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Huang C, Zhang Y, Deng S, Ren Y, Lu W. Trauma-Related Guillain-Barré Syndrome: Systematic Review of an Emerging Concept. Front Neurol 2020; 11:588290. [PMID: 33240210 PMCID: PMC7681248 DOI: 10.3389/fneur.2020.588290] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/02/2020] [Indexed: 02/05/2023] Open
Abstract
Guillain-Barré syndrome (GBS) is mainly associated with preceding exposure to an infectious agent, although the precise pathogenic mechanisms and causes remain unknown. Increasing evidence indicates an association between trauma-related factors and GBS. Here, we performed a systematic review, summarized the current scientific literature related to the onset of GBS associated with trauma, and explored the possible pathogenesis. A literature search of various electronic databases was performed up to May 2020 to identify studies reporting diverse trauma-related triggers of GBS. Data were extracted, summarized descriptively, and evaluated with respect to possible mechanisms. In total, 100 publications, including 136 cases and 6 case series involving GBS triggered by injury, surgery, intracranial hemorrhage, and heatstroke, met our eligibility criteria. The median age of the patients was 53 [interquartile range (IQR) 45-63] years, and 72.1% of the patients were male. The median number of days between the trigger to onset of GBS symptoms was 9 (IQR 6.5-13). Overall, 121 patients (89.0%) developed post-injury/surgical GBS, whereas 13 (9.6%) and 2 (1.5%) patients had preexisting spontaneous intracranial hemorrhage and heatstroke, respectively. The main locations of injury or surgeries preceding GBS were the spine and brain. Based on available evidence, we highlight possible mechanisms of GBS induced by these triggers. Moreover, we propose the concept of "trauma-related GBS" as a new research direction, which may help uncover more pathogenic mechanisms than previously considered for typical GBS triggered by infection or vaccination.
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Affiliation(s)
- Chuxin Huang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yiliu Zhang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shuwen Deng
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yijun Ren
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Wei Lu
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
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Al-Attas AA, Aldayel AY, Al Najjar SA, Alkhonezan SM. Guillain-Barré Syndrome Heralding the Diagnosis of Hodgkin Lymphoma: A Case Report. Case Rep Neurol 2020; 12:365-372. [PMID: 33250750 PMCID: PMC7670385 DOI: 10.1159/000509681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/21/2020] [Indexed: 01/08/2023] Open
Abstract
Lymphoma is a prevalent type of lymphoid tissue malignancy that is seldom associated with Guillain-Barré syndrome (GBS). In the majority of instances, both Hodgkin’s and non-Hodgkin’s lymphoma are not proceeded by GBS. Here, we report on a case of a young patient with a manifestation and investigation suggestive of GBS, signaling an unconfirmed diagnosis of Hodgkin’s lymphoma. A cerebrospinal fluid test revealed an albuminocytological dissociation with a noteworthy rise in protein (2.32 g/L). The patient was initiated on intravenous immunoglobulin (IVIG) treatment and then showed dramatic improvement after the third dose of IVIG. His constitutional presentation alongside high inflammatory labs prompted further investigation. An enhanced pan-computed tomography scan showed multiple enlarged mediastinal and hilar lymph nodes that were confirmed as Hodgkin’s lymphoma after biopsy. Brentuximab was initiated immediately after IVIG therapy. This case highlights consideration of Hodgkin’s lymphoma as a differential diagnosis under the auspices of GBS.
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Affiliation(s)
- Alawi Aqel Al-Attas
- Department of Neurology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdulrahman Yousef Aldayel
- Department of Neurology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
- *Abdulrahman Yousef Aldayel, Department of Neurology, Prince Sultan Military Medical City (PSMMC), Makkah Al Mukarramah Road, As Sulimaniyah, PO Box 7897, Riyadh (Saudi Arabia),
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Madhavan AA, Carr CM, Morris PP, Flanagan EP, Kotsenas AL, Hunt CH, Eckel LJ, Lindell EP, Diehn FE. Imaging Review of Paraneoplastic Neurologic Syndromes. AJNR Am J Neuroradiol 2020; 41:2176-2187. [PMID: 33093137 DOI: 10.3174/ajnr.a6815] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/29/2020] [Indexed: 12/19/2022]
Abstract
Paraneoplastic syndromes are systemic reactions to neoplasms mediated by immunologic or hormonal mechanisms. The most well-recognized paraneoplastic neurologic syndrome, both clinically and on imaging, is limbic encephalitis. However, numerous additional clinically described syndromes affect the brain, spinal cord, and peripheral nerves. Many of these syndromes can have imaging findings that, though less well described, are important in making the correct diagnosis. Moreover, imaging in these syndromes frequently mimics more common pathology, which can be a diagnostic challenge for radiologists. Our goal is to review the imaging findings of paraneoplastic neurologic syndromes, including less well-known entities and atypical presentations of common entities. Specifically, we discuss limbic encephalitis, paraneoplastic cerebellar degeneration, paraneoplastic brain stem encephalitis, cranial neuropathy, myelitis, and polyneuropathy. We also demonstrate common diagnostic pitfalls that can be encountered when imaging these patients.
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Affiliation(s)
- A A Madhavan
- From the Division of Neuroradiology, Department of Radiology (A.A.M., C.M.C., P.P.M., A.L.K., C.H.H., L.J.E., E.P.L., F.E.D.)
| | - C M Carr
- From the Division of Neuroradiology, Department of Radiology (A.A.M., C.M.C., P.P.M., A.L.K., C.H.H., L.J.E., E.P.L., F.E.D.)
| | - P P Morris
- From the Division of Neuroradiology, Department of Radiology (A.A.M., C.M.C., P.P.M., A.L.K., C.H.H., L.J.E., E.P.L., F.E.D.)
| | - E P Flanagan
- Department of Neurology (E.P.F.), Mayo Clinic, Rochester, Minnesota
| | - A L Kotsenas
- From the Division of Neuroradiology, Department of Radiology (A.A.M., C.M.C., P.P.M., A.L.K., C.H.H., L.J.E., E.P.L., F.E.D.)
| | - C H Hunt
- From the Division of Neuroradiology, Department of Radiology (A.A.M., C.M.C., P.P.M., A.L.K., C.H.H., L.J.E., E.P.L., F.E.D.)
| | - L J Eckel
- From the Division of Neuroradiology, Department of Radiology (A.A.M., C.M.C., P.P.M., A.L.K., C.H.H., L.J.E., E.P.L., F.E.D.)
| | - E P Lindell
- From the Division of Neuroradiology, Department of Radiology (A.A.M., C.M.C., P.P.M., A.L.K., C.H.H., L.J.E., E.P.L., F.E.D.)
| | - F E Diehn
- From the Division of Neuroradiology, Department of Radiology (A.A.M., C.M.C., P.P.M., A.L.K., C.H.H., L.J.E., E.P.L., F.E.D.)
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Arratibel N, Sobejano E, Moran JC, Diaz LG, Blázquez A, Baile M, Veiga Á, Caballero MD, García-Sanz R. A Case of Paraneoplastic Cerebellar Degeneration that Preceded the Diagnosis of Classical Hodgkin's Lymphoma by 16 Months. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e922342. [PMID: 32574156 PMCID: PMC7328688 DOI: 10.12659/ajcr.922342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Patient: Male, 44-year-old Final Diagnosis: Hodgkin’s lymphoma Symptoms: Dizziness • dysarthria • unsteadiness Medication: — Clinical Procedure: Chemotherapy • CT scan • onconeuronal antibodies • PET-CT Specialty: Hematology
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Affiliation(s)
- Nerea Arratibel
- Department of Hematology, University Hospital of Salamanca, Salamanca, Spain
| | - Eduardo Sobejano
- Department of Hematology, University Hospital of Salamanca, Salamanca, Spain
| | - Jose Carlos Moran
- Department of Neurology, University Hospital of Salamanca, Salamanca, Spain
| | - Luis G Diaz
- Department of Nuclear Medicine, University Hospital of Salamanca, Salamanca, Spain
| | - Almudena Blázquez
- Department of Radiodiagnostic, University Hospital of Salamanca, Salamanca, Spain
| | - Mónica Baile
- Department of Hematology, University Hospital of Salamanca, Salamanca, Spain
| | - Álvaro Veiga
- Department of Hematology, University Hospital of Salamanca, Salamanca, Spain
| | | | - Ramón García-Sanz
- Department of Hematology, University Hospital of Salamanca, Salamanca, Spain
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