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Dang HH, Nguyen HLT. Comparison of Clinical Features, Short-Term Outcome of Guillain-Barré Syndrome Between Adults and Children: A Retrospective Study in Vietnam. Pediatr Neurol 2024; 155:177-181. [PMID: 38669800 DOI: 10.1016/j.pediatrneurol.2024.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 01/18/2024] [Accepted: 03/31/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Despite extensive research on Guillain-Barré syndrome (GBS) in adults and children, there is a lack of comparison regarding short-term outcomes in various age groups. Our study aims to elucidate the differences in clinical features and short-term outcomes in Vietnam. METHODS After retrospective data collection, we compared clinical features in patients with GBS aged ≤16 years at Children's Hospital 2 and aged >16 years at University Medical Center Ho Chi Minh City from 2017 to 2021. A positive short-term outcome was recorded if patients had a GBS Disability Score of 0 to 2 at hospital discharge. RESULTS We analyzed 109 adults (58.7% males; mean age 50.6 ± 17.7) and 111 children (58.6% males; mean age 7.2 ± 4.9). Comparable antecedent infection and immunization incidence in both groups were observed (35.8% vs 45.9%, P > 0.05). Pain and sensory disturbance were the most common onset symptom in adults (57.8%), whereas lower limb weakness predominated in children (61.3%). Ophthalmoplegia (18.3% vs 5.4%), pain, sensory disturbance (85.3% vs 67.6%), ataxia (33.0% vs 15.3%) were more prevalent in adults (P < 0.05). The axonal subtype was prominent in both adults (51.4%) and children (53.2%). Patients were classified into: classic GBS (49.5% and 68.5%), GBS variants (11.0% and 15.3%), classic Miller Fisher syndrome (MFS) (1.8% and 1.8%), MFS variants (2.8% and 0%), and GBS/MFS overlap (34.9% and 14.4%). Short-term outcomes did not significantly differ based on age. CONCLUSIONS Age-related variations in clinical features were observed, but adults and children exhibited similar short-term functional outcomes.
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Affiliation(s)
- Hung Hoang Dang
- Department of Neurology, University Medical Center Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Hieu Le Trung Nguyen
- Department of Neurology, University Medical Center Ho Chi Minh City, Ho Chi Minh City, Vietnam; Department of Neurology, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam; Department of Neurology, Children's Hospital 2, Ho Chi Minh City, Vietnam.
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2
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Hawkes MA, Wijdicks EFM. Improving Outcome in Severe Myasthenia Gravis and Guillain-Barré Syndrome. Semin Neurol 2024; 44:263-270. [PMID: 38560985 DOI: 10.1055/s-0044-1785509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
When progressive and severe, myasthenia gravis and Guillain-Barré syndrome may have the potential for fatal and unfavorable clinical outcomes. Regardless of important differences in their clinical course, the development of weakness of oropharyngeal muscles and respiratory failure with requirement of mechanical ventilation is the main driver of poor prognosis in both conditions. The need for prolonged mechanical ventilation is particularly relevant because it immobilizes the patient and care becomes extraordinarily complex due to daily risks of systemic complications. Additionally, patients with myasthenia gravis often require long-term immunosuppressive treatments with associated toxicity and infectious risks. Unlike myasthenia gravis, the recovery period is prolonged in Guillain-Barré syndrome, but often favorable, even in the more severely affected patients. Outcome, for a large part, is determined by expert neurocritical care.
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Affiliation(s)
- Maximiliano A Hawkes
- Department of Neurology, Neurocritical Care Services, Mayo Clinic, Rochester, Minnesota
| | - Eelco F M Wijdicks
- Department of Neurology, Neurocritical Care Services, Mayo Clinic, Rochester, Minnesota
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3
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Netto AB, Chandrahasa N, Koshy SS, Taly AB. Hyponatremia in Guillain-Barre Syndrome: A Review of Its Pathophysiology and Management. Can J Neurol Sci 2024:1-11. [PMID: 38361453 DOI: 10.1017/cjn.2024.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Guillain-Barre syndrome (GBS) is the commonest cause of acute polyradiculoneuropathy that requires hospitalization. Many of these patients experience systemic and disease-related complications during its course. Notable among them is hyponatremia. Though recognized for decades, the precise incidence, prevalence, and mechanism of hyponatremia in GBS are not well known. Hyponatremia in GBS patients is associated with more severe in-hospital disease course, prolonged hospitalization, higher mortality, increased costs, and a greater number of other complications in the hospital and worse functional status at 6 months and at 1 year. Though there are several reports of low sodium associated with GBS, many have not included the exact temporal relationship of sodium or its serial values during GBS thereby underestimating the exact incidence, prevalence, and magnitude of the problem. Early detection, close monitoring, and better understanding of the pathophysiology of hyponatremia have therapeutic implications. We review the complexities of the relationship between hyponatremia and GBS with regard to its pathophysiology and treatment.
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Affiliation(s)
- Archana B Netto
- Departments of Neurology, Bangalore Medical College & Research Institute, Bangalore, India
| | - Niveditha Chandrahasa
- Departments of Neurology, Bangalore Medical College & Research Institute, Bangalore, India
| | - Sheril S Koshy
- Departments of Neurology, Bangalore Medical College & Research Institute, Bangalore, India
| | - Arun B Taly
- Departments of Neurology, Bangalore Medical College & Research Institute, Bangalore, India
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4
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Nakane S, Koike H, Hayashi T, Nakatsuji Y. Autoimmune Autonomic Neuropathy: From Pathogenesis to Diagnosis. Int J Mol Sci 2024; 25:2296. [PMID: 38396973 PMCID: PMC10889307 DOI: 10.3390/ijms25042296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/09/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
Autoimmune autonomic ganglionopathy (AAG) is a disease of autonomic failure caused by ganglionic acetylcholine receptor (gAChR) autoantibodies. Although the detection of autoantibodies is important for distinguishing the disease from other neuropathies that present with autonomic dysfunction, other factors are important for accurate diagnosis. Here, we provide a comprehensive review of the clinical features of AAG, highlighting differences in clinical course, clinical presentation, and laboratory findings from other neuropathies presenting with autonomic symptoms. The first step in diagnosing AAG is careful history taking, which should reveal whether the mode of onset is acute or chronic, followed by an examination of the time course of disease progression, including the presentation of autonomic and extra-autonomic symptoms. AAG is a neuropathy that should be differentiated from other neuropathies when the patient presents with autonomic dysfunction. Immune-mediated neuropathies, such as acute autonomic sensory neuropathy, are sometimes difficult to differentiate, and therefore, differences in clinical and laboratory findings should be well understood. Other non-neuropathic conditions, such as postural orthostatic tachycardia syndrome, chronic fatigue syndrome, and long COVID, also present with symptoms similar to those of AAG. Although often challenging, efforts should be made to differentiate among the disease candidates.
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Affiliation(s)
- Shunya Nakane
- Department of Neurology, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan
| | - Haruki Koike
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga 849-8501, Japan
| | - Tomohiro Hayashi
- Department of Neurology, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan
| | - Yuji Nakatsuji
- Department of Neurology, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan
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5
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Galassi G, Mazzoli M, Ariatti A, Bedin R, Marzullo D, Bastia E, Agnoletto V, Gozzi M, Valzania F, Meletti S, Marchioni A. Predictors of respiratory failure in Guillain-Barré syndrome: a 22 year cohort study from a single Italian centre. Eur J Neurol 2024; 31:e16090. [PMID: 37823704 DOI: 10.1111/ene.16090] [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] [Received: 05/01/2023] [Revised: 08/23/2023] [Accepted: 09/21/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND AND PURPOSE The study aimed to identify predictors of respiratory failure leading to mechanical ventilation (MV) and tracheostomy in Guillain-Barré syndrome (GBS). METHODS Two hundred and thirty adult cases admitted to the Neurology Unit of Modena, Italy, between January 2000 and December 2021 were studied. A cut-off of MV starting within 8 weeks from onset of weakness was used. Univariable, multivariable logistic and Cox regression analyses were used to determine which pre-specified clinical and diagnostic characteristics were capable of predicting MV and tracheostomy, due to weaning failure. The model was internally validated within the full cohort. The Erasmus GBS Respiratory Insufficiency Score was retrospectively applied. RESULTS One hundred and seventy-six cases (76.5%) were classified as classical sensorimotor GBS and 54 (23.4%) as variants. Thirty-two patients (13.9%) needed MV: 84.3% required respiratory support within 7 days. Independent predictors of respiratory failure and MV were older age, facial, bulbar, neck flexor weakness, dysautonomia, axonal electrophysiological subtype, cardiovascular comorbidities and higher disability score at entry. There was no association with abnormal spinal fluid parameters nor with positive serology for recent infections. Twenty-two patients (68.7%) were ventilated for more than 7 days; 4.7% died within 8 weeks. The patients who required MV were treated more often with plasma exchange. Independent predictors of tracheostomy due to weaning trial failure were facial, bulbar, neck flexor weakness, autonomic dysfunction, associated cardiovascular morbidities and axonal electrophysiological subtype on nerve conduction study. CONCLUSIONS Our study indicates distinct predictors of MV and tracheostomy in GBS patients.
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Affiliation(s)
- Giuliana Galassi
- Department of Biomedical, Metabolic and Neural Sciences, University Hospitals, Modena, Italy
| | - Marco Mazzoli
- Department of Biomedical, Metabolic and Neural Sciences, University Hospitals, Modena, Italy
| | - Alessandra Ariatti
- Department of Biomedical, Metabolic and Neural Sciences, University Hospitals, Modena, Italy
| | - Roberta Bedin
- Department of Biomedical, Metabolic and Neural Sciences, University Hospitals, Modena, Italy
| | - Donato Marzullo
- Department of Biomedical, Metabolic and Neural Sciences, University Hospitals, Modena, Italy
| | | | | | - Manuela Gozzi
- Department of Imaging, University Hospitals of Modena, Modena, Italy
| | - Franco Valzania
- Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Stefano Meletti
- Department of Biomedical, Metabolic and Neural Sciences, University Hospitals, Modena, Italy
| | - Alessandro Marchioni
- Respiratory Disease Unit, Department of Medical and Surgical Sciences, University Hospitals of Modena, Modena, Italy
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Madden J, Spadaro A, Koyfman A, Long B. High risk and low prevalence diseases: Guillain-Barré syndrome. Am J Emerg Med 2024; 75:90-97. [PMID: 37925758 DOI: 10.1016/j.ajem.2023.10.036] [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] [Received: 08/08/2023] [Revised: 10/18/2023] [Accepted: 10/25/2023] [Indexed: 11/07/2023] Open
Abstract
INTRODUCTION Guillain-Barré syndrome (GBS) is a rare but serious condition that carries with it a high rate of morbidity and mortality. OBJECTIVE This review highlights the pearls and pitfalls of GBS, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. DISCUSSION GBS is a rare immune-mediated neurologic disorder with peripheral nerve injury. It most commonly presents weeks after a bacterial or viral infection, though there are a variety of associated inciting events. The diagnosis is challenging and often subtle, as only 25-30% of patients are diagnosed on their initial healthcare visit. Clinicians should consider GBS in patients with progressive ascending weakness involving the lower extremities associated with hyporeflexia, but the cranial nerves, respiratory system, and autonomic system may be involved. While the ED diagnosis should be based on clinical assessment, further evaluation includes laboratory testing, cerebrospinal fluid (CSF) analysis, and potentially neuroimaging. Not all patients demonstrate albumino-cytological dissociation on CSF testing. Several criteria exist to assist with diagnosis, including the National Institute of Neurological Disorders and Stroke criteria and the Brighton criteria. Management focuses first on assessment of the patient's hemodynamic and respiratory status, which may require emergent intervention. Significant fluctuations in heart rate and blood pressure may occur, and respiratory muscle weakness may result in the need for airway protection. Neurology consultation is recommended, and definitive treatment includes PLEX or IVIG. CONCLUSIONS An understanding of GBS can assist emergency clinicians in diagnosing and managing this potentially deadly disease.
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Affiliation(s)
- Joshua Madden
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Alex Koyfman
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
| | - Brit Long
- SAUSHEC, Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
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7
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Krall JTW, Chakravartty A, Caress JB, Files DC. Identification and Management of Acute Neuromuscular Respiratory Failure in the ICU. Chest 2023; 164:1454-1461. [PMID: 38070961 DOI: 10.1016/j.chest.2023.09.009] [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] [Received: 05/31/2023] [Revised: 08/22/2023] [Accepted: 09/12/2023] [Indexed: 12/18/2023] Open
Abstract
Respiratory failure is a common and potentially life-threatening complication of neuromuscular diseases. Prompt recognition and accurate diagnosis of new or worsening chronic neuromuscular disease have important clinical management and prognostic implications. In this article, we present an approach to the acute presentation of undifferentiated neuromuscular respiratory failure in the ICU and guidance for determination and respiratory management of the underlying disorder.
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Affiliation(s)
- Jennifer T W Krall
- Department of Internal Medicine, Section on Pulmonary, Critical Care, Allergy, and Immunologic Diseases, Wake Forest University School of Medicine, Winston-Salem, NC.
| | - Akash Chakravartty
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - James B Caress
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC
| | - D Clark Files
- Department of Internal Medicine, Section on Pulmonary, Critical Care, Allergy, and Immunologic Diseases, Wake Forest University School of Medicine, Winston-Salem, NC
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8
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Habib AA, Waheed W. Guillain-Barré Syndrome. Continuum (Minneap Minn) 2023; 29:1327-1356. [PMID: 37851033 DOI: 10.1212/con.0000000000001289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
OBJECTIVE This article summarizes the clinical features, diagnostic criteria, differential diagnosis, pathogenesis, and prognosis of Guillain-Barré syndrome (GBS), with insights into the current and future diagnostic and therapeutic interventions for this neuromuscular syndrome. LATEST DEVELOPMENTS GBS is an acute, inflammatory, immune-mediated polyradiculoneuropathy that encompasses many clinical variants and divergent pathogenic mechanisms that lead to axonal, demyelinating, or mixed findings on electrodiagnostic studies. The type of antecedent infection, the development of pathogenic cross-reactive antibodies via molecular mimicry, and the location of the target gangliosides affect the subtype and severity of the illness. The data from the International GBS Outcome Study have highlighted regional variances, provided new and internationally validated prognosis tools that are beneficial for counseling, and introduced a platform for discussion of GBS-related open questions. New research has been undertaken, including research on novel diagnostic and therapeutic biomarkers, which may lead to new therapies. ESSENTIAL POINTS GBS is among the most frequent life-threatening neuromuscular emergencies in the world. At least 20% of patients with GBS have a poor prognosis and significant residual deficits despite receiving available treatments. Research is ongoing to further understand the pathogenesis of the disorder, find new biomarkers, and develop more effective and specific treatments.
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9
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Traub R, Chaudhry V. Neuroprognostication: Guillain-Barré Syndrome. Semin Neurol 2023; 43:791-798. [PMID: 37788681 DOI: 10.1055/s-0043-1775750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Guillain-Barré syndrome is an immune-mediated disease of the peripheral nerves characterized by rapidly progressing symmetric weakness, areflexia, and albuminocytological dissociation. Most patients reach their nadir within 2 weeks. Disease severity can be mild to severe, with 20% of patients requiring mechanical ventilation. Intravenous immunoglobulin and plasma exchange are equally effective treatments. Monitoring strength, respiratory function, blood pressure, and heart rate, as well as pain management and rehabilitative therapy are important aspects of management. About 20% of patients require assistance to walk at 6 months. Older age, preceding diarrhea, and lower Medical Research Council (MRC) sum scores predict poor outcome. Death from cardiovascular and respiratory complications can occur in the acute or recovery phases of the illness in 3 to 7% of the patients. Risk factors for mortality include advanced age and disease severity at onset. Neuropathic pain, weakness, and fatigue can be residual symptoms; risk factors for these include axonal loss, sensory involvement, and severity of illness.
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Affiliation(s)
- Rebecca Traub
- Department of Neurology, University of North Carolina, Chapel Hill, North Carolina
| | - Vinay Chaudhry
- Department of Neurology, University of North Carolina, Chapel Hill, North Carolina
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10
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Gomez F, Mehra A, Ensrud E, Diedrich D, Laudanski K. COVID-19: a modern trigger for Guillain-Barre syndrome, myasthenia gravis, and small fiber neuropathy. Front Neurosci 2023; 17:1198327. [PMID: 37712090 PMCID: PMC10498773 DOI: 10.3389/fnins.2023.1198327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 07/31/2023] [Indexed: 09/16/2023] Open
Abstract
COVID-19 infection has had a profound impact on society. During the initial phase of the pandemic, there were several suggestions that COVID-19 may lead to acute and protracted neurologic sequelae. For example, peripheral neuropathies exhibited distinctive features as compared to those observed in critical care illness. The peripheral nervous system, lacking the protection afforded by the blood-brain barrier, has been a particular site of sequelae and complications subsequent to COVID-19 infection, including Guillain-Barre syndrome, myasthenia gravis, and small fiber neuropathy. We will discuss these disorders in terms of their clinical manifestations, diagnosis, and treatment as well as the pathophysiology in relation to COVID-19.
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Affiliation(s)
- Francisco Gomez
- Department of Neurology, University of Missouri, Columbia, MO, United States
| | - Ashir Mehra
- Department of Neurology, University of Missouri, Columbia, MO, United States
| | - Erik Ensrud
- Department of Neurology, University of Missouri, Columbia, MO, United States
| | - Daniel Diedrich
- Department of Anesthesiology and Perioperative Care, Mayo Clinic, Rochester, MN, United States
| | - Krzysztof Laudanski
- Department of Anesthesiology and Perioperative Care, Mayo Clinic, Rochester, MN, United States
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Al Amrani F, Al-Abdwani R, Al Rashdi F, Al-Ajmi E, Al Futaisi A. Guillain-Barré Syndrome Associated with SARS-CoV-2 in Two Pediatric Patients. Sultan Qaboos Univ Med J 2023; 23:400-404. [PMID: 37655082 PMCID: PMC10467552 DOI: 10.18295/squmj.5.2022.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/24/2022] [Accepted: 05/17/2022] [Indexed: 11/16/2022] Open
Abstract
Guillain-Barré syndrome (GBS) is a recognised complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We report two children with GBS associated with SARS-CoV-2 who presented to a tertiary centre in Muscat, Oman in 2021: The first patient was a three-month-old female infant who presented with bradypnea, encephalopathy, and generalised weakness that required mechanical ventilation. Polymerase chain reaction (PCR) testing of the nasopharyngeal swabs (NPS) was positive for SARS-CoV-2. She had axonal variant GBS based on a nerve conduction study, cerebrospinal fluid analysis, and neuroimaging findings. The second patient was a six-year-old girl with fever, vomiting, and diarrhea followed by ascending weakness who presented with quadriplegia and facial weakness. Subsequently, she developed respiratory muscle weakness and required mechanical ventilation. PCR testing of NPS was negative for SARS-Cov-2, however IgG serology analysis was positive. The clinical course of these two patients was rapidly progressive and both of them required mechanical ventilation. The patient with axonal variant GBS made an incomplete recovery.
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Affiliation(s)
- Fatema Al Amrani
- Pediatric Neurology Unit, Department of Child Health, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Raghad Al-Abdwani
- Pediatric Intensive Care Unit, Department of Child Health, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Fatma Al Rashdi
- Pediatric Emergency Unit, Emergency Medicine Department, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Eiman Al-Ajmi
- Department of Radiology and Molecular Imaging, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Amna Al Futaisi
- Pediatric Neurology Unit, Department of Child Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
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Schnekenberg L, Sedghi A, Schoene D, Pallesen LP, Barlinn J, Woitek F, Linke A, Puetz V, Barlinn K, Mangner N, Siepmann T. Assessment and Therapeutic Modulation of Heart Rate Variability: Potential Implications in Patients with COVID-19. J Cardiovasc Dev Dis 2023; 10:297. [PMID: 37504553 PMCID: PMC10380874 DOI: 10.3390/jcdd10070297] [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: 05/25/2023] [Revised: 07/02/2023] [Accepted: 07/10/2023] [Indexed: 07/29/2023] Open
Abstract
Cardiac damage has been attributed to SARS-CoV-2-related pathology contributing to increased risk of vascular events. Heart rate variability (HRV) is a parameter of functional neurocardiac integrity with low HRV constituting an independent predictor of cardiovascular mortality. Whether structural cardiac damage translates into neurocardiac dysfunction in patients infected with SARS-CoV-2 remains poorly understood. Hypothesized mechanisms of possible neurocardiac dysfunction in COVID-19 comprise direct systemic neuroinvasion of autonomic control centers, ascending virus propagation along cranial nerves and cardiac autonomic neuropathy. While the relationship between the autonomic nervous system and the cytokine cascade in general has been studied extensively, the interplay between the inflammatory response caused by SARS-CoV-2 and autonomic cardiovascular regulation remains largely unclear. We reviewed the current literature on the potential diagnostic and prognostic value of autonomic neurocardiac function assessment via analysis of HRV including time domain and spectral analysis techniques in patients with COVID-19. Furthermore, we discuss potential therapeutic targets of modulating neurocardiac function in this high-risk population including HRV biofeedback and the impact of long COVID on HRV as well as the approaches of clinical management. These topics might be of particular interest with respect to multimodal pandemic preparedness concepts.
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Affiliation(s)
- Luiz Schnekenberg
- Department of Neurology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Annahita Sedghi
- Department of Neurology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Daniela Schoene
- Department of Neurology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Lars-Peder Pallesen
- Department of Neurology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Jessica Barlinn
- Department of Neurology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Felix Woitek
- Dresden Heart Center, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Axel Linke
- Dresden Heart Center, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Volker Puetz
- Department of Neurology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Kristian Barlinn
- Department of Neurology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Norman Mangner
- Dresden Heart Center, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Timo Siepmann
- Department of Neurology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
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Jin M, Liu J, Liu K, Zhao L, Zhao Z, Sun S. Sympathetic skin response (SSR) in pediatric Guillain-Barré syndrome. Front Neurol 2023; 14:1177394. [PMID: 37360330 PMCID: PMC10289187 DOI: 10.3389/fneur.2023.1177394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/19/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction In the present study, sympathetic skin response (SSR) characteristics were explored in children with Guillain-Barré syndrome (GBS) and the value of early diagnosis and prognostic evaluation in GBS complicated by autonomic dysfunction (AD) was evaluated. Methods A total of 25 children with GBS and 30 healthy controls (HCs) were enrolled in this prospective study. SSR findings for the two groups were compared. SSR and nerve conduction study (NCS) results were compared among patients with GBS, and differences in clinical characteristics between the groups with abnormal and normal SSR were analyzed. Results Within the GBS group, six patients (24%) required mechanical ventilation, 17 patients (66.7%) had AD, 18 patients (72%) had an abnormal SSR, and 13 patients (52%) had AD combined with SSR abnormalities. There was a statistically significant difference in SSR latency in the lower limbs between the GBS group and HCs (P < 0.05). There was no statistically significant difference between SSR and NCS results in the acute phase of GBS (P > 0.05), and there was no significant difference in the rate of AD or in Hughes functional grade at nadir between the groups with abnormal and normal SSR (P>0.05). However, there was a statistically significant difference between the results of SSR and NCS tests during the recovery phase (P = 0.003). Abnormal SSR mainly occurred in cases of the acute inflammatory demyelinating polyradiculoneuropathy (AIDP) subtype. In addition, SSR was abnormal in all pediatric GBS patients with poor prognosis 1 month after onset of symptoms. Conclusion Two-thirds of the children with GBS have AD. SSR could be used for early diagnosis and follow-up of GBS and may also be helpful in evaluating disease severity and short-term prognosis.
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Affiliation(s)
- Mei Jin
- The Children Hospital of Hebei Province, Shijiazhuang, Hebei, China
- The Key Laboratory of Pediatric Epilepsy and Neurological Disorders of Hebei Province, Shijiazhuang, Hebei, China
| | - Jing Liu
- The Children Hospital of Hebei Province, Shijiazhuang, Hebei, China
| | - Kang Liu
- The Children Hospital of Hebei Province, Shijiazhuang, Hebei, China
- The Key Laboratory of Pediatric Epilepsy and Neurological Disorders of Hebei Province, Shijiazhuang, Hebei, China
| | - Libo Zhao
- The Children Hospital of Hebei Province, Shijiazhuang, Hebei, China
| | - Ziwei Zhao
- The Children Hospital of Hebei Province, Shijiazhuang, Hebei, China
| | - Suzhen Sun
- The Children Hospital of Hebei Province, Shijiazhuang, Hebei, China
- The Key Laboratory of Pediatric Epilepsy and Neurological Disorders of Hebei Province, Shijiazhuang, Hebei, China
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Mohamed KH, Oshikoya AF, Kumar K, Anigbo CL, Sri Satya Sai Prashanth P, Mohamed AS, Haseeb M, Nasir H. Takotsubo Cardiomyopathy: A Possible Rare Complication of Guillain-Barré Syndrome. Cureus 2023; 15:e40083. [PMID: 37425556 PMCID: PMC10327529 DOI: 10.7759/cureus.40083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 07/11/2023] Open
Abstract
Dysautonomia is a common and severe complication of Guillain-Barré syndrome (GBS), which may manifest as cardiac arrhythmias, labile blood pressure, diaphoresis, and changes in gastrointestinal motility. Takotsubo cardiomyopathy (TCM) is a life-threatening manifestation of dysautonomia in patients with GBS, which is not widely underlined in the literature. The association between GBS and TCM has been well-documented in previous studies; however, there are few reported cases with GBS who developed TCM following their diagnosis with GBS. In this case report, we will discuss our experience treating a 59-year-old female patient who became hemodynamically unstable while recovering from an acute GBS infection. She was diagnosed with TCM after undergoing an echocardiogram and coronary angiogram ruling out thrombotic or obstructive coronary disease and myocarditis.
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Affiliation(s)
- Khalid H Mohamed
- Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, GBR
| | - Adetola F Oshikoya
- Internal Medicine, Near East University, Nicosia, CYP
- Internal Medicine, General Hospital Odan Lagos, Lagos, NGA
| | - Kapil Kumar
- Medicine and Surgery, Liaquat National Hospital and Medical College, Karachi, PAK
| | | | | | | | - Muhammad Haseeb
- Internal Medicine, Allama Iqbal Medical College, Lahore, PAK
- Internal Medicine, Mount Sinai Hospital, Brooklyn, USA
| | - Hira Nasir
- Internal Medicine, Mayo Hospital, Lahore, PAK
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15
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Neumeister J, Huang D, Dzluneski S, Huttleston AM, Megargel C, Falgiani M, Ganti L. Hyperacute and Fulminant Guillain-Barré Syndrome Requiring Emergent Intubation. Cureus 2023; 15:e38499. [PMID: 37273381 PMCID: PMC10237680 DOI: 10.7759/cureus.38499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2023] [Indexed: 06/06/2023] Open
Abstract
Guillain-Barré syndrome (GBS) is an autoimmune-mediated acute polyneuropathy that can progress to life-threatening respiratory failure. The diagnosis and treatment of this pathology are complicated by the rarity of the disease and diversity in clinical presentation due to rarer, more dangerous subtypes of GBS. Understanding the time course of progression from onset to nadir of neurological deficits, maintaining a high index of suspicion, and close airway monitoring are essential in rapid diagnosis, securing the airway, and treatment.
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Affiliation(s)
| | - Derrick Huang
- Emergency Medicine, HCA Florida Ocala Hospital, Ocala, USA
| | | | | | | | - Michael Falgiani
- Emergency Medicine, HCA Florida Ocala Hospital, Ocala, USA
- Emergency Medicine, Envision Physician Services, Plantation, USA
- Emergency Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Latha Ganti
- Emergency Medicine, HCA Florida Ocala Hospital, Ocala, USA
- Emergency Medicine, Envision Physician Services, Plantation, USA
- Emergency Medicine, University of Central Florida College of Medicine, Orlando, USA
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16
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Qinrong H, Yuxia C, Ling L, Huayu L, Lei X, Xiaoli L, Nong X. Reliability and validity of prognostic indicators for Guillain-Barré syndrome in children. Dev Med Child Neurol 2023; 65:563-570. [PMID: 36175376 DOI: 10.1111/dmcn.15418] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 08/20/2022] [Accepted: 08/24/2022] [Indexed: 11/30/2022]
Abstract
AIM To explore the clinical characteristics and prognostic predictors of Guillain-Barré syndrome (GBS) in Chinese paediatric patients. METHOD The clinical features of children with GBS hospitalized in the Children's Hospital of Chongqing Medical University were summarized retrospectively. The correlation between the Erasmus GBS Outcome Score (EGOS)/modified Erasmus GBS Outcome Score (mEGOS), GBS disability score (GDS)/modified Rankin Scale (MRS), Erasmus GBS Respiratory Insufficiency Score (EGRIS), and mechanical ventilation were evaluated. RESULTS One hundred forty-two patients (86 males, 56 females; median 62.50 months [interquartile range 41.00-97.50]) with classic GBS were enrolled in the study. In the present GBS cohort, 134 (94.37%) patients could walk independently (GDS ≤2) and 121 (85.21%) could manage without assistance (MRS ≤2) at 6 months. Eighteen (12.68%) patients with GBS required mechanical ventilation. The performance of mEGOS on admission, mEGOS on day 7, and EGOS-predicted GDS outcome at 4 weeks, 3 months, and 6 months in the paediatric patients with GBS admitted within 2 weeks of disease onset and that of the MRS outcome were evaluated. The EGRIS in individuals who required mechanical ventilation was significantly higher than in patients without mechanical ventilation (median = 6 vs median = 3, p < 0.001). INTERPRETATION In Chinese paediatric patients with GBS who were admitted 2 weeks after disease onset, the mEGOS and EGOS are validated indicators for the prediction of clinical outcomes 6 months after onset. EGRIS is helpful in predicting the implementation of mechanical ventilation in the acute phase. WHAT THIS PAPER ADDS The Erasmus Guillain-Barré syndrome (GBS) Outcome Score (EGOS) and modified EGOS are reliable prognostic predictors in paediatric patients with GBS. The Erasmus GBS Respiratory Insufficiency Score (EGRIS) is an effective predictor of mechanical ventilation in paediatric patients with GBS. An EGRIS of ≥5 indicates a high risk of mechanical ventilation in the acute phase.
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Affiliation(s)
- Huang Qinrong
- Department of Rehabilitation Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
| | - Chen Yuxia
- Department of Rehabilitation Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
| | - Liu Ling
- Department of Rehabilitation Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
| | - Luo Huayu
- Department of Rehabilitation Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
| | - Xu Lei
- Department of Rehabilitation Children's Hospital of Fudan University, Shanghai, People's Republic of China
| | - Li Xiaoli
- Department of Rehabilitation Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
| | - Xiao Nong
- Department of Rehabilitation Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
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17
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Bazán-Rodríguez L, Ruiz-Avalos JA, de Saráchaga AJ, Martinez-Jimenez E, López-Hernández JC, Vargas-Cañas S. Dysautonomia and related outcomes in Guillain-Barre syndrome. Auton Neurosci 2023; 245:103070. [PMID: 36634383 DOI: 10.1016/j.autneu.2022.103070] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 11/14/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Guillain-Barre syndrome (GBS) presents an annual incidence of 1.2-2.3 per 100,000. Sympathetic and parasympathetic nervous systems' peripheral control of visceral organs is affected by GBS aberrant immune response. Associated cardiovascular, gastrointestinal, sudomotor, pupillary, and other systems disturbances cause significant morbidity and mortality. This study aims to evaluate the dysautonomia spectrum in GBS patients, its relationship with patient outcomes, and compare it with those without autonomic disturbances. METHODS We performed an ambispective review study of patients with GBS and dysautonomia admitted to the Institute of Neurology from 2017 to 2021. We recorded demographics, comorbidities, nerve conduction studies, clinical course, hospital complications, and functional outcomes. RESULTS We included 214 patients, mean age 46.44 ± 16.49 years, 51 (31 %) presented dysautonomia, hypertension in most of the patients 39 (84.8 %), hypotension 35 (76.1 %), tachycardia 35 (76.1 %), enteric dysmotility 35 (76.1 %), and need for vasopressor 27 (58.7 %) were common characteristics. Twenty (39.2 %) with a demyelinating form and twenty (39.2 %) with an axonal motor form. The bivariate analysis report factors associated with dysautonomia, were lower cranial nerves (VII, IX, X) involvement (p = 0.002), need for mechanical ventilation (p = 0.0001) and intensive care (p = 0.0001), higher mEGOS (p = 0.05), EGRIS (p = 0.004), GBS disability score (p = 0.004), and delirium presence (p = 0.001). Kaplan-Meier survival analysis showed that dysautonomic patients needed more days for the independent walk (p = 0.004). There was no associated mortality. CONCLUSIONS Autonomic dysfunction in GBS significantly affects the peripheral nervous system. With consequently worse functional results. Further investigation needs to clarify whether more aggressive treatment is beneficial in this category of GBS.
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Affiliation(s)
- Lisette Bazán-Rodríguez
- Neuromuscular Disorders Clinic, National Institute of Neurology and Neurosurgery, Manuel Velasco Suarez, Mexico City, Mexico
| | | | - Adib Jorge de Saráchaga
- Neuromuscular Disorders Clinic, National Institute of Neurology and Neurosurgery, Manuel Velasco Suarez, Mexico City, Mexico
| | | | - Juan Carlos López-Hernández
- Neuromuscular Disorders Clinic, National Institute of Neurology and Neurosurgery, Manuel Velasco Suarez, Mexico City, Mexico
| | - Steven Vargas-Cañas
- Neuromuscular Disorders Clinic, National Institute of Neurology and Neurosurgery, Manuel Velasco Suarez, Mexico City, Mexico.
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18
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Huckemann S, Mueller K, Averdunk P, Kühn E, Hilker L, Kools S, Scholz L, Bulut Y, Brünger J, Fiegert S, Grüter T, Fisse AL, Motte J, Yoon MS, Gold R, Schneider-Gold C, Tönges L, Pitarokoili K. Vagal cross-sectional area correlates with parasympathetic dysfunction in Parkinson's disease. Brain Commun 2023; 5:fcad006. [PMID: 36726777 PMCID: PMC9883711 DOI: 10.1093/braincomms/fcad006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 07/28/2022] [Accepted: 01/13/2023] [Indexed: 01/19/2023] Open
Abstract
The aim of this prospective study was to investigate autonomic function in Parkinson's disease with a multidimensional approach including clinical evaluation tools, head-up tilt test and morphological studies of the vagus nerve. Head-up tilt test parameters including high frequency power of the heart frequency interval, the ratio of low frequency power of the distance between two consecutive R waves in electrocardiogram (RR interval) to the high frequency and low frequency power of systolic blood pressure were used to evaluate parasympathetic, cardiac sympathetic and vasomotor sympathetic functions, respectively, in 80 patients with Parkinson's disease. We examined the cross-sectional area of the vagus nerves bilaterally using nerve ultrasound and compared mean values with a control group of healthy subjects (n = 40) as well as patients with chronic inflammatory demyelinating polyneuropathy (n = 76). The cross-sectional area of right/left vagus nerve of Parkinson's patients was significantly lower compared to the right/left vagus nerve of the control group and of chronic demyelinating polyneuropathy patients. Furthermore, the cross-sectional area of the right vagus nerve was significantly larger from the one of the left vagus nerve for all groups. Based on tilt test, 43 patients (disease duration 7 ± 5, age at evaluation 71 ± 9, Hoehn and Yahr score 2.8 ± 8) were diagnosed with autonomic dysfunction (orthostatic hypertension n = 11, chronotropic incompetence n = 31, postural orthostatic tachycardia syndrome n = 1). Patients with orthostatic hypotension showed significantly higher Unified Parkinson's Disease Rating Scale-III values than those with chronotropic incompetence. The cross-sectional area of the vagus nerve correlated inversely with heart rate in rest and supine position and positively with tilt test parameters representing parasympathetic modulation through vagal activity [high frequency power of the distance between two consecutive R waves in electrocardiogram (RR interval)] at rest. We demonstrate for the first time that morphological characteristics of the vagus nerve correlate with parameters of parasympathetic function from the spectral analysis of cardiovascular parameters in tilt test for Parkinson's patients. This correlation reveals the impact of the atrophy of vagal atrophy for autonomic function in Parkinson's disease. Nerve ultrasound of the vagus nerve could potentially be used as an adjunct to tilt table examination to diagnose autonomic dysfunction.
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Affiliation(s)
- Sophie Huckemann
- Correspondence may also be addressed to: Sophie Huckemann E-mail:
| | - Katharina Mueller
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Paulina Averdunk
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Eva Kühn
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Lovis Hilker
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Saskia Kools
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Leonard Scholz
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Yesim Bulut
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Jil Brünger
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Sean Fiegert
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Thomas Grüter
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Anna Lena Fisse
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Jeremias Motte
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Min-Suk Yoon
- Department of Neurology, Augusta Clinic, Hattingen, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | | | - Lars Tönges
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany,Neurodegeneration Research, Centre for Protein Diagnostics (ProDi), Ruhr University, Bochum, Germany
| | - Kalliopi Pitarokoili
- Correspondence to: Kalliopi Pitarokoili, MD, MSc Department of Neurology, Ruhr University St. Josef-Hospital, Gudrunstr. 56, 44791 Bochum, Germany E-mail:
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19
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Kozyreva AA, Bembeeva RT, Druzhinina ES, Zavadenko NN. [Guillain-Barre syndrome in children]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:20-32. [PMID: 37942969 DOI: 10.17116/jnevro202312309220] [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: 11/10/2023]
Abstract
Guillain-Barré syndrome (GBS) is an immune-mediated disease of the peripheral nervous system that can occur in both children and adults. The classic presentation of GBS is characterized by progressive symmetrical, ascending muscle weakness. Patients with GBS require meticulous monitoring due to the risk of bulbar syndrome, respiratory failure and autonomic dysfunction, which can be life-threatening. Early diagnosis and timely prescription of pathogenetic therapy for GBS are particularly important, especially in young children. Meanwhile, the spectrum of disorders covered by GBS has expanded significantly; its eponym is now designate any variant of acute dysimmune polyneuropathy, and its atypical forms pose a serious diagnostic problem for clinicians. This review article provides an analysis of the data available in the medical literature on GBS in children and discusses the tactics for diagnosing and managing patients with GBS, taking into account the Russian and European clinical recommendations.
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Affiliation(s)
- A A Kozyreva
- Pirogov Russian National Research Medical University, Moscow, Russia
- Russian Children's Clinical Hospital, Moscow, Russia
| | - R Ts Bembeeva
- Pirogov Russian National Research Medical University, Moscow, Russia
- Russian Children's Clinical Hospital, Moscow, Russia
| | - E S Druzhinina
- Pirogov Russian National Research Medical University, Moscow, Russia
- Russian Children's Clinical Hospital, Moscow, Russia
| | - N N Zavadenko
- Pirogov Russian National Research Medical University, Moscow, Russia
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20
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Sakakibara R, Sawai S, Ogata T. Varicella-zoster virus infection and autonomic dysfunction. Auton Neurosci 2022; 242:103018. [PMID: 35863181 DOI: 10.1016/j.autneu.2022.103018] [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: 04/26/2022] [Revised: 06/18/2022] [Accepted: 07/05/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND AND PURPOSE Autonomic dysfunction has been occasionally described in varicella-zoster virus (VZV) infection, while few systematic reviews are available. We systematically review autonomic dysfunction due to VZV infection. METHODS This study followed the PRISMA guideline, and three databases were researched and included cross-sectional studies in full-length publications in the English language using appropriate search keywords. RESULTS A total of 102 articles were identified initially; finally 45 studies were used for review, comprising pupillomotor dysfunction in 4, sudomotor dysfunction in 2, cardiovascular dysfunction in 2, gastrointestinal dysfunction in 14, and urogenital dysfunction in 23. They can be summarized as (1) VZV infection rarely produces orthostatic hypotension, which involves diffuse sympathetic dysfunction by polyneuropathy. (2) In contrast, VZV infection produces dysfunction of the bladder and the bowel, which involves segmental parasympathetic or sympathetic dysfunction by dorsal root ganglionopathy. CONCLUSIONS Awareness of VZV-related autonomic dysfunction is important, because such patients may first visit a gastroenterology or urology clinic. Close collaboration among neurologists, dermatologists, gastroenterologists, and urologists is important to start early antiviral agents and maximize bowel and bladder care in such patients.
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Affiliation(s)
- Ryuji Sakakibara
- Department of Neurology, Sakura Medical Center, Toho University, Sakura, Japan.
| | - Setsu Sawai
- Department of Neurology, Sakura Medical Center, Toho University, Sakura, Japan
| | - Tsuyoshi Ogata
- Department of Neurology, Sakura Medical Center, Toho University, Sakura, Japan
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21
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Kamperidis N, Nightingale J. Neurological disorders and small bowel dysmotility. Curr Opin Gastroenterol 2022; 38:299-306. [PMID: 35645022 DOI: 10.1097/mog.0000000000000836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
PURPOSE OF REVIEW Small bowel dysmotility is common in the context of neurological disorders. Overlooking it can have an adverse impact on patient's quality of life and neurological outcomes. This review focuses on describing the mechanisms and effects of enteric dysmotility in neurological patients and providing treatment options. RECENT FINDINGS Small bowel dysmotility is prevalent among neurological patients. The definition and diagnosis of small bowel dysmotility is a challenge; however, up to two-thirds of neurological patients may experience associated symptoms. Small bowel dysmotility can affect the absorption of nutrients and medication, impacts on social and professional function and can result in malnutrition and its associated morbidity and mortality. SUMMARY Small bowel dysmotility due to a neuropathy can result from acute or chronic disorders in the central and peripheral nervous system and includes the cerebral cortex, brain stem, spinal cord, parasympathetic (vagus) and sympathetic nerves and the myenteric and submucosal plexuses of the intestine. Generalized muscle disorders can also cause an enteral myopathy. Generally, the disorders may be degenerative or inflammatory. Both enteric neuropathy and myopathy may cause symptoms of abdominal pain, nausea/vomiting, bloating, constipation or diarrhoea and can cause malnutrition. The symptoms need to be addressed in order of importance to the patient and malnutrition prevented or treated.
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22
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Severe bradycardia in a teenager as the initial manifestation for Guillain Barré syndrome: a case report. BMC Pediatr 2022; 22:152. [PMID: 35317762 PMCID: PMC8938645 DOI: 10.1186/s12887-022-03165-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 02/16/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Guillain-Barré syndrome is the most common cause of flaccid paralysis, with multiple known clinical variants. Autonomic dysfunction, although frequently reported in the clinical course, is often overlooked in the pediatric population and is usually not the initial presenting symptom in this age group CASE PRESENTATION: We present the case of a previously healthy 17-year-old who arrived at the Emergency Department complaining of gastrointestinal symptoms associated with lipothymia. An initial electrocardiogram (ECG) showed sustained sinus bradycardia subsequently associated with arterial hypertension. Structural and inflammatory cardiac pathology were ruled out, as well as auriculoventricular conduction block and posterior reversible encephalopathy syndrome. On the ninth day after initial symptoms, the patient presented sensory and motor nerve disturbances with the cerebrospinal fluid analysis showing a clear albumin-cytologic dissociation, consistent with an atypical presentation of GBS with autonomic dysfunction. Immunoglobulin therapy was administered, developing subsequent aseptic meningitis, that required discontinuation of previous therapy and treatment with plasmapheresis. Clinical improvement was achieved with full motor function recovery. CONCLUSION This case illustrates a Guillain-Barré syndrome variant in which autonomic dysfunction preceded neurologic deficit, a finding uncommon in children, emphasizing this as an important differential diagnosis for severe bradycardia in pediatric patients.
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23
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Cavallieri F, Sellner J, Zedde M, Moro E. Neurologic complications of coronavirus and other respiratory viral infections. HANDBOOK OF CLINICAL NEUROLOGY 2022; 189:331-358. [PMID: 36031313 PMCID: PMC9418023 DOI: 10.1016/b978-0-323-91532-8.00004-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In humans, several respiratory viruses can have neurologic implications affecting both central and peripheral nervous system. Neurologic manifestations can be linked to viral neurotropism and/or indirect effects of the infection due to endothelitis with vascular damage and ischemia, hypercoagulation state with thrombosis and hemorrhages, systemic inflammatory response, autoimmune reactions, and other damages. Among these respiratory viruses, recent and huge attention has been given to the coronaviruses, especially the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic started in 2020. Besides the common respiratory symptoms and the lung tropism of SARS-CoV-2 (COVID-19), neurologic manifestations are not rare and often present in the severe forms of the infection. The most common acute and subacute symptoms and signs include headache, fatigue, myalgia, anosmia, ageusia, sleep disturbances, whereas clinical syndromes include mainly encephalopathy, ischemic stroke, seizures, and autoimmune peripheral neuropathies. Although the pathogenetic mechanisms of COVID-19 in the various acute neurologic manifestations are partially understood, little is known about long-term consequences of the infection. These consequences concern both the so-called long-COVID (characterized by the persistence of neurological manifestations after the resolution of the acute viral phase), and the onset of new neurological symptoms that may be linked to the previous infection.
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Affiliation(s)
- Francesco Cavallieri
- Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Johann Sellner
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria,Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Marialuisa Zedde
- Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Elena Moro
- Division of Neurology, CHU of Grenoble, Grenoble Alpes University, Grenoble Institute of Neurosciences, Grenoble, France,Correspondence to: Elena Moro, Service de neurologie, CHU de Grenoble (Hôpital Nord), Boulevard de la Chantourne, 38043 La Tronche, France. Tel: + 33-4-76-76-94-52, Fax: +33-4-76-76-56-31
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24
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Sardar Z, Bano S, Ahmar M, Liaquat S, Shafiq B, Numan A. Clinical spectrum and outcome of guillain-barré syndrome with plasmapheresis. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2022. [DOI: 10.4103/injms.injms_50_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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25
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Marzoughi S, Marulanda L, Ngo D, Chen T. Pearls & Oy-sters: Delayed Diagnosis of Acute Motor Axonal Neuropathy With Cardiac Arrest. Neurology 2021; 98:336-339. [PMID: 34906977 DOI: 10.1212/wnl.0000000000013220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We present the case of a 53-year-old female who presented with right lower extremity weakness with preceding systemic symptoms including fever and chest pain. She developed rapid quadriparesis over 24 hours and had ventricular fibrillation with cardiac arrest. Examination demonstrated tetraplegia, facial diplegia with spared extra-ocular movements and areflexia. Electrodiagnostic studies including nerve conduction studies and electromyography were consistent with Acute Motor Axonal Neuropathy (AMAN). This case highlights an atypical asymmetric presentation with initially preserved reflexes, rapid progression and cardiac dysfunction that can occur independent of dysautonomia. Treatment options include intravenous immunoglobulin (IVIg) or plasmapheresis as well as supportive care and long term multidisciplinary rehabilitation and communication strategies.
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Affiliation(s)
- Sina Marzoughi
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Laura Marulanda
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Dian Ngo
- School of Pharmacy, Department of Pharmacy, University of British Columbia, Vancouver BC, Canada
| | - Tychicus Chen
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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26
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Al-Kuraishy HM, Al-Gareeb AI, Qusti S, Alshammari EM, Gyebi GA, Batiha GES. Covid-19-Induced Dysautonomia: A Menace of Sympathetic Storm. ASN Neuro 2021; 13:17590914211057635. [PMID: 34755562 PMCID: PMC8586167 DOI: 10.1177/17590914211057635] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Among the plethora of debilitating neurological disorders of COVID-19 syndrome in survivors, the scope of SARS-CoV-2-induced dysautonomia (DNS) is yet to be understood, though the implications are enormous. Herein, we present an inclusive mini-review of SARS-CoV-2-induced DNS and its associated complications. Although, the direct link between Covid-19 and DSN is still speculative, the hypothetical links are thought to be either a direct neuronal injury of the autonomic pathway or a para/post-infectious immune-induced mechanism. SARS-CoV-2 infection-induced stress may activate the sympathetic nervous system (SNS) leading to neuro-hormonal stimulation and activation of pro-inflammatory cytokines with further development of sympathetic storm. Sympathetic over-activation in Covid-19 is correlated with increase in capillary pulmonary leakage, alveolar damage, and development of acute respiratory distress syndrome. Furthermore, SARS-CoV-2 can spread through pulmonary mechanoreceptors and chemoreceptors to medullary respiratory center in a retrograde manner resulting in sudden respiratory failure. Taken together, DSN in Covid-19 is developed due to sympathetic storm and inhibition of Parasympathetic nervous system-mediated anti-inflammatory effect with development of cytokine storm. Therefore, sympathetic and cytokine storms together with activation of Renin-Angiotensin-System are the chief final pathway involved in the development of DSN in Covid-19.
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Affiliation(s)
- Hayder M Al-Kuraishy
- Department of Clinical Pharmacology and Medicine, College of Medicine, Almustansiriyia University
| | - Ali I Al-Gareeb
- Department of Clinical Pharmacology and Medicine, College of Medicine, Almustansiriyia University
| | - Safaa Qusti
- Biochemistry Department, Faculty of Science, 37848King Abdulaziz University, Jeddah, Saudi Arabia
| | - Eida M Alshammari
- Department of Chemistry, College of Sciences, University of Ha'il, Ha'il, Saudi Arabia
| | - Gideon Ampoma Gyebi
- Department of Biochemistry, 236312Faculty of Science and Technology Bingham University, Karu, Nasarawa, Nigeria
| | - Gaber El-Saber Batiha
- Department of Pharmacology and Therapeutics, Faculty of Veterinary Medicine, 289643Damanhour University, AlBeheira, Egypt
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27
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Cao X, Tang M, Liu H, Yue X, Luo G, Yan Y. Case Report: Abnormal ECG and Pantalgia in a Patient With Guillain-Barré Syndrome. Front Cardiovasc Med 2021; 8:742740. [PMID: 34692793 PMCID: PMC8526714 DOI: 10.3389/fcvm.2021.742740] [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: 07/16/2021] [Accepted: 09/13/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Guillain–Barré syndrome (GBS) is an acute immune-mediated disorder in the peripheral nervous system (PNS) characterized by symmetrical limb weakness, sensory disturbances, and clinically absent or decreased reflexes. Pantalgia and dysautonomia, including cardiovascular abnormalities, are common findings in the spectrum of GBS. It is usually challenging to distinguish GBS-related electrocardiogram (ECG) abnormities and chest pain from acute coronary syndrome (ACS) in patients with GBS due to the similar clinical symptom and ECG characteristics. Here, we present a case of GBS complicating ACS. Case Summary: A 37-year-old woman with a 2-month history of GBS presented to the emergency department due to pantalgia. The ECG showed a pattern of transitional T-wave inversion in the leads I, aVL, and V2 through V4 and shortly returned to normal, which appeared several times in a short time, but lab testing was unremarkable. Then, a further coronary computed tomography angiography (CTA) revealed the presence of critical stenosis of the left anterior descending artery, leading to the diagnosis of ACS. During the follow-up, she suffered from a non-ST-elevation myocardial infarction and accepted revascularization of the left anterior descending artery in the second week after discharge. Conclusion: Guillain–Barré syndrome could accompany chest pain and abnormalities on ECG. Meanwhile, it is essential to bear in mind that “GBS-related ECG abnormalities and chest pain” is a diagnosis of exclusion that can only be considered after excluding coronary artery disease, especially when concomitant chest pain, despite being a common presentation of pantalgia, occurs.
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Affiliation(s)
- Xiangqi Cao
- Stroke Centre and Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Manyun Tang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Hui Liu
- The Biobank of The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xin Yue
- Department of Cardiology, Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, United States
| | - Guogang Luo
- Stroke Centre and Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yang Yan
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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28
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Tagaloa E, Venter F, Liang L, Bhaika J, Aguirre D, Patel J, Nasrawi F. A Rare Case of Guillain-Barré Syndrome With Severe Pandysautonomia. J Investig Med High Impact Case Rep 2021; 9:23247096211019558. [PMID: 34027705 PMCID: PMC8150453 DOI: 10.1177/23247096211019558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Acute pandysautonomia is a rare disorder characterized by autonomic failure affecting sympathetic, parasympathetic, and enteric functions. We present a case of acute inflammatory demyelinating polyneuropathy (AIDP) with severe pandysautonomia in a young, otherwise healthy, female who presented with gastrointestinal symptoms and sensory demyelinating polyneuropathy, which progressively worsened and subsequently developed bladder dysfunction and orthostatic hypotension. We discuss the challenges with diagnostic workup as well as the challenges we encountered as part of the management.
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Affiliation(s)
| | | | - Li Liang
- Kern Medical Center, Bakersfield, CA, USA
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29
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Abstract
PURPOSE OF REVIEW This article discusses the pathophysiology, presentation, diagnosis, treatment, and prognosis of common neuromuscular disorders seen in the intensive care unit, including Guillain-Barré syndrome, myasthenia gravis, and intensive care unit-acquired weakness. RECENT FINDINGS Guillain-Barré syndrome can have an excellent prognosis if patients are diagnosed early, appropriately treated, and monitored for complications, including respiratory failure and dysautonomia. Intensive care unit-acquired weakness increases overall mortality in patients who are critically ill, and distinguishing between critical illness myopathy and critical illness polyneuropathy may have important prognostic implications. SUMMARY Neuromuscular disorders are not rare in the intensive care unit setting, and precise identification and treatment of these conditions can greatly impact long-term outcomes.
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30
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Velásquez-Rimachi V, López-Saavedra AV, Rodriguez-López E, Elguera-Huaman H, Meza K, Alva-Díaz C, Pacheco-Barrios K. Clinical-epidemiological characteristics associated with discharge outcomes and seasonality among surviving patients with Guillain-Barré syndrome in a national third-level hospital, Lima, Peru. ARQUIVOS DE NEURO-PSIQUIATRIA 2021; 79:697-704. [PMID: 34550186 DOI: 10.1590/0004-282x-anp-2020-0154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 11/13/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Guillain-Barré syndrome (GBS) is an autoimmune disease that affects the peripheral nervous system. Severe motor deficit (SMD), respiratory impairment, cranial nerve involvement and autonomic dysfunction are associated with a poor prognosis. OBJECTIVE To investigate the association between the clinical-epidemiological characteristics and the discharge results among Peruvian patients with GBS. METHODS We carried out a retrospective observational study on patients with GBS who survived until discharge. We used the Brighton Collaboration's criteria and considered Hughes Severity Scale (HSS) scores greater than two to be SMD. We defined the discharge results as an improvement if the HSS score decreased by at least one point from admission to hospital discharge and defined hospital stay as prolonged if > 14 days. RESULTS We analyzed 92 patients, among whom 70.7% were male. Quadriparesis (81.1%) and hyporeflexia (86.8%) were the most characteristic manifestations. We observed that more than half of the cases were in summer and winter. Gastrointestinal infections were associated with a higher proportion of prolonged stays. The proportion of improvement was lower among patients who had an SMD at hospital admission. We confirmed these results through fitting in multivariate models. CONCLUSIONS The prolonged stay was related to previous gastrointestinal infection, while a less improvement in SMD individuals at admission. Prospective multicenter surveillance systems are needed for monitoring GBS cases in low-income settings like Peru.
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Affiliation(s)
- Victor Velásquez-Rimachi
- Universidad Nacional Mayor de San Marcos, Facultad de Medicina, Lima, Peru.,Red de Eficacia Clínica y Sanitaria, Lima, Peru.,Universidad Científica del Sur, Grupo de Investigación en Neurociencia, Efectividad Clínica y Salud Pública, Lima, Peru
| | - Angélica Verónica López-Saavedra
- Universidad Nacional Mayor de San Marcos, Facultad de Medicina, Lima, Peru.,Red de Eficacia Clínica y Sanitaria, Lima, Peru.,Universidad Nacional Mayor de San Marcos, Sociedad Científica de San Fernando, Lima, Peru
| | - Ethel Rodriguez-López
- Universidad Nacional Mayor de San Marcos, Facultad de Medicina, Lima, Peru.,Red de Eficacia Clínica y Sanitaria, Lima, Peru.,Universidad Nacional Mayor de San Marcos, Sociedad Científica de San Fernando, Lima, Peru
| | - Hillary Elguera-Huaman
- Universidad Nacional Mayor de San Marcos, Facultad de Medicina, Lima, Peru.,Universidad Nacional Mayor de San Marcos, Sociedad Científica de San Fernando, Lima, Peru
| | - Kelly Meza
- Weill Cornell Medicine, Department of Pediatrics, Division of Pediatric Nephrology, New York NY, USA
| | - Carlos Alva-Díaz
- Universidad Científica del Sur, Grupo de Investigación en Neurociencia, Efectividad Clínica y Salud Pública, Lima, Peru.,Universidad Científica del Sur, Facultad de Ciencias de la Salud, Lima, Peru
| | - Kevin Pacheco-Barrios
- Universidad San Ignacio de Loyola, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru.,SYNAPSIS Mental Health and Neurology Non-Profit Organization, Lima, Peru
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31
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李 承, 孙 瑞, 冯 丽, 江 军. Risk factors associated with the need for mechanical ventilation in children with Guillain-Barré syndrome. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2021; 23:922-926. [PMID: 34535207 PMCID: PMC8480164 DOI: 10.7499/j.issn.1008-8830.2106003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/16/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To study the risk factors associated with the need for mechanical ventilation in children with Guillain-Barré syndrome (GBS). METHODS The medical data of 107 children with GBS were retrospectively reviewed. According to whether mechanical ventilation was required, the children were divided into a mechanical ventilation group with 16 children and a non-mechanical ventilation group with 91 children. The risk factors associated with the need for mechanical ventilation in children with GBS were identified by a multivariate logistic regression analysis. RESULTS Among the 107 children, 16 (15.0%) required mechanical ventilation. Compared with the non-mechanical ventilation group, the mechanical ventilation group had a significantly higher proportion of children with facial and/or bulbar muscle weakness, a significantly shorter duration from the onset to the peak of the disease, and a significantly higher Hughes Functional Grading Scale score at the first visit (P<0.05). Facial and/or bulbar muscle weakness and short duration from the onset to the peak of the disease were risk factors associated with the need for mechanical ventilation in children with GBS (OR=5.053 and 1.239 respectively, P<0.05). CONCLUSIONS Facial and/or bulbar muscle weakness and short duration from the onset to the peak of the disease may increase the risk of mechanical ventilation in children with GBS. Citation.
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32
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Buoite Stella A, Furlanis G, Frezza NA, Valentinotti R, Ajcevic M, Manganotti P. Autonomic dysfunction in post-COVID patients with and witfhout neurological symptoms: a prospective multidomain observational study. J Neurol 2021; 269:587-596. [PMID: 34386903 PMCID: PMC8359764 DOI: 10.1007/s00415-021-10735-y] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/21/2021] [Accepted: 07/26/2021] [Indexed: 02/07/2023]
Abstract
The autonomic nervous system (ANS) can be affected by COVID-19, and dysautonomia may be a possible complication in post-COVID individuals. Orthostatic hypotension (OH) and postural tachycardia syndrome (POTS) have been suggested to be common after SARS-CoV-2 infection, but other components of ANS function may be also impaired. The Composite Autonomic Symptom Scale 31 (COMPASS-31) questionnaire is a simple and validated tool to assess dysautonomic symptoms. The aim of the present study was to administer the COMPASS-31 questionnaire to a sample of post-COVID patients with and without neurological complaints. Participants were recruited among the post-COVID ambulatory services for follow-up evaluation between 4 weeks and 9 months from COVID-19 symptoms onset. Participants were asked to complete the COMPASS-31 questionnaire referring to the period after COVID-19 disease. Heart rate and blood pressure were manually taken during an active stand test for OH and POTS diagnosis. One-hundred and eighty participants were included in the analysis (70.6% females, 51 ± 13 years), and OH was found in 13.8% of the subjects. Median COMPASS-31 score was 17.6 (6.9-31.4), with the most affected domains being orthostatic intolerance, sudomotor, gastrointestinal and pupillomotor dysfunction. A higher COMPASS-31 score was found in those with neurological symptoms (p < 0.01), due to more severe orthostatic intolerance symptoms (p < 0.01), although gastrointestinal (p < 0.01), urinary (p < 0.01), and pupillomotor (p < 0.01) domains were more represented in the non-neurological symptoms group. This study confirms the importance of monitoring ANS symptoms as a possible complication of COVID-19 disease that may persist in the post-acute period.
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Affiliation(s)
- Alex Buoite Stella
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Trieste University Hospital-ASUGI, University of Trieste, Strada di Fiume, 447, 34149, Trieste, Italy
| | - Giovanni Furlanis
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Trieste University Hospital-ASUGI, University of Trieste, Strada di Fiume, 447, 34149, Trieste, Italy
| | - Nicolò Arjuna Frezza
- School of Medicine and Surgery, Department of Medicine, Surgery and Health Sciences, Trieste University Hospital-ASUGI, University of Trieste, Strada di Fiume, 447, 34149, Trieste, Italy
| | - Romina Valentinotti
- Infectious Diseases, Trieste University Hospital-ASUGI, University of Trieste, Strada di Fiume, 447, 34149, Trieste, Italy
| | - Milos Ajcevic
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Trieste University Hospital-ASUGI, University of Trieste, Strada di Fiume, 447, 34149, Trieste, Italy
- Department of Engineering and Architecture, University of Trieste, Via Alfonso Valerio 10, Trieste, Italy
| | - Paolo Manganotti
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Trieste University Hospital-ASUGI, University of Trieste, Strada di Fiume, 447, 34149, Trieste, Italy.
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33
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Puentes D, Teijelo D, Stiep TS, Mannava S, Margolesky J. Takotsubo Cardiomyopathy as a Manifestation of Dysautonomia in Guillain-Barré Syndrome: A Case Series and Review of the Literature. Cureus 2021; 13:e16069. [PMID: 34345553 PMCID: PMC8324066 DOI: 10.7759/cureus.16069] [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] [Accepted: 06/30/2021] [Indexed: 11/18/2022] Open
Abstract
Guillain-Barré syndrome (GBS) is an inflammatory polyneuropathy that classically presents with low back pain, sensory paresthesias, and rapidly progressive weakness. Patients with GBS can develop dysautonomia, and Takotsubo cardiomyopathy (TCM) is a rare potential manifestation of this dysautonomia. This association has been reported only 12 times in the literature so far, which we review here. We present two cases of GBS associated with TCM, to increase awareness with regard to this comorbid relationship, which would encourage prompt initiation of proper supportive care to avoid morbidity and mortality. We report the case of two patients - a 58-year-old man and a 79-year-old woman - who developed TCM in the setting of axonal variants of GBS. Electrodiagnostic results, cerebrospinal fluid profiles, and echocardiogram findings were consistent with these diagnoses. Both patients were treated with intravenous immunoglobulin (IVIG) in an intensive care unit (ICU) setting. Echocardiogram findings were reversible. TCM should be recognized as a potential complication of GBS in patients with dysautonomia. This case series adds to the sparse body of literature describing the association between these two conditions. It is not clear if patients with axonal variants of GBS are more predisposed to developing TCM; further, larger case series in the future may help identify the risk factors associated with it. We hope to shed more light on this possible association to expedite the diagnosis and management of this condition.
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34
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Liu L, Ye Y, Wang L, Song X, Cao J, Qi Y, Xing Y. Nerve ultrasound evaluation of Guillain-Barré syndrome subtypes in northern China. Muscle Nerve 2021; 64:560-566. [PMID: 34355400 DOI: 10.1002/mus.27386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 08/01/2021] [Accepted: 08/02/2021] [Indexed: 01/23/2023]
Abstract
INTRODUCTION/AIMS Ultrasound (US) studies have demonstrated patchy enlargement of spinal and peripheral nerves in Guillain-Barré syndrome (GBS). However, whether ultrasound yields useful information for early classification of GBS has not been established. We aimed to evaluate nerve ultrasound in patients with GBS in northern China and compare the sonographic characteristics between demyelinating and axonal subtypes. METHODS Between November 2018 and October 2019, 38 hospitalized GBS patients within 3 wk of disease onset and 40 healthy controls were enrolled. Ultrasonographic cross-sectional areas (CSA) of the peripheral nerves, vagus nerve, and cervical nerve roots were prospectively recorded in GBS subtypes and controls. RESULTS Ultrasonographic CSA exhibited significant enlargement in most patients' nerves compared with healthy controls, most prominent in cervical nerves. The CSA tended to be larger in acute inflammatory demyelinating polyneuropathy (AIDP) than in acute motor axonal neuropathy (AMAN)/acute motor and sensory axonal neuropathy (AMSAN), especially in cervical nerves (C5: 5.9 ± 1.6 mm2 vs. 7.0 ± 1.7 mm2 , p = .042; C6: 10.5 ± 1.8 mm2 vs. 12.0 ± 2.1 mm2 , p = .033). The chi-squared test revealed significant differences in nerve enlargement in C5 (p < .001), C6 (p < .001), the proximal median nerve (p < .001), and the vagus nerve (p = .003) between GBS and controls. The vagus nerve was larger in patients with autonomic dysfunction than in patients without it (2.3 ± 1.0 mm2 vs. 1.4 ± 0.5 mm2 , p = .003). DISCUSSION The demyelinating subtype presented with more significant cervical nerve enlargement in GBS. Vagus nerve enlargement may be a useful marker for autonomic dysfunction.
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Affiliation(s)
- Li Liu
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China.,Center of Vascular Ultrasonography, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China.,Department of Neurology, Changchun City People's hospital, Changchun, China
| | - Yuqin Ye
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Lijuan Wang
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Xiaonan Song
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Jie Cao
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Yajie Qi
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Yingqi Xing
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China.,Center of Vascular Ultrasonography, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China.,Department of Neurology, The First Hospital of Jilin University, Changchun, China
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35
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I Espiritu A, Separa KJNJ, Milla FJC, Adiao KJB, Leochico CFD, Jamora RDG. Clinical features and real-world outcomes of Guillain-Barré syndrome in the Philippines. Neurol Res 2021; 43:995-1004. [PMID: 34229572 DOI: 10.1080/01616412.2021.1948750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Our study aimed to determine the profile of Guillain-Barré syndrome (GBS) in the Philippines, compare the outcomes who received intravenous immunoglobulin (IVIg) and therapeutic plasma exchange (TPE), and determine the factors related to hospital stay and late motor recovery. METHODS We conducted a retrospective cohort study of adult GBS patients admitted to the Philippine General Hospital from 2009 to 2019. RESULTS We included 105 patients with confirmed GBS diagnoses. The median age was 43 years (interquartile range 32 to 56); the female-to-male ratio was 1.62:1; the predominant variant was acute inflammatory demyelinating polyneuropathy (n = 40, 38.1%). The difference in outcomes of patients in the IVIg (n = 44) and TPE (n = 24) groups (walking with aid/GBS-disability scores/ventilator dependency at 1 month, duration dependent on the ventilator, intensive care unit stay, and hospital stay) were not statistically significant, except for mild disability at 1 month (p = 0.009). Pneumonia, urinary tract infection, and dysautonomia were significantly related to a prolonged hospital stay. No predetermined variables were associated with late motor recovery. After adjusting for age and sex, the cumulative hazard risk for late motor recovery was 0.69 (95% CI 0.27-1.74). CONCLUSION Our study presented the first comprehensive information regarding the features and outcomes of GBS patients in the Philippines. ABBREVIATIONS AIDP - Acute inflammatory demyelinating polyneuropathy; AMAN - Acute motor axonal neuropathy; AMSAN - Acute motor and sensory axonal neuropathy; GBS - Guillain-Barré syndrome; GBS-DS - Guillain-Barré syndrome disability scale; ICU - Intensive care unit; IVIg - Intravenous immunoglobulin; MFS - Miller-Fisher syndrome; PGH - Philippine General Hospital; TPE - Therapeutic plasma exchange.
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Affiliation(s)
- Adrian I Espiritu
- Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.,Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Karl Josef Niño J Separa
- Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Francis Jordan C Milla
- College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Karen Joy B Adiao
- Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Carl Froilan D Leochico
- Department of Rehabilitation Medicine, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.,Department of Physical Medicine and Rehabilitation, St. Luke's Medical Center, Quezon City and Global City, Philippines
| | - Roland Dominic G Jamora
- Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.,Institute for Neurosciences, St. Luke's Medical Center, Quezon City and Global City, Philippines
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36
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Shang P, Feng J, Wu W, Zhang HL. Intensive Care and Treatment of Severe Guillain-Barré Syndrome. Front Pharmacol 2021; 12:608130. [PMID: 33995011 PMCID: PMC8113987 DOI: 10.3389/fphar.2021.608130] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 01/27/2021] [Indexed: 12/12/2022] Open
Abstract
Guillain–Barré syndrome (GBS) is an acute polyneuropathy mostly characterized by acute flaccid paralysis with or without sensory/autonomous nerve dysfunction. Current immuno therapies including intravenous immunoglobulin (IVIg), plasma exchange (PE), and newly developed biological drugs benefit patients by alleviating hyperreactive immune responses. Up to 30% of patients develop respiratory failure during hospitalization and require mechanical ventilation and intensive care. Immunotherapies, mechanical ventilation, supportive care, and complication management during the intensive care unit (ICU) stay are equally emphasized. The most important aspect of intensive care and treatment of severe GBS, that is, mechanical ventilation, has been extensively reviewed elsewhere. In contrast to immunotherapies, care and treatment of GBS in the ICU setting are largely empirical. In this review, we intend to stress the importance of intensive care and treatment, other than mechanical ventilation in patients with severe GBS. We summarize the up-to-date knowledge of pharmacological therapies and ICU management of patients with severe GBS. We aim to answer some key clinical questions related to the management of severe GBS patients including but not limited to: Is IVIg better than PE or vice versa? Whether combinations of immune therapies benefit more? How about the emerging therapies promising for GBS? When to perform tracheal intubation or tracheostomy? How to provide multidisciplinary supportive care for severe cases? How to avert life-threatening complications in severe cases?
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Affiliation(s)
- Pei Shang
- Department of Neurology, First Hospital of Jilin University, Changchun, China.,Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Jiachun Feng
- Department of Neurology, First Hospital of Jilin University, Changchun, China
| | - Wei Wu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Hong-Liang Zhang
- Department of Life Sciences, National Natural Science Foundation of China, Beijing, China
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37
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Goodman BP, Khoury JA, Blair JE, Grill MF. COVID-19 Dysautonomia. Front Neurol 2021; 12:624968. [PMID: 33927679 PMCID: PMC8076737 DOI: 10.3389/fneur.2021.624968] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 03/19/2021] [Indexed: 01/04/2023] Open
Abstract
Objective: To report a case series of dysautonomia associated with COVID-19 infection. Methods: This is a retrospective review of patients evaluated in the autonomic clinic at our institution with suspected signs and symptoms of dysautonomia who underwent formal evaluation, including autonomic testing. Results: Six patients were identified with signs and symptoms suggestive of dysautonomia who underwent autonomic testing. All patients had symptoms typical of COVID-19 infection, though none were hospitalized for these or other symptoms. All patients reported symptoms of postural lightheadedness and near-syncope, fatigue, and activity intolerance. Five patients reported the onset of autonomic symptoms concomitant with other COVID-19 symptoms, with the other patient reporting symptom onset 6 weeks following initial COVID-19 symptoms. Autonomic testing demonstrated an excessive postural tachycardia in 4 patients, a hypertensive response with head-up tilt in 3 patients, orthostatic hypotension in 1 patient, and sudomotor impairment in 1 of the patients with excessive postural tachycardia. Conclusions: We present clinical features and results of autonomic testing in 6 patients with a history COVID-19 infection. While all patients reported typical features of orthostatic intolerance, fatigue, and activity intolerance, the results of autonomic testing were heterogenous, with orthostatic hypotension in 1 patient, excessive postural tachycardia typical of postural tachycardia syndrome in 4 patients, and postural hypertension in 3 patients.
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Affiliation(s)
- Brent P Goodman
- Department of Neurology, Mayo Clinic, Scottsdale, AZ, United States
| | - Julie A Khoury
- Department of Neurology, Mayo Clinic, Scottsdale, AZ, United States
| | - Janis E Blair
- Infectious Disease, Mayo Clinic, Scottsdale, AZ, United States
| | - Marie F Grill
- Department of Neurology, Mayo Clinic, Scottsdale, AZ, United States
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Gastrointestinal dysfunction in neuroinflammatory diseases: Multiple sclerosis, neuromyelitis optica, acute autonomic ganglionopathy and related conditions. Auton Neurosci 2021; 232:102795. [PMID: 33740560 DOI: 10.1016/j.autneu.2021.102795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/09/2021] [Accepted: 03/02/2021] [Indexed: 01/25/2023]
Abstract
Disorders of the nervous system can produce a variety of gastrointestinal (GI) dysfunctions. Among these, lesions in various brain structures can cause appetite loss (hypothalamus), decreased peristalsis (presumably the basal ganglia, pontine defecation center/Barrington's nucleus), decreased abdominal strain (presumably parabrachial nucleus/Kolliker-Fuse nucleus) and hiccupping and vomiting (area postrema/dorsal vagal complex). In addition, decreased peristalsis with/without loss of bowel sensation can be caused by lesions of the spinal long tracts and the intermediolateral nucleus or of the peripheral nerves and myenteric plexus. Recently, neural diseases of inflammatory etiology, particularly those affecting the PNS, are being recognized to contribute to GI dysfunction. Here, we review neuroinflammatory diseases that potentially cause GI dysfunction. Among such CNS diseases are multiple sclerosis, neuromyelitis optica spectrum disorder, myelin oligodendrocyte glycoprotein associated disorder, and autoimmune encephalitis. Peripheral nervous system diseases impacting the gut include Guillain-Barre syndrome, chronic inflammatory demyelinating polyneuropathy, acute sensory-autonomic neuropathy/acute motor-sensory-autonomic neuropathy, acute autonomic ganglionopathy, myasthenia gravis and acute autonomic neuropathy with paraneoplastic syndrome. Finally, collagen diseases, such as Sjogren syndrome and systemic sclerosis, and celiac disease affect both CNS and PNS. These neuro-associated GI dysfunctions may predate or present concurrently with brain, spinal cord or peripheral nerve dysfunction. Such patients may visit gastroenterologists or physicians first, before the neurological diagnosis is made. Therefore, awareness of these phenomena among general practitioners and collaboration between gastroenterologists and neurologists are highly recommended in order for their early diagnosis and optimal management, as well as for systematic documentation of their presentations and treatment.
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Arsenijevic M, Berisavac I, Bozovic I, Stojiljkovic-Tamas O, Palibrk A, Lukic-Rajic S, Vujovic B, Peric S. Self-reported autonomic dysfunction in a recovery phase of Guillain-Barré syndrome. Clin Neurol Neurosurg 2020; 201:106427. [PMID: 33360355 DOI: 10.1016/j.clineuro.2020.106427] [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: 10/08/2020] [Revised: 12/06/2020] [Accepted: 12/07/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Autonomic dysfunction occurs in approximately two-thirds of Guillain-Barré syndrome (GBS) patients in the acute phase of the disease. Although improving over time, subclinical autonomic involvement may be present for 3-8 years after the GBS episode. The aim of this study was to determine the frequency of self-reported autonomic disorders in GBS patients three and six months after disease onset compared to healthy controls (HCs). METHODS Our study included adult patients diagnosed with GBS from May 2017 until May 2018 in seven healthcare centers (67.6 % with demyelinating and 13.6 % with axonal syubtype). Functional disability was assessed by the Guillain-Barré syndrome disability scale (GDS). Each subject filled in the Serbian version of the SCOPA-Aut questionnaire. Using GDS and SCOPA-Aut, patients were tested at month 3 (M3) (n = 71) and month 6 (M6) (n = 70) from symptom onset. RESULTS Dysautonomia was more common in patients with GBS compared to HCs at M3 (p < 0.01), while there was no difference at M6 (p > 0.05). Among autonomic disorders, constipation, complications to pass stool, and orthostatic hypotension were the most frequently reported. Patients with axonal variants had worse total SCOPA-Aut scores at M3 in comparison to AIDP patients (11.7 ± 10.1 vs. 6.1 ± 5.1, p < 0.05). GDS score correlated with the total SCOPA-Aut score. CONCLUSION Autonomic symptoms are common in GBS patients during the recovery phase. They are more pronounced in patients with axonal forms of GBS and those with a higher degree of functional disability.
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Affiliation(s)
- Mirjana Arsenijevic
- Neurology Clinic, Clinical Center of Serbia, Dr Subotic Street 6, 11 000 Belgrade, Serbia
| | - Ivana Berisavac
- Neurology Clinic, Clinical Center of Serbia, Dr Subotic Street 6, 11 000 Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Dr Subotic Street 8, 11 000 Belgrade, Serbia
| | - Ivo Bozovic
- Neurology Clinic, Clinical Center of Serbia, Dr Subotic Street 6, 11 000 Belgrade, Serbia
| | | | - Aleksa Palibrk
- Neurology Clinic, Clinical Center of Serbia, Dr Subotic Street 6, 11 000 Belgrade, Serbia
| | - Sonja Lukic-Rajic
- Neurology Clinic, Clinical Center of Vojvodina, Hajduk Veljkova Street 1-9, 21 000 Novi Sad, Serbia; Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia
| | - Balsa Vujovic
- Neurology Clinic, Clinical Center of Montenegro, Ljubljanska Street nn, 81 000 Podgorica, Montenegro
| | - Stojan Peric
- Neurology Clinic, Clinical Center of Serbia, Dr Subotic Street 6, 11 000 Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Dr Subotic Street 8, 11 000 Belgrade, Serbia.
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Shang P, Zhu M, Baker M, Feng J, Zhou C, Zhang HL. Mechanical ventilation in Guillain-Barré syndrome. Expert Rev Clin Immunol 2020; 16:1053-1064. [PMID: 33112177 DOI: 10.1080/1744666x.2021.1840355] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: Up to 30% of patients with Guillain-Barré syndrome (GBS) develop respiratory failure requiring intensive care unit (ICU) admission and mechanical ventilation. Progressive weakness of the respiratory muscles is the leading cause of acute respiratory distress and respiratory failure with hypoxia and/or hypercarbia. Bulbar weakness may compromise airway patency and predispose patients to aspiration pneumonia. Areas covered: Clinical questions related to the use of mechanical ventilation include but are not limited to: When to start? Invasive or noninvasive? When to wean from mechanical ventilation? When to perform tracheostomy? How to manage complications of GBS in the ICU including nosocomial infection, ventilator-associated pneumonia, and ICU-acquired weakness? In this narrative review, the authors summarize the up-to-date knowledge of the incidence, pathophysiology, evaluation, and general management of respiratory failure in GBS. Expert opinion: Respiratory failure in GBS merits more attention from caregivers. Emergency intubation may lead to life-threatening complications. Appropriate methods and time point of intubation and weaning, an early tracheostomy, and predictive prophylaxis of complications benefit patients' long-term prognosis.
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Affiliation(s)
- Pei Shang
- Department of Neurology, First Hospital of Jilin University , Changchun, China.,Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic College of Medicine and Science , Rochester, MN, USA
| | - Mingqin Zhu
- Department of Neurology, First Hospital of Jilin University , Changchun, China.,Departments of Laboratory Medicine and Pathology, Neurology and Immunology, Mayo Clinic , Rochester, MN, USA
| | - Matthew Baker
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic College of Medicine and Science , Rochester, MN, USA
| | - Jiachun Feng
- Department of Neurology, First Hospital of Jilin University , Changchun, China
| | - Chunkui Zhou
- Department of Neurology, First Hospital of Jilin University , Changchun, China
| | - Hong-Liang Zhang
- Department of Life Sciences, National Natural Science Foundation of China , Beijing, China
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Garrido D, Martins J, Jordão M, Raimundo P, Jacinto R, Estevens R, Taveira I, Macedo A, Nzwalo H. Triggers of posterior reversible encephalopathy in Guillain-Barre syndrome. Clin Neurol Neurosurg 2020; 198:106250. [DOI: 10.1016/j.clineuro.2020.106250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/21/2020] [Accepted: 09/23/2020] [Indexed: 10/23/2022]
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Kaur D, Tiwana H, Stino A, Sandroni P. Autonomic neuropathies. Muscle Nerve 2020; 63:10-21. [PMID: 32926436 DOI: 10.1002/mus.27048] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 08/07/2020] [Accepted: 08/11/2020] [Indexed: 12/17/2022]
Abstract
Autonomic neuropathies represent a complex group of disorders that preferentially target autonomic fibers and can be classified as either acute/subacute or chronic in onset. Acute-onset autonomic neuropathies manifest with such conditions as paraneoplastic syndromes, Guillain-Barre syndrome, Sjögren syndrome, infection, or toxins/chemotherapy. When the presentation is acute, immune-mediated, and without a secondary cause, autoimmune autonomic ganglionopathy is likely, and should be considered for immunotherapy. Of the chronic-onset forms, diabetes is the most widespread and disabling, with autonomic impairment portending increased mortality and cardiac wall remodeling risk. Acquired light chain (AL) and transthyretin (TTR) amyloidosis represent two other key etiologies, with TTR amyloidosis now amenable to newly-approved gene-modifying therapies. The COMPASS-31 questionnaire is a validated outcome measure that can be used to monitor autonomic severity and track treatment response. Symptomatic treatments targeting orthostatic hypotension, among other symptoms, should be individualized and complement disease-modifying therapy, when possible.
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Affiliation(s)
- Divpreet Kaur
- Department of Neurology, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Harmanpreet Tiwana
- Department of Neurology, Dartmouth-Hitchcok Medical Center, Lebanon, New Hampshire, USA
| | - Amro Stino
- Department of Neurology, Division of Neuromuscular Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Paola Sandroni
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
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Xiromerisiou G, Kalampokini S, Rikos D, Provatas A, Tsouris Z, Markou K, Ralli S, Dardiotis E. Posterior reversible encephalopathy in a GT1a positive oculopharyngeal variant of Guillain-Barré syndrome: A case-report and review of the literature. Clin Neurol Neurosurg 2020; 196:106037. [DOI: 10.1016/j.clineuro.2020.106037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 11/16/2022]
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Salvalaggio A, Cagnin A, Marson P, Ferracci F, Cortelli P, Corbetta M, Briani C. Posterior reversible encephalopathy syndrome associated with Guillain-Barré syndrome: Case report and clinical management considerations. J Clin Apher 2020; 35:231-233. [PMID: 32289176 DOI: 10.1002/jca.21783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 03/03/2020] [Accepted: 03/27/2020] [Indexed: 11/09/2022]
Abstract
Around half of the patients with Guillain-Barré syndrome (GBS) present autonomic dysfunction requiring admission to intensive care unit in up to a quarter of patients. Treatment of GBS consists of plasma exchange (PE) and intravenous immunoglobulins (IVIG). Posterior reversible encephalopathy syndrome (PRES) consists in a reversible subcortical vasogenic brain edema caused by endothelial damage triggered by abrupt blood pressure changes. We report on a woman who presented with PRES in the course of GBS treated first with IVIG, and then with PE. The present report underlines the challenge that the clinicians face when these two rare syndromes concur. The literature is not helpful considering that both blood pressure fluctuations and IVIG are reported to be involved in the pathogenesis of PRES. In the present letter, both pathogenic mechanisms and clinical management considerations are discussed.
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Affiliation(s)
| | | | - Piero Marson
- Apheresis Unit, Blood Transfusion Service, University Hospital of Padova, Padova, Italy
| | - Franco Ferracci
- Neurology Unit, "San Martino" Hospital of Belluno, Belluno, Italy
| | - Pietro Cortelli
- IRCCS - Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical and NeuroMotor Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | | | - Chiara Briani
- Department of Neurosciences, University of Padova, Padova, Italy
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