Guillain-Barré syndrome presenting with severe musculoskeletal pain

Orthopaedic manifestations and diagnostic clues in children with Guillain-Barré syndrome

INTRODUCTION

Guillain-Barré syndrome (GBS) is an acute inflammatory demyelinating polyneuropathy characterized by symmetric limb weakness. Children with GBS sometimes consult the orthopaedists because of limb pain and gait disturbance. The orthopaedists, however, are unfamiliar with GBS, since it has rarely been delineated in detail in the orthopaedic literature. In the present study, we specifically describe orthopaedic manifestations and diagnostic clues in pediatric GBS.

METHODS

We reviewed seven patients with pediatric GBS in regard to age, gender, clinical symptoms, department at the first medical consultation, initial diagnosis, physical and laboratory findings, medical interventions, and the latest clinical outcome.

RESULTS

There were five boys and two girls, with a mean age at presentation of 7.2 years. Gait disturbance associated with lower limb pain and weakness was the most frequent early clinical symptom. Among the five patients who presented initially at the orthopaedic department, three were misdiagnosed. Loss of deep tendon reflexes was seen in all patients. Anti-ganglioside antibodies were positive in three and protein levels of cerebrospinal fluid were elevated in five patients. Six patients recovered completely after intravenous immunoglobulin (IVIG) treatment, while one patient who had not undergone IVIG treatment showed minor residual disability.

CONCLUSIONS

Acute symmetrical limb pain and gait disturbance associated with loss of tendon reflexes were important clinical manifestations of pediatric GBS. Early diagnosis is essential to prevent delayed recovery, long-term weakness, and permanent functional disabilities.

Pseudomeningoencephalitic presentation of pediatric Guillain-Barré syndrome

Guillain-Barré syndrome is an acute, autoimmune polyradiculoneuropathy that improves with immune-modulating treatment if instituted early in the illness. Preliminary diagnosis relies on the clinician's recognition of the typical symptoms and signs as supporting evidence of the illness, such as nerve conduction studies, which may not be available emergently. We report eight children with Guillain-Barré syndrome in whom the initial presentation was atypical and suggested a primary central nervous system illness. In these patients, the predominant clinical symptoms included drowsiness, headache, irritability, and meningismus, although the classic features of Guillain-Barré syndrome (weakness, hyporeflexia) were also present. The atypical presentation caused delay in diagnosis in some cases. It is important to recognize this variant of pediatric Guillain-Barré syndrome to ensure expeditious diagnosis and treatment.

Acute inflammatory demyelinating polyradiculopathy in children: clinical and electrodiagnostic studies

Clinical and electrophysiological features in 43 children with acute inflammatory demyelinating polyradiculoneuropathy (AIDP) were retrospectively studied. More than one-third of these children were less than 3 years old. Some distinctive clinical features specific to adults or to children were identified. Initial symptoms such as ataxia and severe limb or back pain were more frequent in children. By using the criteria suggested here, according to our neurophysiological findings, the diagnosis of AIDP could be proposed as early of the first days of illness in 90% of the children and is confirmed during the second week. The neurophysiological evolution was very similar in children and adults except that recovery occurred sooner in children. Prognosis was better in childhood (complete recovery in all but 2 patients with minor disabilities).

Pain in the Guillain-Barré syndrome: a clinical review

The Guillain-Barré syndrome, or acute inflammatory polyneuropathy, is often regarded as a predominantly motor neuropathy with few sensory features, which has a good prognosis in most cases. However, pain is a common symptom occurring in up to 72% of cases. The types of pain are protean including paraesthesiae, dysaesthesia, axial and radicular pain, meningism, myalgia, joint pain and visceral discomfort, etc., and patients may present in a variety of clinical settings such as intensive care units, acute medical wards or rehabilitation departments. These factors, combined with the fact that the condition is relatively uncommon, means that no controlled trial of pain management has been done and a range of treatments has been proposed. We review the various pains which may be associated with Guillain-Barré syndrome and discuss suggestions for their management.