Rehabilitation of a Rare Case of Severe Pediatric Miller Fisher Guillain Barre Syndrome After Moderate Trauma: A Case Report

ABSTRACT

Case Diagnosis Severe Miller Fisher Guillain-Barre Syndrome (MF-GBS) following Utility Terrain Vehicle (UTV) collision in a teenager. Case Description or Program Description A 15-yearold male driving a UTV was hit by a car. He was helmeted and restrained. He sustained a brief loss of consciousness and multiple limb, L3 compression and L4 transverse process fractures. He went home 10 days after the collision ambulating independently and dressing himself with some assistance due to an arm cast. He returned in 3 days with weakness in his neck and all limbs. This progressed rapidly to dysphonia, dysphagia, inability to move eyes, lips or tongue, severe neuropathic pain and finally respiratory failure. Neurology diagnosed post traumatic MF-GBS and treated with IVIG then plasmapheresis. Legs improved slightly but not respiratory status. Pediatric rehab was consulted. Gabapentin relieved his pain so narcotics were discontinued. Tracheostomy and G-tube were placed. Pediatric intensivists expected home on vent with G-tube feedings. The therapy team dealt with numerous challenges requiring teamwork and collaboration with various different PICU personnel. Team and care conferences were frequent. The patient moved through a variety of equipment, splints and respiratory support. His rehab was performed in the PICU due to respiratory needs, COVID precautions & staffing. Home discharge was at 3 months using vent at night, ambulating with a walker, speaking with a PMV, eating independently and requiring minimal assistance for dressing. Setting(s) Pediatric Intensive Care Unit Assessment/Results: Post traumatic GBS can occur in teenagers. The rehab team solved complex problems involving neuropathic pain and weakness, casts, the PICU setting and non-rehab personnel Discussion (relevance) Post traumatic GBS is rare, reported in adults but not in adolescents. MF-GBS severity can lead to disagreement on appropriate length of stay and expected outcome. Conclusion(s) Post traumatic GBS can occur in pediatric patients. Physiatrists see unusual cases, improve patient care, comfort, outcomes and patient/family satisfaction.