Case Report: Early-Onset Guillain-Barre Syndrome Mimicking Stroke.

Introduction: Guillain-Barre syndrome (GBS) is an acute immune-mediated inflammatory demyelinating polyneuropathy characterized by symmetrical limb weakness and areflexia. GBS can have different clinical manifestations; hence, the initial symptoms are also varied. Here, we describe a rare case of GBS presenting as hemiparesis and cranial nerve palsy, which mimic brainstem stroke. Case Presentation: A 53-year-old man was admitted to the hospital with a 3-h history of left-arm weakness, glossolalia, and right eyelid droop. After admission, his condition suddenly worsened, with quadriplegia, bilateral peripheral facial palsy, bilateral ophthalmoplegia, and other neurological symptoms. Based on the findings from a neurological examination, MRI, cerebrospinal fluid analysis, and nerve conduction study, a diagnosis of GBS was made. He received intravenous immunoglobulin (0.4 kg/day) for 5 days. After 20 days of systematic therapy, his dysphagia, dyspnea, facial paralysis, ocular movement disorder, and leg weakness recovered almost completely, but his arms were still moderately impaired, with a power of 4/5. Fortunately, the patient recovered well without any sequelae after 2 years of follow-up. Conclusions: In patients with an atypical presentation, the diagnosis of GBS is often delayed. With this case report, we intend to highlight the fact that some symptoms mimicking stroke may be a feature of GBS at onset; close observation and timely diagnosis are crucial for clinicians. Neuroimaging is a valuable diagnostic tool in differentiating stroke from GBS.

[Pain sites in the sternocleidomastoid muscle trigger points and the gender-related factors].

OBJECTIVE: To study gender-related factors in the painful sites and degree of pains in the trigger points of the sternocleidomastoid muscle. METHODS: The trigger points of the sternocleidomastoid muscle of healthy volunteers of either gender with different ages were examined by measurable pressure using the right thumb, and the pain degree was assessed with visual analog scale (VAS). RESULT: The VAS score was 5.226+/-0.331 in senior male subjects and 5.531+/-0.379 in senior female subjects, without significant differences between them (P>0.05). Nor was significant difference detected between the scores of young male and female subjects (2.940+/-0.331 vs 3.982+/-0.405, P>0.05). In terms of the pain severity, the difference was significant between the medial and anterior areas and between the medial and posterior areas of the mastoid process (P<0.05), but not between the anterior and posterior areas of the mastoid process (P>0.05). CONCLUSION: There is no significant gender-related difference in the pain in the trigger points of the sternocleidomastoid muscle elicited by compression with the right thumb. The anterior and posterior areas of the mastoid process are relatively sensitive to compression pain.