[Fluctuations in Guillain-Barré syndrome related with intravenous human immunoglobulin (triphasic course): case report]. / Síndrome de Guillain-Barré com flutuações relacionadas ao tratamento com imunoglobulina humana endovenosa. Curso trifásico. Relato de caso.

The authors report the case of a patient with severe Guillain-Barré syndrome (tetraplegic and on mechanical ventilation), that was treated with intravenous immunoglobulin (IVIg), 2 g/Kg. At first, there was clinical improvement, followed by clinical deterioration two weeks later. On the second course of IVIg there was, again, clinical improvement and then deterioration, 65 days after treatment. Finally, on the third course of treatment definitive recovery was achieved and no more relapses happened so far (three years after the treatment). The authors review the literature about fluctuations related to treatment with IVIg. Conclusions are that these patients should be closely observed during the first weeks after IVIg treatment, and that further studies are still necessary to elaborate alternative protocols on the prevention of these cases.

Dynamic study of arachnoid cysts with metrizamide.

Intracranial arachnoid cyst do not usually present diagnostic problems when studied by CT, since they appear as low density images similar to those produced by CSF, do not change on intravenous contrast perfusion, and are located extraparenchymatously. Sometimes, however, their diagnosis can become difficult or doubtful mainly in cases of deep, basal or paramedian cysts [12, 18, 22, 24]. On the other hand, the functional or dynamic aspects of these structures remain unknown when the study is limited to simple CT. Computed cisternography with metrizamide (CCM) and time control will not only show the relationship between these structures and the arachnoid space but also their dynamic aspect, which may determine the surgical treatment.