been reported to occur after total hip arthroplasty, orthopedic trauma, and spine surgery. We report a unique case of GBS after elective revision lumbar spine surgery. A 62-year-old female presented with persistent low back pain and radiculopathy and elected to have revision lumbar spine surgery. Approximately 24 to 36 hours after hospital discharge, she returned to the hospital with weakness in her legs. After an electromyography (EMG), the patient was diagnosed with GBS and placed on intravenous immunoglobulin (IVIG). She developed respiratory failure, which required intubation and eventually converted to a tracheostomy and was finally decannulated. Over the course of 12 months, she improved to her pre-surgical baseline, gaining 5/5 strength in her upper and lower extremities and was able to ambulate independently without any aids. This was a case of GBS that occurred in a patient approximately two weeks after revision lumbar surgery. GBS is a poorly understood and rare complication of lumbar spine surgery that needs to be recognized quickly to be effectively treated.
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Affiliation(s)
- Aymen Rashid
- Department of Orthopedic Surgery, SUNY Upstate Medical University
| | - Swamy Kurra
- Department of Orthopedic Surgery, SUNY Upstate Medical University
| | - William Lavelle
- Department of Orthopedic Surgery, SUNY Upstate Medical University
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Sahai N, Hwang KS, Emami A. Guillain–Barré syndrome following elective spine surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 26:6-8. [DOI: 10.1007/s00586-016-4577-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 04/20/2016] [Accepted: 04/21/2016] [Indexed: 11/30/2022]
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13
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Yang B, Lian Y, Liu Y, Wu BY, Duan RS. A retrospective analysis of possible triggers of Guillain–Barre syndrome. J Neuroimmunol 2016; 293:17-21. [DOI: 10.1016/j.jneuroim.2016.02.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 02/04/2016] [Accepted: 02/08/2016] [Indexed: 02/07/2023]
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14
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Huang SL, Qi HG, Liu JJ, Huang YJ, Xiang L. A Rare Complication of Spine Surgery: Guillain-Barré Syndrome. World Neurosurg 2015; 84:697-701. [PMID: 25931309 DOI: 10.1016/j.wneu.2015.04.045] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 04/20/2015] [Accepted: 04/22/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Since little has been reported about Guillain-Barré syndrome (GBS) after spine surgery, we sought to determine some of the clinical features and the management of the condition. METHODS A total of 4 cases of GBS after spine surgery were included. The medical charts of the patients were reviewed to obtain demographic and clinical details. All the patients underwent neurologic and electrophysiologic examinations and were followed up after surgery. RESULTS The onset of symptoms about GBS was 2-7 days after the operation. Neurologic evaluation showed weaknesses of upper and lower extremities and repeal of tendon reflexes. The patients exhibited typical clinical symptoms and signs of GBS and electromyographic findings. Lumbar puncture was performed in 2 cases, and cerebrospinal fluid examination showed albuminocytological dissociation. All the 4 patients were diagnosed as GBS on the basis of typical clinical, laboratory, and electrophysiologic findings. Intravenous immunoglobulin was instituted. At follow-up, one patient needed ventilator support; one patient could transfer from bed to chair; one walked with assistive devices; and the remaining patient had residual minor neurologic deficits. CONCLUSIONS These cases warn surgeons to be alert to the association of GBS and spine surgery. On the basis of our experience, we recommend consideration of this rare diagnosis in patients with paralysis after spine surgery.
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Affiliation(s)
- Sheng-Li Huang
- Department of Orthopaedics, the Second Affiliated Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, China
| | - Hua-Guang Qi
- Department of Function Examination, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, China
| | - Jing-Jie Liu
- Department of Neurology, the Second Affiliated Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, China
| | - Ya-Juan Huang
- Department of Orthopaedics, the Second Affiliated Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, China
| | - Li Xiang
- Department of Neurology, the Second Affiliated Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, China.
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Boghani Z, Livingston AD, Simpson EP, Holman PJ, Grossman RG. Acute Onset of Guillain-Barré Syndrome After Elective Spinal Surgery. World Neurosurg 2015; 84:376-9. [PMID: 25836269 DOI: 10.1016/j.wneu.2015.03.036] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 03/17/2015] [Accepted: 03/18/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Guillain-Barré syndrome (GBS) is an acute peripheral neuropathy caused by an autoimmune response against myelin of peripheral nerves. GBS has been reported after surgery, in general, and after spinal surgery, in particular. In most cases, GBS developed 1-3 weeks after surgery. METHODS Report of 2 cases of GBS after elective spine surgery that developed in the immediate postoperative period. RESULTS Within 1 and 3 hours after surgery, respectively, both patients developed ascending loss of motor and sensory function. They were taken back urgently to the operating room for wound exploration to ensure that an epidural hematoma had not developed. Cerebrospinal fluid studies and electromyography/nerve conduction velocity were then rapidly obtained and were compatible with acute inflammatory demyelinating polyradiculoneuropathy. Therapy was initiated with administration of intravenous immunoglobulin and plasmapheresis. Both patients made substantial motor recovery during the course of 1-2 years but have residual sensory abnormalities. CONCLUSIONS GBS developing acutely after spinal surgery is a rare occurrence but should be considered in the differential diagnosis of neurological deterioration after surgery. Rapid diagnosis and treatment are essential for recovery of neurological function.
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Affiliation(s)
- Zain Boghani
- Department of Neurosurgery, Houston Methodist Hospital Neurological Institute, Houston, Texas, USA
| | - Andrew D Livingston
- Department of Neurosurgery, Houston Methodist Hospital Neurological Institute, Houston, Texas, USA
| | - Ericka P Simpson
- Department of Neurology, Houston Methodist Hospital Neurological Institute, Houston, Texas, USA
| | - Paul J Holman
- Department of Neurosurgery, Houston Methodist Hospital Neurological Institute, Houston, Texas, USA
| | - Robert G Grossman
- Department of Neurosurgery, Houston Methodist Hospital Neurological Institute, Houston, Texas, USA.
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