ABSTRACT
Objetivos: Describir las características clínicas y paraclínicas de pacientes con síndrome de Guillain-Barré en el Hospital Regional Lambayeque entre los años 2011 y 2015. Material y métodos: Se revisaron las historias clínicas de pacientes con síndrome de Guillain-Barré atendidos en el Hospital Regional Lambayeque en la ciudad de Chiclayo-Perú, Resultados: Encontramos 16 pacientes con Síndrome de Guillain-Barré, 56% varones y 44% mujeres; la enfermedad se presentó mayormente en adultos de 20 a 60 años (44%). La mayor proporción de casos se dio durante las estaciones de invierno y primavera. El subtipo axonal fue el más común (62,5%). En cinco de seis pacientes en los que se practicó punción lumbar para efectuar tests de líquido cefalo-raquídeo se encontró disociación albuminocitológica. Cinco de los pacientes requirieron ventilación mecánica y tres de ellos fallecieron. Conclusiones: Este primer reporte del Síndrome de Guillain-Barré realizado en un hospital del norte del Perú, demuestra diferencias en las características clínicas y paraclínicas de nuestros pacientes.
Objectives: To describe clinical and paraclinical characteristics of patients with Guillain-Barré Syndrome (GBS) admitted to the Regional Hospital of Lambayeque from 2011 to 2015. Material and methods: The charts of patients with GBS treated in the Regional Hospital of Lambayeque (Chiclayo, Peru) were reviewed. Results: We found 16 patients with GBS, 56% male and 44% female; the disease was mainly observed in adults between 20-60 years (44%). The major proportion of cases was seen in the winter and spring seasons. The axonal form was the most common subtype (62.5%). In five of six patients in whom lumbar puncture was performed to test cerebro-spinal fluid, albumin-cytological dissociation was found. Five patients required artificial ventilation and three died. Conclusions: This is the first study of patients with GBS in a hospital in Northern Peru, demonstrating specific characteristics in the patient population hereby studied.
ABSTRACT
Objective In certain situations, severe forms of Guillain-Barré syndrome (GBS) show no response or continue to deteriorate after intravenous immunoglobulin (IVIg) infusion. It is unclear what the best treatment option would be in these circumstances.Method This is a case report on patients with severe axonal GBS in whom a second cycle of IVIg was used.Results Three patients on mechanical ventilation who presented axonal variants of GBS, with autonomic dysfunction, bulbar impairment and Erasmus score > 6, showed no improvement after IVIg infusion of 400 mg/kg/d for 5 days. After 6 weeks, we started a second cycle of IVIg using the same doses and regimen as in the previous one. On average, 5 days after the second infusion, all the patients were weaned off mechanical ventilation and showed resolution of their blood pressure and heart rate fluctuations.Conclusions A second cycle of IVIg may be an option for treating severe forms of GBS.
Objetivo Em determinadas situações, as formas graves da síndrome de Guillain-Barré (GBS) não mostram resposta ou continuam a deteriorar após a infusão endovenosa de imunoglobulina (IVIg). Não está claro qual seria a melhor opção de tratamento nestas circunstâncias.Método Este é o relato de caso de pacientes com grave comprometimento axonal em GBS, nos quais um segundo ciclo de IVIg foi utilizado.Resultados Três pacientes em ventilação mecânica que apresentavam variantes de GBS com disfunção autonômica, comprometimento bulbar e valores de Erasmus > 6, não mostraram melhora após infusão de IVIg 400 mg/kg/d por 5 dias. Após 6 semanas, foi iniciado um segundo ciclo de IVIg utilizando as mesmas doses e esquema feitos previamente. Em média, após 5 dias da segunda infusão, todos os pacientes haviam sido retirados da ventilação mecânica e mostravam resolução de suas flutuações de pressão arterial e frequência cardíaca.Conclusões O segundo ciclo de IVIg pode ser uma alternativa para tratamento de formas graves de GBS.
Subject(s)
Female , Humans , Male , Middle Aged , Guillain-Barre Syndrome/therapy , Immunoglobulins, Intravenous/administration & dosage , Immunologic Factors/administration & dosage , Axons , Respiration, Artificial , Severity of Illness Index , Time Factors , Treatment OutcomeABSTRACT
Guillain Barre Syndrome (GBS) is an acute neuromuscular weakness and paralysis associated with areflexia and often spontaneous recovery, but carries the potential risk of respiratory depression owing to muscle weakness. Worldwide, 1 to 3 cases/100,000 are reported. The syndrome is most commonly reported as symmetrical ascending weakness in arms and legs accompanied by hyporeflexia or areflexia. Sensory disturbances are not required for diagnosis, but may or may not be present. Acute inflammatory demyelinating poly-radiculoneuropathy (AIDP) is the most common variant, but acute motor and sensory axonal neuropathy (ASMAN) is more severe and usually leads to partial or slow recovery. We present a case of GBS presenting with asymmetric weakness and sensory disturbance in a patient with bloody diarrhea of unknown etiology. This patient had asymmetrical paralysis mimicking stroke, but the physical findings, laboratory studies, normal CT and MRI of the brain, Electromyogram (EMG) and the patient’s improvement with Intravenous Immunoglobulin (IVIG) support the diagnosis of GBS. People with inflammatory bowel disease are at increased risk of developing GBS. Persons with antecedent Campylobacter jejuni infections are 77 percent more likely to contract GBS compared to the general population, and Cytomegalovirus (CMV) and Epstein Barr virus (EBV) are also implicated risk factors.
ABSTRACT
This paper reports a case of dengue in a six-year-old female child who suddenly developed excruciating headaches, fever, myalgia and paresis. Laboratory examinations included blood count, platelet count, biochemical tests (BUN, creatinine, aminotransferases, and total bilirubin and bilirubin fractions) and specific IgM titers (enzyme-immunoassay with recombinant tetravalent dengue). After ten days of hospitalization and having already been in a home environment, a new clinical image emerged, characterized by dysphagia, dysphonia, weakness, peripheral facial palsy and paresthesia. The diagnosis of Guillain-Barré Syndrome was based on clinical findings, cerebrospinal fluid examination, electrophysiological findings and the exclusion of other pathologies. Our case, as some shown in previous reports, calls attention to the possibility that Guillain-Barré Syndrome may occur in association with dengue.
Este trabalho relata o caso de uma criança, sexo feminino, seis anos que desenvolveu subitamente cefaléia lancinante, febre, mialgia e paresia. Os exames de investigação clínica, que incluíram hemograma, contagem de plaquetas, dosagens bioquímicas (uréia, creatinina, transferases e billirrubina total e frações) e por títulos específicos de IgM, por enzima-imunoensaio (EIA) com antígeno tetravalente de dengue. Após dez dias de internação e já em ambiente domiciliar, novo quadro clínico surgiu caracterizado por disfagia, disfonia, paresia, paralisia facial periférica e parestesias. O diagnóstico do dengue e da Síndrome de Guillain-Barré foi baseado nos achados clínicos, no exame do líquido cefalorraquidiano, achados eletrofisiológicos e na exclusão de outras patologias. Neste caso, como em alguns relato anteriores, chama a atenção para a possibilidade de que Síndrome de Guillain-Barré pode ocorrer em associação com a dengue.
Subject(s)
Child , Female , Humans , Dengue/complications , Guillain-Barre Syndrome/etiology , Dengue/diagnosis , Guillain-Barre Syndrome/diagnosisABSTRACT
Liver transplantation is the only definitive treatment modality of end stage liver diseases. Demyelinative disease is rarely seen in patients after liver transplantation, but a higher incidence has been noticed recently. The disease is liable to be misdiagnosed as immunosuppressant-induced psychiatric disorders at early stage. Central pontine myelinolysis is more disastrous and it will greatly influence the short-term survival and long-term life quality of the patients after liver transplantation. When it is manifested as peripheral nervous system disorder, the disease usually has a subtle onset, making it difficult for diagnosis and treatment. The causes for various demyelinative diseases should be understood to prevent it in patients after liver transplantation. The specific mechanism for demyelinative disease after liver transplantation remains unclear. We introduce the possible causes of common demyelinative diseases, hoping to provide reference for prevention and treatment of such conditions after liver transplantation.