1
|
Piña-Rosales E, Gonzalez-Salido J, Barron-Cervantes NM, Colado-Martinez J, Garcia-Santos RA, Guevara-Arnal L. Guillain-Barré Syndrome in an Immunocompromised Patient: A Case Report. Cureus 2024; 16:e54380. [PMID: 38505462 PMCID: PMC10948623 DOI: 10.7759/cureus.54380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2024] [Indexed: 03/21/2024] Open
Abstract
Guillain-Barré syndrome (GBS) in post-transplant patients is a rare clinical presentation. Although in the literature this neurological condition has been mainly associated with viral infections secondary to immunosuppression, GBS should not only be suspected in patients with an acute condition. It is essential to always rule out a viral or bacterial cause, looking for the most common sources, i.e., urinary, respiratory, and gastrointestinal. The diagnosis of GBS is clinically based, and its management is based on the use of intravenous immunoglobulin (IVIG) or plasma exchange. Its timely diagnosis allows treatment to be started early, thus improving the prognosis of these patients and reducing the time of hospitalization and complications associated with it. This report shows how an interdisciplinary approach is vital in such cases, as both the precipitant and the disease must be managed to decrease the morbidity and mortality associated with this condition. It is crucial to evaluate the benefits and risks of withdrawing immunosuppressive treatment in post-transplant patients, and being able to recognize when restarting them is indicated.
Collapse
Affiliation(s)
- Enrique Piña-Rosales
- Internal Medicine, Fundación Clínica Médica Sur (South Medical Clinical Foundation), Mexico City, MEX
| | - Jimena Gonzalez-Salido
- Medicine, School of Medicine, Universidad La Salle (La Salle University), Mexico City, MEX
| | | | - Jimena Colado-Martinez
- Medicine, School of Medicine, Universidad La Salle (La Salle University), Mexico City, MEX
| | - Raúl A Garcia-Santos
- Neurology, Fundación Clínica Médica Sur (South Medical Clinical Foundation), Mexico City, MEX
| | - Luis Guevara-Arnal
- Nephrology, Fundación Clínica Médica Sur (South Medical Clinical Foundation), Mexico City, MEX
| |
Collapse
|
2
|
James N, Reddy S, Maheshwari U, Elamurugan N, Kumar N, Kumar AN, Tejaswini SD, Ranganathan LN, S B. Incidence of Cardiovascular Instability in Patients With Guillain-Barré Syndrome: A Retrospective Study. Cureus 2024; 16:e52778. [PMID: 38389637 PMCID: PMC10882565 DOI: 10.7759/cureus.52778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
Introduction Guillain-Barré syndrome (GBS) is an autoimmune disease affecting radicles and peripheral nerves resulting in acute flaccid paralysis. Respiratory failure, autonomic dysfunction, and secondary complications such as pneumonia, and venous thromboembolism are the major causes of death and disability in GBS. Cardiovascular complications play a major role in the prognosis of GBS patients. The aim is to determine the incidence of cardiovascular instability in GBS patients and to see if there are any specific risk groups associated with the development of cardiovascular instability. Methodology This is a retrospective descriptive study conducted in a tertiary care center in South India. Data on 50 consecutive GBS patients were collected from hospital records including case sheets, death summaries, and discharge summaries. Patients with evidence of sepsis, blood loss, heavy alcohol consumption, and chronic liver disease were excluded from the study. Baseline demographic data, symptom onset to admission time, baseline Erasmus Guillain-Barré Syndrome Respiratory Insufficiency Score (EGRIS), and baseline liver function tests were documented. The presence of heart rate and blood pressure fluctuations was noted from the records. Frequency data were calculated from the categorical variables. Analysis of non-parametric variables by chi-square test was done using IBM SPSS Statistics for Windows, Version 25.0 (Released 2017; IBM Corp., Armonk, New York, United States). Results Cardiovascular instability was present in 15 (30%) patients in the study population. It was present in all patients (100%) who require mechanical ventilation. The incidence of cardiovascular instability was higher in patients who had lesser onset to admission times (41.9% vs 10.5%; p=0.019), EGRIS≥4 (40.6% vs 11.1%; p=0.029), and lower cranial nerve involvement (40% vs 6.7%; p=0.018). Conclusion Of patients with GBS, 30% developed cardiovascular instability during their disease course. Patients with lesser onset to admission times, EGRIS ≥4, and those with lower cranial nerve involvement had a greater incidence of cardiovascular instability.
Collapse
Affiliation(s)
- Noel James
- Institute of Neurology, Madras Medical College, Chennai, IND
| | - Sanjeeva Reddy
- Institute of Neurology, Madras Medical College, Chennai, IND
| | - Uma Maheshwari
- Institute of Neurology, Madras Medical College, Chennai, IND
| | | | - Nirumal Kumar
- Institute of Neurology, Madras Medical College, Chennai, IND
| | - Arun N Kumar
- Institute of Neurology, Madras Medical College, Chennai, IND
| | | | | | | |
Collapse
|
3
|
Rajurkar RD, Patil DS, Jagzape MV. Pediatric Physiotherapeutic Approach for Guillain-Barre Syndrome Associated With Dengue Fever: A Case Report. Cureus 2023; 15:e46488. [PMID: 37927682 PMCID: PMC10623497 DOI: 10.7759/cureus.46488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/03/2023] [Indexed: 11/07/2023] Open
Abstract
Guillain-Barre syndrome (GBS) is a peripheral nerve system (PNS) inflammatory disorder characterized by sudden, acute, symmetrical, generally ascending limb weakness with diminished or absent deep tendon reflexes, upper- and lower-extremity paresthesias, and sensory complaints. GBS is caused by an aberrant immunological response to an infection, which causes peripheral nerve damage. Dengue virus has been linked to a number of neurological diseases, including GBS. In the current case report, an eight-year-old child was taken to the hospital with dengue fever and lower limb paralysis. Physiotherapy methods focused on muscle strength and functional activity. The major goal of this case study was to assess functional tasks and enhance the patient's reaction to physical treatment. We find that the patient's response to strength and functional tasks was excellent in the early phases of recovery.
Collapse
Affiliation(s)
- Reva D Rajurkar
- Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Deepali S Patil
- Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Medhavi V Jagzape
- Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| |
Collapse
|
4
|
Swonger RM, Syros A, Finch L, Moore J, Lauture A, Soto Rincon A, Tinker N, Zbeidy R, Ghulmiyyah L, Paidas M. Guillain-Barre Syndrome With Concomitant Severe Preeclampsia: A Case Report. Cureus 2023; 15:e40796. [PMID: 37485223 PMCID: PMC10362806 DOI: 10.7759/cureus.40796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 07/25/2023] Open
Abstract
With an estimated 100,000 new cases yearly worldwide, Guillain-Barre syndrome (GBS) is the most common cause of flaccid paralysis. GBS is exceedingly rare in pregnancy and carries high maternal and fetal risk. We report a case of a 38-year-old essential primigravida who presented at 38 weeks six days gestational age with ascending paraplegia progressing to dysarthria, dysphagia, and facial weakness. A clinical diagnosis of GBS was made in an outside institution, supported by elevated protein on lumbar puncture. During the antepartum period, a diagnosis of gestational hypertension progressed to preeclampsia with severe features when a sudden rise in liver function tests occurred. The patient underwent an uneventful planned cesarean delivery but could not be extubated due to respiratory failure. After a 20-day critical care admission, she was extubated and had an improvement in neurologic status to near her baseline.
Collapse
Affiliation(s)
| | - Alina Syros
- Miller School of Medicine, University of Miami, Miami, USA
| | - Lindsey Finch
- Obstetrics and Gynecology, University of Miami/Jackson Memorial Hospital, Miami, USA
| | - Jessica Moore
- Obstetrics and Gynecology, University of Miami/Jackson Memorial Hospital, Miami, USA
| | | | - Alvaro Soto Rincon
- Anesthesiology, University of Miami/Jackson Memorial Hospital, Miami, USA
| | - Nicholas Tinker
- Obstetrics and Gynecology, University of Miami/Jackson Memorial Hospital, Miami, USA
| | - Reine Zbeidy
- Anesthesiology and Perioperative Medicine, University of Miami/Jackson Memorial Hospital, Miami, USA
| | - Labib Ghulmiyyah
- Obstetrics and Gynaecology, University of Miami/Jackson Memorial Hospital, Miami, USA
| | - Michael Paidas
- Obstetrics and Gynecology, University of Miami/Jackson Memorial Hospital, Miami, USA
| |
Collapse
|
5
|
Lim CS, Kaisbain N, Lim WJ. A Rare Combination: Dengue Fever Complicated With Guillain-Barre Syndrome. Cureus 2023; 15:e40957. [PMID: 37503499 PMCID: PMC10369010 DOI: 10.7759/cureus.40957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2023] [Indexed: 07/29/2023] Open
Abstract
Guillain-Barre syndrome (GBS) is an uncommon neurological complication of dengue viral infection. It is more commonly reported with Campylobacter jejuni, Epstein-Barr virus, and Cytomegalovirus infection. We report an uncommon case of a 49-year-old man with dengue fever, who developed bilateral lower limb weakness and areflexia on day two of dengue illness. He was diagnosed with GBS as a sequel of dengue infection with the nerve conduction study showing evidence of demyelinating neuropathy. He recovered gradually without immunotherapy and was discharged after a week of hospitalization.
Collapse
Affiliation(s)
- Chee Siew Lim
- Internal Medicine, Hospital Sultanah Aminah, Johor Bahru, MYS
| | | | - Wei Juan Lim
- Cardiology, National Heart Institute/Institut Jantung Negara Sdn Bhd (IJN), Kuala Lumpur, MYS
| |
Collapse
|
6
|
Luijten LWG, Doets AY, Arends S, Dimachkie MM, Gorson KC, Islam B, Kolb NA, Kusunoki S, Papri N, Waheed W, Walgaard C, Yamagishi Y, Lingsma H, Jacobs BC. Modified Erasmus GBS Respiratory Insufficiency Score: a simplified clinical tool to predict the risk of mechanical ventilation in Guillain-Barré syndrome. J Neurol Neurosurg Psychiatry 2023; 94:300-308. [PMID: 36428088 DOI: 10.1136/jnnp-2022-329937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 10/26/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND This study aimed to determine the clinical and diagnostic factors associated with mechanical ventilation (MV) in Guillain-Barré syndrome (GBS) and to simplify the existing Erasmus GBS Respiratory Insufficiency Score (EGRIS) for predicting the risk of MV. METHODS Data from the first 1500 patients included in the prospective International GBS Outcome Study (IGOS) were used. Patients were included across five continents. Patients <6 years and patients from Bangladesh were excluded. Univariable logistic and multivariable Cox regression were used to determine which prespecified clinical and diagnostic characteristics were associated with MV and to predict the risk of MV at multiple time points during disease course. RESULTS 1133 (76%) patients met the study criteria. Independent predictors of MV were a shorter time from onset of weakness until admission, the presence of bulbar palsy and weakness of neck flexion and hip flexion. The modified EGRIS (mEGRIS) was based on these factors and accurately predicts the risk of MV with an area under the curve (AUC) of 0.84 (0.80-0.88). We internally validated the model within the full IGOS cohort and within separate regional subgroups, which showed AUC values of 0.83 (0.81-0.88) and 0.85 (0.72-0.98), respectively. CONCLUSIONS The mEGRIS is a simple and accurate tool for predicting the risk of MV in GBS. Compared with the original model, the mEGRIS requires less information for predictions with equal accuracy, can be used to predict MV at multiple time points and is also applicable in less severely affected patients and GBS variants. Model performance was consistent across different regions.
Collapse
Affiliation(s)
- Linda W G Luijten
- Neurology, Erasmus Medical Center, Rotterdam, The Netherlands.,Neurology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Alex Y Doets
- Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Samuel Arends
- Neurology, Erasmus Medical Center, Rotterdam, The Netherlands.,Neurology, Haga Hospital, Den Haag, The Netherlands
| | - Mazen M Dimachkie
- Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kenneth C Gorson
- Neurology, St. Elizabeth's Medical Center, Boston, Massachusetts, USA
| | - Badrul Islam
- Laboratory of Gut-Brain Signaling, Laboratory Sciences and Services Division (LSSD), International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Noah A Kolb
- Neurology, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Susumu Kusunoki
- Neurology, Kindai University Faculty of Medicine Graduate School of Medical Sciences, Osakasayama, Osaka, Japan
| | - Nowshin Papri
- Neurology, Erasmus Medical Center, Rotterdam, The Netherlands.,Laboratory of Gut-Brain Signaling, Laboratory Sciences and Services Division (LSSD), International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Waqar Waheed
- Neurology, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Christa Walgaard
- Neurology, IJsselland Hospital, Capelle aan den IJssel, The Netherlands
| | - Yuko Yamagishi
- Neurology, Kindai University Faculty of Medicine Graduate School of Medical Sciences, Osakasayama, Osaka, Japan
| | - Hester Lingsma
- Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Bart C Jacobs
- Neurology and Immunology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | |
Collapse
|
7
|
Kommu S, Cirra V, Pesala SPR, Arepally S. Atypical Guillain-Barre Syndrome With a Sensory Level and Hyper-Acute Presentation: A Case Report. Cureus 2023; 15:e38262. [PMID: 37139032 PMCID: PMC10151066 DOI: 10.7759/cureus.38262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2023] [Indexed: 05/05/2023] Open
Abstract
A 46-year-old man with a prior history of cervical spondylosis and myelopathy needing cervical spinal surgery three years back presented to the emergency department with acute onset areflexic flaccid weakness of both lower extremities, with a sensory level at T10. Magnetic resonance imaging studies (MRI) of the cervical, thoracic, and lumbar spine ruled out significant cord compression, spinal cord ischemia, spinal shock, or findings to suggest transverse myelitis. CSF analysis showed normal albumin and protein; however, with the features of paraplegia with flaccidity, areflexia, absence of bowel and bladder symptoms, and MRI ruling out other possibilities, a diagnosis of Guillain-Barre syndrome (GBS) was made. The patient was treated with intravenous immunoglobulin (IVIG) and showed a clinical response, with improvement in strength in both lower extremities. This case is rare and unique, as it exhibits atypical features for a GBS case, including a sensory level and hyper-acute presentation, with the onset of weakness to a nadir within an hour. This case highlights the importance of awareness of such atypical GBS presentations so that the diagnosis is not missed and is appropriately managed for favorable patient outcomes.
Collapse
Affiliation(s)
- Sharath Kommu
- Hospital Medicine, Marshfield Clinic Health System, Rice Lake, USA
| | - Vidyasagar Cirra
- Hospital Medicine, Marshfield Clinic Health System, Rice Lake, USA
| | | | - Shalini Arepally
- Family Medicine, Marshfield Clinic Health System, Rice Lake, USA
| |
Collapse
|
8
|
Muacevic A, Adler JR. Co-Occurring Subacute Combined Degeneration and Guillain-Barré Syndrome Resulting From Nitrous Oxide Abuse: A Case Report. Cureus 2022; 14:e32756. [PMID: 36686110 PMCID: PMC9851792 DOI: 10.7759/cureus.32756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 01/24/2023] Open
Abstract
Growing in prevalence as a recreational drug of abuse across a broad scope of people, nitrous oxide (N2O) has proven to be a public health concern. Side effects of its abuse have a great degree of variation among people ranging from neurologic, psychiatric, and medical symptoms. We present a rare case of a 23-year-old female with a history of N2O abuse, who presented with symptoms of both subacute combined degeneration syndrome (SCD) and Guillain-Barré syndrome (GBS). She presented with three weeks history of progressive bilateral lower extremity weakness, burning and tingling sensation, difficulty walking, and falls. This patient underwent an extensive medical workup upon hospitalization. Notable findings of the magnetic resonance imaging (MRI) of her cervical spine showed an abnormal cervical cord signal intensity pattern typical for vitamin B12 deficiency and her lumbar puncture showed albuminocytological dissociation, which confirmed the diagnosis of GBS. For these conditions, this patient was successfully treated with weekly vitamin B12 injections and five treatments of plasmapheresis. Her condition was additionally complicated by worsening anxiety and depression, which were treated with gabapentin, escitalopram, trazodone, hydroxyzine, and melatonin. She demonstrated great clinical improvement with almost complete resolution of her symptoms at the time of her hospital discharge. This case highlights the easy accessibility, addiction potential, and adverse consequences related to N2O abuse.
Collapse
|
9
|
Muacevic A, Adler JR, Vaishnav B, Wadivkar AN, Basha F. Neurological Complications in Post-COVID-19 Infected Patients: A Case Series. Cureus 2022; 14:e32374. [PMID: 36632274 PMCID: PMC9827432 DOI: 10.7759/cureus.32374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
In December 2019, the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is the causative agent of coronavirus disease 2019 (COVID-19), emerged in China and quickly spread to other countries. COVID-19 infection can present in a variety of ways, ranging from mild upper respiratory illness with no symptoms to severe acute respiratory distress syndrome with multiorgan involvement and death. With increasing frequency, new associations and clinical complications, such as thrombotic states, mucormycosis, and others have been reported. Neurological complications can occur during infection, during the immediate recovery period, or as late sequel of infection in COVID-19. We present an intriguing case series of neurological complications following COVID-19 pneumonia.
Collapse
|
10
|
Connors C, Hrdlicka H. Occupational and Physical Therapy Rehabilitation Strategies for COVID-19 Related Guillain-Barré Syndrome: A Case Report. Arch Phys Med Rehabil 2022; 103:e88-e89. [DOI: 10.1016/j.apmr.2022.08.662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Research Objectives To describe the occupational and physical therapy strategies used to rehabilitate COVID-19 related Guillain-Barré Syndrome (GBS). Design Single patient retrospective case report. Setting Long-term acute care hospital located in Wallingford, Connecticut, USA. Participants A 61 year old male admitted for physical and occupational therapy rehabilitation following intravenous immunoglobulin treatment for COVID-19 related GBS. The patient gave his written approval for the creation of this case report. Interventions Individual occupational and physical therapy sessions, occupational and physical therapy co-treatment sessions, and targeted group therapy sessions focused on leg, arm, and fine motor coordination exercises. Main Outcome Measures Manual muscle testing, range-of-motion, grip-strength, Activity Measure for Post-Acute Care, and St. Louis University Mental Status Exam. Results Despite the unforeseen complication of a distal right fibula fracture, the patient was successfully discharged directly home 56 days after LTACH admission. The patient discharged with clinically improved ambulation, strength, self-care, and cognition. Conclusions This unique case highlights the complex and significant rehabilitation needs a patient may require to regain independence after a diagnosis of COVID-19 associated GBS. Author(s) Disclosures The authors have no conflicts of interest to disclose.
Collapse
|
11
|
Siddiqi AR, Khan T, Tahir MJ, Asghar MS, Islam MS, Yousaf Z. Miller Fisher syndrome after COVID-19 vaccination: Case report and review of literature. Medicine (Baltimore) 2022; 101:e29333. [PMID: 35608434 PMCID: PMC9276158 DOI: 10.1097/md.0000000000029333] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/02/2022] [Indexed: 02/07/2023] Open
Abstract
RATIONALE Miller Fisher syndrome (MFS) is a rare variant of Guillain-Barre syndrome, classically diagnosed based on the clinical triad of ataxia, areflexia, and ophthalmoplegia. MFS is usually preceded by viral infections and febrile illness; however, only a few cases have been reported after vaccinations. PATIENT CONCERNS A 53-year-old hypertensive male presented with a 2-day history of progressive ascending paralysis of the lower limbs along with diplopia and ataxia, 8 days after the first dose of the Sinovac-Coronavac coronavirus disease 2019 (COVID-19) vaccination, with no prior history of any predisposing infections or triggers. DIAGNOSES Physical examination showed moderate motor and sensory loss with areflexia in the lower limbs bilaterally. Routine blood investigations and radiological investigations were unremarkable. Cerebrospinal fluid analysis showed albuminocytologic dissociation and nerve conduction studies revealed prolonged latencies with reduced conduction velocities. The diagnosis of MFS was established based on the findings of physical examination, cerebrospinal fluid analysis, and nerve conduction studies. INTERVENTIONS A management plan was devised based on intravenous immunoglobulins, pregabalin, and physiotherapy. However, due to certain socioeconomic factors, the patient was managed conservatively with regular physiotherapy sessions. OUTCOMES Follow-up after 6 weeks showed remarkable improvement, with complete resolution of symptoms 10 weeks after the discharge. LESSONS This case suggests that MFS is a rare adverse effect after COVID-19 vaccination and additional research is required to substantiate a temporal association. Further studies are needed to understand the pathophysiology behind such complications to enhance the safety of COVID-19 vaccinations in the future.
Collapse
Affiliation(s)
- Ahsun Rizwan Siddiqi
- Wah Medical College, Affiliated with University of Health Sciences, Wah, Pakistan
| | - Tehrim Khan
- Wah Medical College, Affiliated with University of Health Sciences, Wah, Pakistan
| | | | | | - Md. Saiful Islam
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka-1342, Bangladesh
- Centre for Advanced Research Excellence in Public Health, Savar, Dhaka-1342, Bangladesh
| | | |
Collapse
|
12
|
Fiorini AC, Finsterer J, Scorza FA. The spectrum of SARS-CoV-2 associated polyradiculitis is broad. QJM 2022; 114:835. [PMID: 34191022 PMCID: PMC8344672 DOI: 10.1093/qjmed/hcab178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ana C Fiorini
- Programa de Estudos Pós-Graduado em Fonoaudiologia, Pontifícia Universidade Católica de São Paulo (PUC-SP), Brazil; Departamento de Fonoaudiologia, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
| | - Josef Finsterer
- Klinik Landstrasse, Messerli Institute, Vienna, Austria
- Corresponding author: Finsterer J, MD, PhD, Postfach 20, 1180 Vienna, Austria, Tel. +43-1-71165-72085, Fax. +43-1-71165,
| | - Fulvio A Scorza
- Disciplina de Neurociência. Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brasil
| |
Collapse
|
13
|
Lavilla Olleros C, López-Rubio M, Fanciulli C, González-Munera A, Millán Núñez-Cortés J. [Isolated facial diplegia as an atypical variant of Guillain-Barre syndrome after suspected SARS-CoV-2 infection]. Rev Fac Cien Med Univ Nac Cordoba 2021; 78:405-7. [PMID: 34962738 DOI: 10.31053/1853.0605.v78.n4.32392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 03/26/2021] [Indexed: 11/21/2022] Open
Abstract
Introducción Desde que se inició la pandemia por el SARS-CoV-2, se han descrito numerosos casos de síndrome de Guillain-Barré secundario a la COVID-19. Su presentación típica es la triada de parestesias, debilidad muscular ascendente y arreflexia, aunque hay diversas variantes regionales como la diplejía facial. Presentación del caso Mujer de 35 años que, dos semanas después de un contacto estrecho con un caso confirmado de COVID-19, ingresa por miopericarditis probablemente viral, con estudio de autoinmunidad negativo, múltiples serologías virales negativas y positividad para IgG anti-SARS-CoV-2 con PCR negativa. Una semana tras el alta presenta paresia de ambos nervios faciales sin otras alteraciones neurológicas. Se realiza TAC craneal sin hallazgos y EMG que evidencia afectación bilateral de los nervios faciales. La paciente rechaza realización de punción lumbar. Discusión La diplejía facial puede ocurrir en el contexto de diversas patologías, como tumores meníngeos o troncoencefálicos, agentes infecciosos, síndrome de Guillain-Barré, patologías autoinmunes, traumatismos, causas metabólicas o causas congénitas. En el caso descrito tras descartar mediante pruebas de imagen y analíticamente el resto de etiologías, y dada la presentación clínica, permanece como causa más probable el síndrome de Guillain-Barré, posiblemente secundario a infección por SARS-CoV-2 dada la positividad de IgG anti-SARS-CoV-2 tras un contacto con un caso confirmado. Conclusión Este caso apoya la hipótesis de que la COVID-19 puede desencadenar el síndrome de Guillain-Barré, específicamente en forma de diplejía facial, una variante atípica que se debe conocer para su identificación y manejo precoz como parte de este síndrome.
Collapse
|
14
|
Shafiq A, Salameh MA, Laswi I, Mohammed I, Mhaimeed O, Mhaimeed N, Mhaimeed N, Paul P, Mushannen M, Elshafeey A, Fares A, Holroyd S, Zakaria D. Neurological Immune Related Adverse Events Post-COVID-19 Vaccination: A Systematic Review. J Clin Pharmacol 2021; 62:291-303. [PMID: 34921562 DOI: 10.1002/jcph.2017] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 12/14/2021] [Indexed: 11/07/2022]
Abstract
The COVID-19 pandemic has affected millions of individuals worldwide. The global scientific effort to design an effective vaccine against this virus has led to the development of several vaccine candidates. The expedited roll-out of these vaccines has created some public distrust regarding the safety of these new vaccines. This review compiles clinical data from reports of diagnosed immune-related neurological events that have occurred post-COVID-19 vaccine administration with the exception of those secondary to hematological abnormalities. A systematic literature search was performed, using several databases, to identify reports of post-vaccination adverse neurological events. The search resulted in 18 studies that met our criteria. These studies included 78 patients who had received COVID-19 vaccines and experienced at least one neurological adverse effect. The most common neurological event was Facial nerve palsy (62.3% of all events). Other less frequently reported events included the reactivation of herpes zoster, Guillain-Barre Syndrome, other demyelinating diseases, and neuropathy. The underlying mechanism was hypothesized to be related to vaccine-induced type 1 interferon production leading to decreased tolerance of the myelin sheath antigens. Other hypotheses include vaccine-induced transient lymphopenia and immune dysregulation. Most of the reported events were time-limited and resolved spontaneously. Given the rarity of reported neurological events compared to the total number of vaccines administered, and the similarity in the incidence of events between COVID-19 vaccines and other more common vaccines, there is little evidence to support a causal relationship between COVID-19 vaccines and adverse neurological events. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Ameena Shafiq
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Al Luqta St. Ar-Rayyan, Doha, P.O. Box 24144, Qatar
| | - Mohammad A Salameh
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Al Luqta St. Ar-Rayyan, Doha, P.O. Box 24144, Qatar
| | - Ibrahim Laswi
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Al Luqta St. Ar-Rayyan, Doha, P.O. Box 24144, Qatar
| | - Ibrahim Mohammed
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Al Luqta St. Ar-Rayyan, Doha, P.O. Box 24144, Qatar
| | - Omar Mhaimeed
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Al Luqta St. Ar-Rayyan, Doha, P.O. Box 24144, Qatar
| | - Nada Mhaimeed
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Al Luqta St. Ar-Rayyan, Doha, P.O. Box 24144, Qatar
| | - Narjis Mhaimeed
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Al Luqta St. Ar-Rayyan, Doha, P.O. Box 24144, Qatar
| | - Pradipta Paul
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Al Luqta St. Ar-Rayyan, Doha, P.O. Box 24144, Qatar
| | - Malik Mushannen
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Al Luqta St. Ar-Rayyan, Doha, P.O. Box 24144, Qatar
| | - Abdallah Elshafeey
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Al Luqta St. Ar-Rayyan, Doha, P.O. Box 24144, Qatar
| | - Ahmed Fares
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Al Luqta St. Ar-Rayyan, Doha, P.O. Box 24144, Qatar
| | - Sean Holroyd
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Al Luqta St. Ar-Rayyan, Doha, P.O. Box 24144, Qatar
| | - Dalia Zakaria
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Al Luqta St. Ar-Rayyan, Doha, P.O. Box 24144, Qatar
| |
Collapse
|
15
|
Lin J, Gao Q, Xiao K, Tian D, Hu W, Han Z. Efficacy of therapies in the treatment of Guillain-Barre syndrome: A network meta-analysis. Medicine (Baltimore) 2021; 100:e27351. [PMID: 34731107 PMCID: PMC8519256 DOI: 10.1097/md.0000000000027351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/09/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Guillain-Barre syndrome (GBS) is a disease with the features of acuteness, paralysis, inflammation, and in peripheral nerves. There are many current treatment options with varying efficacy, and to assess their effectiveness, we performed a network meta-analysis (NMA). The study protocol was registered at PROSPERO (CRD: 42019119178). Posted history: this manuscript was previously posted to medRxiv: doi: https://doi.org/10.1101/2020.06.03.20121780. METHODS The literature search database includes Web of Science, PubMed, Embase, and the Cochrane library that meets the requirements. We performed the NMA using controlled trials with 2 kinds of outcomes. We used the gemtc R package to perform the NMA to evaluate different GBS treatments' relative results. The consistency of direct and indirect evidence was also assessed by R software with gemtc package. RESULTS This NMA study included a total of 2474 subjects from 28 trials with 15 kinds of therapies. No improvement was observed in methylprednisolone and prednisolone compared with placebo. Conversely, plasma exchange (PE) and intravenous immunoglobulin (IVIg) were more effective than placebo. There was no significant difference between different doses and courses of PE and IVIg. For combination treatment, such as IVIg+eculizumab, immunoadsorption followed by IVIg and PE followed by IVIg, they didn't show significant advantages than IVIg and PE in NMA. On the consistency examination between direct and indirect evidence, there was no apparent heterogeneity between them. Funnel plots indicated there was little possibility of publication bias in this study. CONCLUSION PE or IVIg has significant efficacy for GBS patients. The effects of several kinds of therapies should be further explored. Corticosteroids have no considerable impact on GBS.
Collapse
Affiliation(s)
- Jingfeng Lin
- Hangzhou Seventh People's Hospital, Hangzhou, China
| | - Qiang Gao
- Beijing University of Chinese Medicine, Beijing, China
| | - Kang Xiao
- Beijing University of Chinese Medicine, Beijing, China
| | - Danfeng Tian
- Beijing University of Chinese Medicine, Beijing, China
| | - Wenyue Hu
- Beijing University of Chinese Medicine, Beijing, China
| | - Zhenyun Han
- Shenzhen Hospital of Beijing University of Chinese Medicine (Longgang), Shenzhen, China
| |
Collapse
|
16
|
Goedee HS, Rajabally YA. To treat or not to treat mild Guillain-Barré syndrome: limited evidence for but still none against. J Neurol Neurosurg Psychiatry 2021; 92:1027-1028. [PMID: 34103337 DOI: 10.1136/jnnp-2021-326848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 11/04/2022]
Affiliation(s)
- H Stephan Goedee
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center Rudolf Magnus, Utrecht, Utrecht, The Netherlands
| | - Yusuf A Rajabally
- Regional Neuromuscular clinic, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
17
|
Madala S, Macdougall K, Morvillo G, Guarino R, Sokoloff A. Guillain-Barré Syndrome as a Presenting Symptom in Breast Cancer: The Importance of Considering Paraneoplastic Neurologic Syndrome. Cureus 2021; 13:e17932. [PMID: 34532200 PMCID: PMC8436832 DOI: 10.7759/cureus.17932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 11/17/2022] Open
Abstract
Paraneoplastic neurological syndromes (PNS) are a group of rare immune-mediated disorders with neurological sequela in cancer patients. It usually occurs when an immune response against a systemic tumor is incorrectly directed to the nervous system. Compared to other reported manifestations of PNS in breast cancer, Guillain Barre syndrome (GBS) is exceedingly rare. There is only one other reported case in the literature of GBS that was diagnosed in a breast cancer patient. We report the second recorded case of a 61-year-old female with a history of early-stage breast cancer, who presented with symptoms of lower extremity weakness initially suspected to be GBS but later found to have been recurrent breast cancer. No specific guidelines are available for the treatment of PNS. Treatment of underlying malignancy with chemotherapy and immunotherapies are usually recommended.
Collapse
Affiliation(s)
- Samragnyi Madala
- Internal Medicine, Hofstra Northwell School of Medicine, Staten Island, USA
| | | | | | | | | |
Collapse
|
18
|
Tsagkas C, Wendebourg MJ, Mehling M, Lorscheider J, Lyrer P, Décard BF. Acute Polyradiculomyelitis With Spinal Cord Gray Matter Lesions: A Report of Two Cases. Front Neurol 2021; 12:721669. [PMID: 34489856 PMCID: PMC8416670 DOI: 10.3389/fneur.2021.721669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/15/2021] [Indexed: 11/14/2022] Open
Abstract
Objective: Inflammatory polyradiculomyelitis belongs to a rare group of immune-mediated diseases affecting both the central and peripheral nervous system. We aimed to describe an unusual presentation of acute polyradiculomyelitis with marked spinal cord lesions restricted to the gray matter. Methods: Thorough examination of two case reports including clinical, MRI, serologic, electrophysiologic and CSF examinations as well as short-term follow-up. Results: We present two adult patients with acute polyradiculomyelitis and unusual spinal cord lesions restricted to the gray matter on MRI. The clinical presentation, serologic, electrophysiologic and CSF features of the two patients varied, whereas both patients demonstrated severe, asymmetrical, predominantly distal, motor deficits of the lower extremities as well as bladder and bowel dysfunction. Both patients only partially responded to anti-inflammatory treatment. Severe motor impairment and bladder dysfunction persisted even months after symptom onset. Conclusions: To our best of knowledge, these are the first reports of acute polyradiculomyelitis with distinct involvement of the lower thoracic spinal cord gray matter. Currently, it remains unclear whether gray matter lesions reflect a separate pathophysiologic mechanism or an exceedingly rare presentation of spinal cord involvement in acute polyradiculomyelitis.
Collapse
Affiliation(s)
- Charidimos Tsagkas
- Neurology Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Maria Janina Wendebourg
- Neurology Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Matthias Mehling
- Neurology Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Johannes Lorscheider
- Neurology Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Philippe Lyrer
- Neurology Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Bernhard Friedrich Décard
- Neurology Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| |
Collapse
|
19
|
Goedee HS, Attarian S, Kuntzer T, Van den Bergh P, Rajabally YA. Iatrogenic immune-mediated neuropathies: diagnostic, epidemiological and mechanistic uncertainties for causality and implications for clinical practice. J Neurol Neurosurg Psychiatry 2021; 92:975-982. [PMID: 34103346 DOI: 10.1136/jnnp-2019-321663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/19/2021] [Indexed: 11/03/2022]
Abstract
Acute and chronic immune-mediated neuropathies have been widely reported with medical intervention. Although causal relationship may be uncertain in many cases, a variety of drugs, several vaccination types, surgical procedures and bone marrow transplants have been reported as possible cause or trigger of a putative immune-mediated response resulting in acute and chronic neuropathies. We conducted a systematic review of the literature from 1966 to 2020 on reported cases of possible iatrogenic immune-mediated neuropathies. We determined in each case the likelihood of causality based on frequency of the association, focusing primarily on clinical presentation and disease course as well as available ancillary investigations (electrophysiology, blood and cerebrospinal fluid and neuropathology). The response to immunotherapy and issue of re-exposure were also evaluated. We also considered hypothesised mechanisms of onset of immune-mediated neuropathy in the specific iatrogenic context. We believe that a likely causal relationship exists for only few drugs, mainly antitumour necrosis factor alpha agents and immune checkpoint inhibitors, but remains largely unsubstantiated for most other suggested iatrogenic causes. Unfortunately, given the lack of an accurate diagnostic biomarker for most immune-mediated neuropathies, clinical assessment will often override ancillary investigations, resulting in lower levels of certainty that may continue to cast serious doubts on reliability of their diagnosis. Consequently, future reports of suspected cases should collect and exhaustively assess all relevant data. At the current time, besides lack of evidence for causality, the practical implications on management of suspected cases is extremely limited and therapeutic decisions appear likely no different to those made in non-iatrogenic cases.
Collapse
Affiliation(s)
- H Stephan Goedee
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Thierry Kuntzer
- Service of Neurology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Peter Van den Bergh
- Centre de Référence Neuromusculaire, Cliniques Universitaires St-Luc, Brussels, Belgium
| | - Yusuf A Rajabally
- Inflammatory Neuropathy Clinic, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK .,Aston Medical School, Aston University, Birmingham, UK
| |
Collapse
|
20
|
Scendoni R, Petrelli C, Scaloni G, Logullo FO. Electromyoneurography and laboratory findings in a case of Guillain-Barré syndrome after second dose of Pfizer COVID-19 vaccine. Hum Vaccin Immunother 2021; 17:4093-4096. [PMID: 34347563 DOI: 10.1080/21645515.2021.1954826] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Guillain-Barre syndrome (GBS) is an acute immune-mediated disease of the peripheral nerves and nerve roots (polyradiculoneuropathy) that is usually elicited by various infections. We present a case of GBS after receiving the second dose of Pfizer-COVID 19 vaccine. Diagnosis was made after performing an accurate clinical examination, electromyoneurography and laboratory tests. In particular, anti-ganglioside antibodies have tested positive. During this pandemic with ongoing worldwide mass vaccination campaign, it is critically important for clinicians to rapidly recognize neurological complications or other side effects associated with COVID-19 vaccination.
Collapse
Affiliation(s)
- Roberto Scendoni
- Macerata Territorial Health Department, Legal Medicine Unit ASUR Marche AV3, Macerata, Italy
| | - Cristina Petrelli
- Neurological Unit ASUR Marche AV3, Macerata Hospital, Macerata, Italy
| | - Giorgia Scaloni
- Hospital Medical Direction, ASUR Marche AV3, Macerata Hospital, Macerata, Italy
| | | |
Collapse
|
21
|
Brown M, Petrassi A, Bureau BL, Khan N, Jha P. SARS-CoV-2-Associated Guillain-Barre Syndrome Obscured by Diabetes Mellitus Peripheral Neuropathy. Cureus 2021; 13:e14209. [PMID: 33948399 PMCID: PMC8086757 DOI: 10.7759/cureus.14209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Multiple neurological complications, including Guillain-Barre syndrome (GBS), have been reported in association with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak. GBS has well-known associations with viruses such as influenza, human immunodeficiency virus, Zika, severe acute respiratory syndrome, Middle East respiratory syndrome, Epstein-Barr virus, and cytomegalovirus. Till date, there have been around 50 distinct published cases of GBS occurring concurrently or shortly after SARS-CoV-2 infection. This report describes the case of a 53-year-old male who presented with bilateral extremity paresthesias two weeks after a positive SARS-CoV-2 test. His symptoms were originally thought to be due to underlying diabetic peripheral neuropathy, but as they progressed, he was eventually diagnosed with SARS-CoV-2-associated GBS. Though GBS may not be a common sequelae of SARS-CoV-2 infection, the prevalence of diabetes mellitus-associated peripheral neuropathy is high enough to warrant awareness and prompt recognition of neurological symptoms that deviate from the baseline in individuals with recent, confirmed SARS-CoV-2 infection.
Collapse
Affiliation(s)
- Miranda Brown
- Internal Medicine, Medical College of Wisconsin, Milwaukee, USA
| | - Alana Petrassi
- Internal Medicine, Medical College of Wisconsin, Milwaukee, USA
| | - Britta L Bureau
- Internal Medicine/Neurology, Medical College of Wisconsin, Milwaukee, USA
| | - Nabeel Khan
- Internal Medicine, Medical College of Wisconsin, Milwaukee, USA
| | - Pinky Jha
- Internal Medicine, Medical College of Wisconsin, Milwaukee, USA
| |
Collapse
|
22
|
Abstract
There is growing evidence of neurological involvement in patients with coronavirus disease 19 (COVID-19), suggesting that Guillain-Barre syndrome (GBS) can also occur with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as a neurological complication. Herein, we describe a unique case of a 45-year-old male who manifested with sudden onset progressive symmetric ascending paralysis leading to quadriplegia one week after developing fever, cough, and dyspnea. On examination, he had areflexia in lower limbs and hyporeflexia in upper limbs. Hypoesthesia to fine touch and vibration distal to calf was noted. His reverse transcriptase-polymerase chain reaction (RT-PCR) was positive for COVID-19, and his cerebrospinal fluid (CSF) analysis revealed albumin-cytologic dissociation. The diagnosis of GBS was made based on clinical presentation and neurophysiological studies due to COVID-19. He was commenced on intravenous immunoglobulin, and improvement in his condition was observed. He was discharged to a rehabilitation center for regular physical therapy.
Collapse
Affiliation(s)
| | - Saher T Shiza
- Internal Medicine, Deccan College of Medical Sciences, Hyderabad, IND
| | | | - Manal Dawe
- Medicine, Capital Medical University, Beijing, CHN
| | | |
Collapse
|
23
|
Kusunoki S. CSF sphingomyelin: possible biomarker of demyelination. J Neurol Neurosurg Psychiatry 2021; 92:232. [PMID: 33361407 DOI: 10.1136/jnnp-2020-324931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 11/19/2020] [Accepted: 11/21/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Susumu Kusunoki
- Department of Neurology, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan
| |
Collapse
|
24
|
Kusunoki S, Willison HJ, Jacobs BC. Antiglycolipid antibodies in Guillain-Barré and Fisher syndromes: discovery, current status and future perspective. J Neurol Neurosurg Psychiatry 2021; 92:311-318. [PMID: 33376111 DOI: 10.1136/jnnp-2020-325053] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/14/2020] [Accepted: 12/14/2020] [Indexed: 11/03/2022]
Abstract
Guillain-Barré syndrome (GBS) and Fisher syndrome (FS) are acute autoimmune neuropathies, often preceded by an infection. Antiglycolipid antibody titres are frequently elevated in sera from the acute-phase patients. Particularly, IgG anti-GQ1b antibodies are positive in as high as 90% of FS cases and thus useful for diagnosis. The development of animal models of antiglycolipid antibody-mediated neuropathies proved that some of these antibodies are directly involved in the pathogenetic mechanisms by binding to the regions where the respective target glycolipid is specifically localised. Discovery of the presence of the antibodies that specifically recognise a new conformational epitope formed by two different gangliosides (ganglioside complex) in the acute-phase sera of some patients with GBS suggested the carbohydrate-carbohydrate interaction between glycolipids. This finding indicated the need for further research in basic glycobiological science. Antiglycolipid antibodies, in particular antigangliosides antibodies, are mostly detected in acute motor axonal neuropathy type of GBS and in FS, and less frequently in the acute inflammatory demyelinating polyneuropathy (AIDP) type of GBS or in central nervous system (CNS) diseases. In the future, the search for the putative antibodies in AIDP and those that might be present in CNS diseases should continue. In addition, more efficient standardisation of antiglycolipid antibody detection methods and use as biomarkers in daily clinical practice in neurology is needed.
Collapse
Affiliation(s)
- Susumu Kusunoki
- Department of Neurology, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Hugh J Willison
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Bart C Jacobs
- Department of Neurology and Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
25
|
Jacobs BC. Neurofilament light chain as biomarker for axonal damage in Guillain-Barré syndrome. J Neurol Neurosurg Psychiatry 2020; 92:jnnp-2020-324308. [PMID: 33154185 PMCID: PMC7803883 DOI: 10.1136/jnnp-2020-324308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/02/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Bart C Jacobs
- Neurology and Immunology, Erasmus Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
26
|
Leonhard SE, Cornblath DR, Endtz HP, Sejvar JJ, Jacobs BC. Guillain-Barré syndrome in times of pandemics. J Neurol Neurosurg Psychiatry 2020; 91:1027-1029. [PMID: 32732383 PMCID: PMC7509514 DOI: 10.1136/jnnp-2020-324230] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/20/2020] [Indexed: 01/26/2023]
Affiliation(s)
| | | | - Hubert P Endtz
- Medical Microbiology & Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands.,Fondation Mérieux, Lyon, France
| | - James J Sejvar
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Bart C Jacobs
- Neurology and Immunology, Erasmus MC, Rotterdam, The Netherlands
| |
Collapse
|
27
|
Abstract
March 11, 2020, marked the start of the coronavirus disease 2019 (COVID-19) pandemic. COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was being reported as severe respiratory illness. However, since the recognition of this novel virus, there has been a constant realization that it may present or manifest in a multitude of ways. At first, the typical signs and symptoms were what one would expect from a respiratory virus: cough, shortness of breath, and fever. However, as the disease became more prevalent, neurologic symptoms were reported such as headaches, hypogeusia, and hyposmia. This case report aims to add to the growing body of neurologic manifestations by presenting two cases, Bell's palsy and Guillain-Barre Syndrome. Each case involves flaccid paralysis as the primary presentation.
Collapse
Affiliation(s)
- Ahmed Elkhouly
- Internal Medicine, St. Francis Medical Center, Trenton, USA
| | - Adam C Kaplan
- Internal Medicine, St. Francis Medical Center, Seton Hall University-Hackensack Meridian School of Medicine, Trenton, USA
| |
Collapse
|
28
|
Ocampo Rojas SJ. [COVID-19 neurologic manifestation]. ACTA ACUST UNITED AC 2020; 77:130. [PMID: 32558518 DOI: 10.31053/1853.0605.v77.n2.28410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/05/2020] [Indexed: 11/21/2022]
Abstract
Dear Director: Reading your article "The pandemic due to the new covid-19 coronavirus", I would like to deepen the contributions of the symptoms of this disease. What has started as a pathology manifested by a respiratory syndrome such as atypical pneumonia, is currently associated with several non-respiratory manifestations (1). Guillain-Barré syndrome in a female traveler from Wuhan is one of the first reported neurological manifestations (2). The literature is rich in terms of headaches, seizures and strokes in seriously ill patients, although the first and last of these may be due to systemic complications of this novel coronavirus, a higher incidence of events has been reported in patients with a history of neurological manifestations. (3.4). One of the most recent manifestations reported is neuromuscular diseases. Guidon et al. criticize the lack of rigor in the reports on neuromuscular manifestations (4). If anything is certain, one manifestation of this pandemic is the large amount of information available in the scientific field, many of these without the same methodological rigor as before the pandemic, accentuating the responsibility of the reader to critically analyze all the information.
Collapse
|
29
|
Abstract
Guillain-Barre syndrome (GBS) is the most common cause of flaccid paralysis in affected patients. Here we present a case of GBS presenting with flaccid paralysis as well as hyponatremia. The association of hyponatremia in GBS is discussed, as well as other potential causes and risk factors.
Collapse
Affiliation(s)
- Daniel Griffin
- Pulmonology and Critical Care, University of Missouri-Kansas City, Kansas City, USA
| | - Hussein Asad
- Pulmonary and Critical Care, University of Missouri-Kansas City, Kansas City, USA
| | - Parth Patel
- Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, USA
| | - Ashraf Gohar
- Pulmonary and Critical Care and Sleep, University of Missouri-Kansas City (Hospital Hills Campus), Kansas City, USA
| |
Collapse
|
30
|
Abode-Iyamah K, Bohnen AM. Guillain-Barre Syndrome After Minimally Invasive Transforaminal Interbody Fusion: A Case Report. Cureus 2019; 11:e6222. [PMID: 31890423 PMCID: PMC6929252 DOI: 10.7759/cureus.6222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 11/22/2019] [Indexed: 02/06/2023] Open
Abstract
Guillain-Barre syndrome (GBS) is an autoimmune disorder in which an individual's immune system attacks the peripheral nerve myelin. Although rare, but serious, the syndrome typically starts with numbness, tingling, or weakness in the lower extremities and progresses in an ascending fashion. Severe weakness can transmit into paralysis and respiratory compromise. Although rare, GBS has been reported as a complication of multiple surgeries including orthopedic, cardiovascular, transplant, and general surgeries. To our knowledge, we here present the first case report of GBS after minimally invasive transforaminal interbody fusion. Furthermore, we highlight the importance of understanding the presenting symptoms and identifying proper examination findings, particularly in the setting of confounding factors, for prompt diagnosis, treatment, and reduction of morbidity.
Collapse
|
31
|
Leonhard SE, Munts AG, van der Eijk AA, Jacobs BC. Acute-onset chronic inflammatory demyelinating polyneuropathy after Zika virus infection. J Neurol Neurosurg Psychiatry 2018; 89:1118-1119. [PMID: 29175895 DOI: 10.1136/jnnp-2017-317346] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 11/07/2017] [Accepted: 11/08/2017] [Indexed: 11/04/2022]
Affiliation(s)
- Sonja E Leonhard
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Alexander G Munts
- Department of Neurology, Spaarne Gasthuis Hospital, Haarlem, The Netherlands
| | | | - Bart C Jacobs
- Department of Neurology and Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
32
|
Manam R, Martin JL, Gross JA, Chaudhary D, Chowdhary S, Espinosa PS, Santos ES. Case Reports of Pembrolizumab-induced Acute Inflammatory Demyelinating Polyneuropathy. Cureus 2018; 10:e3371. [PMID: 30510881 PMCID: PMC6257738 DOI: 10.7759/cureus.3371] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Pembrolizumab is a humanized monoclonal antibody that blocks the programmed cell death 1 (PD-1) pathway, thereby enhancing antitumor immunity. As the use of immune checkpoint inhibitors becomes more prevalent, so do immune-related adverse events associated with their use. The immune-related adverse events linked with this class of drugs are commonly seen and most of the time are classified as mild adverse events. These are easily treated with steroids if recognition of symptomatology and treatment are promptly established. However, neurologic immune-related adverse events are less understood and have been infrequently cited in the medical literature, thus representing a challenge for clinicians.
Collapse
Affiliation(s)
- Rupesh Manam
- Internal Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Jasmine L Martin
- Internal Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Joshua A Gross
- Internal Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Dhishna Chaudhary
- Internal Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | | | | | | |
Collapse
|
33
|
van den Berg B, Storm EF, Garssen MJP, Blomkwist-Markens PH, Jacobs BC. Clinical outcome of Guillain-Barré syndrome after prolonged mechanical ventilation. J Neurol Neurosurg Psychiatry 2018; 89:949-954. [PMID: 29627773 DOI: 10.1136/jnnp-2018-317968] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 02/27/2018] [Accepted: 03/13/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Patients with Guillain-Barré syndrome (GBS) may suffer from respiratory failure for months or longer. The aim of this study was to determine the frequency, clinical course and outcome of patients with GBS requiring prolonged mechanical ventilation (MV). METHODS Prospectively collected data from 526 patients with GBS participating in previous trials were analysed to determine the frequency and duration of prolonged MV (longer than 2 months). In addition, a cross-sectional study was conducted in patients with GBS requiring MV to determine the clinical course and long-term outcome with the ability to walk unaided as primary endpoint. RESULTS In the cohort study, 145 of 526 patients with GBS (28%) required MV, including 33 (6%) patients with prolonged MV. Patients requiring prolonged MV had a lower Medical Research Council sum score and more frequent bulbar involvement and inexcitable nerves compared with shorter ventilated patients. At 6 months, 18% of patients with prolonged MV were able to walk unaided compared with 76% of patients requiring shorter MV (P<0.001). In the cross-sectional study, 63 patients requiring MV were included with a median follow-up of 11 years (range 2-44 years). Twenty-six (41%) of these patients needed prolonged MV (median 93 days, range 62-261). Fifteen (58%) of these patients were able to walk unaided at maximum follow-up and eight (31%) reached this endpoint more than 1 year after diagnosis. CONCLUSIONS Prolonged ventilation in GBS is associated with poor prognosis, yet patients requiring prolonged ventilation may show slow but persistent recovery for years and even reach the ability to walk and live independently.
Collapse
Affiliation(s)
- Bianca van den Berg
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Eline F Storm
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marcel J P Garssen
- Department of Neurology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | | | - Bart C Jacobs
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
34
|
Abstract
A 42-year-old man, returning to Europe after a 2-month stay in China, reported cough and runny nose. Five days later, he developed neck discomfort and rapidly evolving weakness, spreading from his arms to the facial, bulbar and neck muscles, and then the legs. He developed dysphagia and breathlessness, and was intubated in the emergency department. Cerebrospinal fluid showed mildly elevated protein. On day 2 he had fixed dilated pupils, with absent oculocephalic reflexes, and a flaccid upper limb paralysis. MR scans of the brain and spinal cord were normal. The early features of descending weakness, bulbar involvement and fixed dilated pupils made it difficult to distinguish between Guillain-Barré syndrome and botulism, and early investigations were inconclusive. We initially gave both botulinum antitoxin and intravenous immunoglobulin, but initially delayed plasma exchange as this would have removed the botulinum antitoxin. Diagnostic testing for botulism has low sensitivity, so we urge pre-emptive treatment if it is clinically suspected.
Collapse
Affiliation(s)
- Robert Durcan
- Department of Neurology, Mater Misericordiae University Hospital, Dublin, Ireland.,Dublin Neurological Institute, Dublin, Ireland
| | - Olwen Murphy
- Department of Neurology, Mater Misericordiae University Hospital, Dublin, Ireland.,Dublin Neurological Institute, Dublin, Ireland.,Johns Hopkins University, Baltimore, Maryland, USA
| | - Valerie Reid
- Department of Neurology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Tim Lynch
- Department of Neurology, Mater Misericordiae University Hospital, Dublin, Ireland.,Dublin Neurological Institute, Dublin, Ireland
| |
Collapse
|
35
|
Uncini A, Vallat JM. Autoimmune nodo-paranodopathies of peripheral nerve: the concept is gaining ground. J Neurol Neurosurg Psychiatry 2018; 89:627-635. [PMID: 29248893 DOI: 10.1136/jnnp-2017-317192] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 10/15/2017] [Accepted: 11/13/2017] [Indexed: 12/20/2022]
Abstract
Peripheral neuropathies are classified as primarily demyelinating or axonal. Microstructural alterations of the nodal region are the key to understand the pathophysiology of neuropathies with antibodies to gangliosides and the new category of nodo-paranodopathy has been proposed to better characterise these disorders and overcome some inadequacies of the dichotomous classification. Recently, the research in autoimmune neuropathies has been boosted by reports of patients carrying immunoglobulin G4 antibodies against paranodal axo-glial proteins with distinct phenotypes and showing loss of transverse bands, terminal myelin loop detachment, nodal widening and axonal loss. These patients have been classified up to now as chronic inflammatory demyelinating polyradiculoneuropathy but, in our opinion, better fit into the nodo-paranodopathy category because nerve injury is due to dismantling of the paranode, segmental de-remyelination is absent and the pathogenic mechanism is not inflammatory. Evidence from nerve conductions and electron microscopy studies in patients and mutant animal models can reconcile the apparent contrast between the electrophysiological 'demyelinating' features, explainable just by the paranodal involvement and the axonal pathology. These patients broaden the autoimmune nodo-paranodopathy category and re-emphasise the usage of the term that pointing to the site of nerve injury reminds specific pathophysiological mechanisms, reconciles contrasting electrophysiological and pathological findings, and avoids misdiagnosis and taxonomic confusion. In our opinion, the nodo-paranodopathy term more adequately classifies the peripheral nerve disorders due to an autoimmune attack directed and limited to the nodal region integrating the traditional classification of peripheral neuropathies.
Collapse
Affiliation(s)
- Antonino Uncini
- Department of Neurosciences, Imaging and Clinical Sciences University G. d'Annunzio, Chieti-Pescara, Italy
| | - Jean-Michel Vallat
- Department of Neurology and 'Centre de Référence des neuropathies rares', CHU Limoges, Limoges, France
| |
Collapse
|
36
|
Fukumoto Y, Kuwahara M, Kawai S, Nakahama K, Kusunoki S. Acute demyelinating polyneuropathy induced by nivolumab. J Neurol Neurosurg Psychiatry 2018; 89:435-437. [PMID: 28844069 DOI: 10.1136/jnnp-2017-316510] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 07/03/2017] [Accepted: 08/07/2017] [Indexed: 11/04/2022]
Affiliation(s)
- Yuta Fukumoto
- Department of Neurology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Motoi Kuwahara
- Department of Neurology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Shigeru Kawai
- Department of Neurology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Kenji Nakahama
- Department of Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Osaka, Japan
| | - Susumu Kusunoki
- Department of Neurology, Kindai University Faculty of Medicine, Osaka, Japan
| |
Collapse
|
37
|
Abstract
Introduction. Guillain-Barré Syndrome (GBS) is an acute demyelinating polyneuropathy which can occur post-infection. Criteria of diagnosis of GBS include areflexia with progressive bilateral weakness in arms and legs. GBS can lead to severe respiratory and cardiac complications. The fatality rate can be up to 5 % in patients, depending on the severity of the symptoms. HIV can cause a range of neurological disorders including, on rare occasions, GBS. GBS can occur at any stage of HIV infection, highlighting the complexity of diagnosis of GBS within HIV patients. Case presentation. A 57 year old female with lumbar back pain radiating to the legs, poor mobility and tiredness, with reports of a viral-like illness four days previously, was initially diagnosed with a lower respiratory tract infection and discharged. Seventeen days later the patient was readmitted to hospital with progressive lower and upper limb weakness, areflexia and sensory loss. She was diagnosed with GBS and was unexpectedly discovered to be HIV-positive. HIV avidity was low indicating a recently acquired HIV infection. The patient was treated with intravenous immunoglobulin for five days for the GBS and commenced antriretrovirals for HIV. The patient was discharge from hospital 53 days after admission with walking aids and regular physiotherapy follow-up. CONCLUSION . This case highlighted the need for all clinicians to be aware that patients with symptoms of GBS, regardless of clinical history should be offered an HIV test. GBS can be the first sign a patient is HIV-positive.
Collapse
Affiliation(s)
- Samantha J Shepherd
- West of Scotland Specialist Virology Centre, Level 5, New Lister Building, 10-16 Alexandra Parade, Glasgow G31 2ER, UK
| | - Heather Black
- Infectious Diseases Unit, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - Emma C Thomson
- MRC-University of Glasgow Centre for Virus Research, Stoker Building, 464 Bearsden Road, Glasgow G61 1QH, UK
| | - Rory N Gunson
- West of Scotland Specialist Virology Centre, Level 5, New Lister Building, 10-16 Alexandra Parade, Glasgow G31 2ER, UK
| |
Collapse
|
38
|
Abstract
A 35-year-old man presented with myalgia and bilateral hand weakness, 3 days after the onset of lethargy, fevers and rigours. The hand weakness caused functional impairment including difficulty pressing keys on his mobile phone. On examination, there was mild bilateral hand weakness with normal reflexes. His serum creatine kinase was mildly raised at 503 U/L (24-195), viral PCR throat swab was negative and electromyogram showed subtle myopathic changes in the distal forearm muscles. Nerve conduction studies found no evidence of neuropathy. Forced vital capacity was reduced on admission (1.5 L) but improved within 24 hours (2.3 L). We gave supportive intravenous fluids and his weakness improved within 48 hours. He was discharged and reported that the weakness had fully resolved within weeks. The diagnosis was viral myositis. Distal forearm myositis rarely follows H1N1 influenza in adults but is an important differential for postinfective neurological symptoms.
Collapse
Affiliation(s)
- Sayan Datta
- Department of Neurology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Jeremy Cosgrove
- Department of Neurology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Taimour Alam
- Department of Neurophysiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Helen L Ford
- Department of Neurology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| |
Collapse
|
39
|
Abstract
We are describing a case of an 18-year-old male patient with cytomegalovirus (CMV) associated guillain-barre syndrome (GBS) who presented with an acute onset of generalized weakness and numbness in the extremities, dysphagia, and facial diplegia, followed by respiratory failure, which led to mechanical ventilation. He had positive immunoglobulin G and immunoglobulin M antibodies against CMV, and CMV polymerase chain reaction was positive with <2000 copies of deoxyribonucleic acid. Human immunodeficiency virus test was negative. He received a course of ganciclovir, intravenous immunoglobulin, and plasmapheresis. After improving from acute episode, patient was transferred to a rehabilitation facility for physical and occupational therapy. At the rehabilitation facility, he exhibited signs of acute abdomen with pain in the left upper quadrant secondary to peritonitis from dislodged gastrostomy tube and underwent exploratory laparotomy. During the hospital course he was found to have splenic infarct and colitis on the computed tomography of abdomen. This case showed an immunocompetent young patient with multisystem complications including guillain-barre syndrome (GBS), splenic infarct, hepatitis, and colitis due to CMV.
Collapse
Affiliation(s)
| | - Murali Krishna Gurram
- Department of Internal Medicine, Health East Care System, Saint Paul, Minnesota, USA
| |
Collapse
|
40
|
|