Wernicke’s encephalopathy post hyperemesis gravidarum misdiagnosed as Guillain-Barre syndrome: lessons for the frontline

2021 ◽  
Vol 14 (3) ◽  
pp. e239977
Author(s):  
Kaushiki Kirty ◽  
Yashendu Sarda ◽  
Annu Jacob ◽  
Delanthabettu Venugopala
Keyword(s):  
Pregnant Woman ◽  
Hyperemesis Gravidarum ◽  
Early Recognition ◽  
Wernicke’S Encephalopathy ◽  
Guillain Barre Syndrome ◽  
Neurological Deficits ◽  
Wernicke's Encephalopathy ◽  
Motor Neuropathy ◽  
Guillain Barré Syndrome ◽  
Guillain Barré

We report a case of a 26-year-old pregnant woman, who presented with subacute limb weakness. This was initially suspected to be Guillain-Barre syndrome but subsequently found to be the motor neuropathy of dry beriberi (vitamin B1, thiamine deficiency) along with associated Wernicke’s encephalopathy (WE). The underlying cause was revealed as hyperemesis gravidarum (HG). HG complicates up to 3% of pregnancies and if severe, without nutritional supplements, may lead to electrolyte disturbances, calorie loss and vitamin deficiency. Although the association of HG and WE was first reported in 1939, it remains an under diagnosed condition with potential for serious and permanent neurological deficits, and some mortality, in both mother and baby. Early recognition of the problem, with timely and careful fluid, electrolyte, glucose and vitamin replacement is needed to avoid complications. We highlight current best practice in the treatment of WE. An open mind to the possibility of HG complications in any pregnant woman presenting with neurological symptoms is probably the most important lesson to learn from the front line.

scholarly journals Concurrent Guillain-Barré syndrome and myositis complicating dengue fever

2020 ◽  
Vol 13 (2) ◽  
pp. e232940 ◽  
Author(s):  
Manisha Gulia ◽  
Preeti Dalal ◽  
Monica Gupta ◽  
Daljinderjit Kaur
Keyword(s):  
Creatine Kinase ◽  
Dengue Fever ◽  
Elevated Serum ◽  
Guillain Barre Syndrome ◽  
Uneventful Recovery ◽  
Motor Neuropathy ◽  
Limb Weakness ◽  
Guillain Barré Syndrome ◽  
Bilateral Lower Limb ◽  
Guillain Barré

Dengue is an arboviral infection that classically presents with fever, headache, joint pain, skin flush and morbilliform rashes. Neurological manifestations are well recognised but their exact incidence is unknown. Though myalgias are common in dengue virus infection, myositis and/or elevated serum creatine kinase is an uncommon complication. Guillain-Barré syndrome is another rare neurological manifestation associated with dengue fever. Here, we report the case of a 21-year-old man with serologically confirmed dengue fever presenting with severe myalgia, bilateral lower and upper limb weakness with raised creatine kinase, MRI suggestive of myositis and myonecrosis and nerve conduction velocity showing bilateral lower limb and axillary sensory motor neuropathy. He was managed conservatively and made an uneventful recovery.

Two success stories in the management of Guillain–Barré syndrome illustrate the challenges of intensive care unit care in Malawi

2020 ◽  
pp. 004947552096275
Author(s):  
Lauren Onofrey ◽  
Claire Naus ◽  
Kiran T Thakur ◽  
Clement Kadyaudzu ◽  
Meghan Prin
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Early Recognition ◽  
Tertiary Hospital ◽  
Guillain Barre Syndrome ◽  
Intensive Care Unit Care ◽  
Low Resource ◽  
Success Stories ◽  
Guillain Barré Syndrome ◽  
Guillain Barré

The management of critical illness is especially challenging in low-resource environments, and early recognition and supportive care are essential, regardless of the ability to employ advanced or invasive therapy. In this report, we discuss two patients with Guillain–Barré syndrome who were managed successfully in the intensive care unit of a tertiary hospital in Malawi. Both patients recovered and were discharged home. The management and outcomes of these patients provide case-based lessons for improving intensive care unit medicine in low-resource contexts.

scholarly journals Paralytic ileus as the presenting symptom for Guillain–Barré syndrome: a case report

2019 ◽  
Vol 48 (4) ◽  
pp. 030006051989316
Author(s):  
Kuang-Heng Lee ◽  
Tsung-Han Ho ◽  
Jiunn-Tay Lee ◽  
Li-Fan Lin ◽  
Wei-Chou Chang ◽  
...  
Keyword(s):  
Paralytic Ileus ◽  
Early Recognition ◽  
Early Stage ◽  
Immunoglobulin Therapy ◽  
Guillain Barre Syndrome ◽  
Rapid Progression ◽  
Limb Weakness ◽  
Intravenous Immunoglobulin Therapy ◽  
Guillain Barré Syndrome ◽  
Guillain Barré

Guillain–Barré syndrome (GBS) is an acute neuroimmunological disorder characterized by rapidly ascending symmetrical limb weakness, areflexia, and sensory deficits. Approximately 65% of patients with GBS present with autonomic dysfunction, which commonly occurs in advanced stages. However, paralytic ileus, a sign of gastrointestinal dysautonomia, is rare as the presenting feature in GBS before motor weakness becomes evident. We report the case of a 54-year-old man admitted to the Emergency Department with paralytic ileus as the prodromal feature in early-stage GBS. Total parenteral feeding and prokinetic use were initiated, but no clinical improvement was observed. The patient showed rapid progression to quadriplegia, which was ultimately determined to be respiratory muscle failure requiring mechanical ventilation and intensive care unit admission. He underwent 5 days of intravenous immunoglobulin therapy and muscle strength was partially improved thereafter. However, the patient’s enteral nutritional support was undesirable because of persistent poor gastric emptying complicated by fungemia and profound sepsis throughout the hospital course. Finally, he died 1 month after admission. Ignorance of this unusual prodrome to GBS could result in delayed treatment, along with potential progression to life-threatening events. Early recognition of GBS and prompt immunotherapy are critical for reducing morbidity and mortality.

scholarly journals Comprehensive rehabilitation treatment for pregnant women with Guillain-Barré syndrome - a case report

2019 ◽  
Vol 22 (3) ◽  
pp. 57-61
Author(s):  
Katarzyna Hojan ◽  
Berenika Wruk ◽  
Anna Tymińska ◽  
Jan Kurnatowski ◽  
Hanna Norman
Keyword(s):  
Case Report ◽  
Pregnant Woman ◽  
Vital Signs ◽  
Guillain Barre Syndrome ◽  
Sensory Loss ◽  
Limb Weakness ◽  
Rehabilitation Treatment ◽  
Guillain Barré Syndrome ◽  
Comprehensive Rehabilitation ◽  
Guillain Barré

Guillain-Barré syndrome (GBS) is an acute demyelinating poliradioculopathy and autoimmune condition, with a fast rapid natural course, and with high disability and usually episodic immune treatment. Clinical features include areflexia, limb weakness and uncommonly, sensory loss proceeding to neuromuscular paralysis involving bulbar, facial and respiratory function with maximum severity of symptoms atin 2-4 weeks. The eEtiology of GBS is not incompletely understood, however, prognosis is usually good with early detection and prompt treatment. In thise paper, we present a unique case of comprehensive rehabilitation treatment for a pregnant woman with GBS atin the 8th week of pregnancy. On the basis of this case report, we discuss possible and safe rehabilitation treatment for women in the first trimester of pregnancy, with significantly weakened muscle strength, after stabilizsation of vital signs and immunotherapy. The paper describes comprehensive care provided to the pregnant woman with teraplegia, hyperstesia and dysphagia after stabiliszation of vital signs, which was conducted until delivery atin the 39th week of pregnancy. This article is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License. null

scholarly journals Diagnosis and management of Guillain–Barré syndrome in ten steps

2019 ◽  
Vol 15 (11) ◽  
pp. 671-683 ◽  
Author(s):  
Sonja E. Leonhard ◽  
Melissa R. Mandarakas ◽  
Francisco A. A. Gondim ◽  
Kathleen Bateman ◽  
Maria L. B. Ferreira ◽  
...  
Keyword(s):  
Early Recognition ◽  
French Polynesia ◽  
Guillain Barre Syndrome ◽  
Intensive Care Unit Treatment ◽  
Diagnosis And Management ◽  
Immune Mediated ◽  
Management Of Complications ◽  
Guillain Barré Syndrome ◽  
Guillain Barré ◽  
Progression Prediction

Abstract Guillain–Barré syndrome (GBS) is a rare, but potentially fatal, immune-mediated disease of the peripheral nerves and nerve roots that is usually triggered by infections. The incidence of GBS can therefore increase during outbreaks of infectious diseases, as was seen during the Zika virus epidemics in 2013 in French Polynesia and 2015 in Latin America. Diagnosis and management of GBS can be complicated as its clinical presentation and disease course are heterogeneous, and no international clinical guidelines are currently available. To support clinicians, especially in the context of an outbreak, we have developed a globally applicable guideline for the diagnosis and management of GBS. The guideline is based on current literature and expert consensus, and has a ten-step structure to facilitate its use in clinical practice. We first provide an introduction to the diagnostic criteria, clinical variants and differential diagnoses of GBS. The ten steps then cover early recognition and diagnosis of GBS, admission to the intensive care unit, treatment indication and selection, monitoring and treatment of disease progression, prediction of clinical course and outcome, and management of complications and sequelae.

Morning sickness of pregnancy: more than meets the eye

2016 ◽  
Vol 30 (3) ◽  
Author(s):  
Noorazizah Arsad ◽  
Kah Teik Chew ◽  
Nur Azurah Abdul Ghani ◽  
Hui Jan Tan ◽  
Norasyikin A. Wahab ◽  
...  
Keyword(s):  
Gestational Age ◽  
Small For Gestational Age ◽  
Hyperemesis Gravidarum ◽  
Early Recognition ◽  
Wernicke’S Encephalopathy ◽  
Wernicke's Encephalopathy ◽  
Morning Sickness ◽  
Life Threatening ◽  
Life Threatening Complication ◽  
In Pregnancy

AbstractWernicke’s encephalopathy (WE) is a rare life-threatening complication following severe hyperemesis gravidarum. Early recognition of this condition and prompt thiamine administration is the key to preventing devastating sequelae. We report a successful delivery of a small-for-gestational-age (SGA) baby by a patient with WE and thyrotoxicosis in pregnancy.

Sign in / Sign up

Export Citation Format

Share Document