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Fujii Y, Kanbayashi T, Kobayashi S, Uchibori A, Chiba A, Sonoo M. [Finger drop variant of Guillain-Barré syndrome: a case report]. Rinsho Shinkeigaku 2022; 62:810-813. [PMID: 36184417 DOI: 10.5692/clinicalneurol.cn-001780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
We report the case of a 31-year-old man with a finger drop variant of Guillain-Barré syndrome (GBS). The patient visited a neurological clinic with complaints of difficulty in extending the fingers, which occurred seven days after he had fever and diarrhea. The physician who first saw the patient suspected posterior interosseous nerve palsy and referred him to our hospital. Neurological examination 35 days after the onset revealed distal weakness of the upper extremities, particularly in the bilateral extensor digitorum (Medical Research Council [MRC] scale 1/1 [right/left]). The left triceps surae muscle was also weak (MRC scale 5/4). Bilateral Achilles tendon reflexes were absent, but other neurological findings were normal. Cerebrospinal fluid examination showed albuminocytologic dissociation. Serum immunoglobulin G antibodies against GM1 were positive. Nerve conduction studies revealed reduced amplitude of compound muscle action potentials (CMAPs) without evidence of demyelination in the median, ulnar, radial, and tibial nerves. CMAP amplitude was most severely reduced in the radial nerve among the upper extremity nerves. We diagnosed the patient with acute motor axonal neuropathy. His symptoms gradually improved after treatment with intravenous immunoglobulin. When encountering acute finger drop, neurologists should consider the finger drop variant of GBS as a differential diagnosis.
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Affiliation(s)
- Yuki Fujii
- Department of Neurology, Teikyo University School of Medicine
| | | | | | - Ayumi Uchibori
- Department of Neurology, Faculty of Medicine, Kyorin University
| | - Atsuro Chiba
- Department of Neurology, Faculty of Medicine, Kyorin University
| | - Masahiro Sonoo
- Department of Neurology, Teikyo University School of Medicine
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Boob MA, Dadgal R, Salphale VG. Emphasis on the Optimal Functional Recovery Through a Structured Inpatient Rehabilitation Program Along With a Home Exercise Regime in an Individual With Miller-Fisher Syndrome: A Case Report. Cureus 2022; 14:e29919. [DOI: 10.7759/cureus.29919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022] Open
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Yamagishi Y, Kuwahara M, Suzuki H, Sonoo M, Kuwabara S, Yokota T, Nomura K, Chiba A, Kaji R, Kanda T, Kaida KI, Mutoh T, Yamasaki R, Takashima H, Matsui M, Nishiyama K, Sobue G, Kusunoki S. Serum IgG anti-GD1a antibody and mEGOS predict outcome in Guillain-Barré syndrome. J Neurol Neurosurg Psychiatry 2020; 91:1339-1342. [PMID: 33041261 DOI: 10.1136/jnnp-2020-323960] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/08/2020] [Accepted: 08/31/2020] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Approximately 15%-20% of patients with Guillain-Barré syndrome (GBS) are unable to walk independently at 6 months from the onset of neurological symptom. The modified Erasmus GBS outcome score (mEGOS) has been reported as a prognostic tool.Herein we investigated the association between a poor outcome, inability to walk independently at 6 months and presence of antiganglioside antibodies. METHODS The clinical and serological data of 177 patients with GBS were retrospectively collected in Japan to assess the associations between a poor outcome and serum IgG antibodies against each ganglioside (GM1, GD1a, GalNAc-GD1a, GQ1b and GT1a). In addition, we investigated whether the combination of mEGOS and serum IgG antibodies against gangliosides is useful in predicting a poor outcome. RESULTS The patients with IgG anti-GD1a antibodies more frequently showed poor outcomes than those without these antibodies (9 (36%) of 25 vs 8 (6%) of 127 patients, p<0.001). Particularly, 80% showed a poor outcome when they had both serum IgG anti-GD1a antibody and a high mEGOS of ≥10 on day 7 of admission. CONCLUSIONS The combination of serum IgG anti-GD1a antibodies and a high mEGOS could help in making a more accurate prognosis of patients than mEGOS alone, especially for predicting poor outcomes.
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Affiliation(s)
- Yuko Yamagishi
- Department of Neurology, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Motoi Kuwahara
- Department of Neurology, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Hidekazu Suzuki
- Department of Neurology, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Masahiro Sonoo
- Department of Neurology, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Chiba University Graduate School of Medicine, Chiba, Chiba, Japan
| | - Takanori Yokota
- Department of Neurology, Tokyo Medical and Dental University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Kyoichi Nomura
- Department of Neurology, Saitama Medical Center, Kawagoe, Saitama, Japan
| | - Atsuro Chiba
- Department of Neurology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Ryuji Kaji
- Department of Clinical Neuroscience, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
| | - Takashi Kanda
- Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Ken-Ichi Kaida
- Department of Neurology, Saitama Medical Center, Kawagoe, Saitama, Japan
| | - Tatsuro Mutoh
- Department of Neurology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Ryo Yamasaki
- Department of Neurology, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Hiroshi Takashima
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Kagoshima, Japan
| | - Makoto Matsui
- Department of Neurology, Kanazawa Medical University, Kahoku-gun, Ishikawa, Japan
| | - Kazutoshi Nishiyama
- Department of Neurology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Gen Sobue
- Research Division of Dementia and Neurodegenerative Disease, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Susumu Kusunoki
- Department of Neurology, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan
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Uncini A, Notturno F, Kuwabara S. Hyper-reflexia in Guillain-Barré syndrome: systematic review. J Neurol Neurosurg Psychiatry 2020; 91:278-284. [PMID: 31937584 DOI: 10.1136/jnnp-2019-321890] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 01/02/2023]
Abstract
Areflexia or hyporeflexia is a mandatory clinical criterion for the diagnosis of Guillain-Barré syndrome (GBS). A systematic review of the literature from 1 January 1993 to 30 August 2019 revealed 44 sufficiently detailed patients with GBS and hyper-reflexia, along with one we describe. 73.3% of patients were from Japan, 6.7% from the USA, 6.7% from India, 4.4% from Italy, 4.4% from Turkey, 2.2% from Switzerland and 2.2% from Slovenia, suggesting a considerable geographical variation. Hyper-reflexia was more frequently associated with antecedent diarrhoea (56%) than upper respiratory tract infection (22.2%) and the electrodiagnosis of acute motor axonal neuropathy (56%) than acute inflammatory demyelinating polyneuropathy (4.4%). Antiganglioside antibodies were positive in 89.7% of patients. Hyper-reflexia was generalised in 90.7% of patients and associated with reflex spread in half; it was present from the early progressive phase in 86.7% and disappeared in a few weeks or persisted until 18 months. Ankle clonus or Babinski signs were rarely reported (6.7%); spasticity never developed. 53.3% of patients could walk unaided at nadir, none needed mechanical ventilation or died. 92.9% of patients with limb weakness were able to walk unaided within 6 months. Electrophysiological studies showed high soleus maximal H-reflex amplitude to maximal compound muscle action potential amplitude ratio, suggestive of spinal motoneuron hyperexcitability, and increased central conduction time, suggestive of corticospinal tract involvement, although a structural damage was never demonstrated by MRI. Hyper-reflexia is not inconsistent with the GBS diagnosis and should not delay treatment. All GBS variants and subtypes can present with hyper-reflexia, and this eventuality should be mentioned in future diagnostic criteria for GBS.
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Affiliation(s)
- Antonino Uncini
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", Chieti-Pescara, Italy
| | - Francesca Notturno
- Institute of Neurology, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
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