scholarly journals An Acute, Severe Axonal Sensorimotor Polyneuropathy in the Setting of Nitrous Oxide Abuse

2020 ◽  
Vol 10 (4) ◽  
pp. 293-296
Author(s):  
Jules C. Beal ◽  
Yishan Cheng ◽  
Sabiha Merchant ◽  
Reza Zarnegar
Keyword(s):  
Nitrous Oxide ◽  
Vitamin B12 ◽  
Clinical Picture ◽  
Guillain Barre Syndrome ◽  
Sensory Loss ◽  
Laboratory Evaluation ◽  
Sensorimotor Polyneuropathy ◽  
Guillain Barré Syndrome ◽  
B12 Deficiency ◽  
Guillain Barré

Nitrous oxide, often used as an anesthetic agent, is also increasingly a drug of abuse due to its euphoric and anxiolytic effects. Frequent exposure to nitrous oxide can lead to neurologic complications, including B12 deficiency and resultant subacute myeloneuropathy, as well as direct neurotoxicity. A clinical presentation of acute sensorimotor polyneuropathy mimicking Guillain-Barré syndrome after chronic nitrous oxide abuse has been reported only rarely. Here we present a 17-year-old previously healthy girl presented with 10 days of progressive ascending sensory loss and weakness in the legs. She admitted to heavy nitrous oxide abuse over a period of a year or more. Laboratory evaluation was significant for normal vitamin B12 level with elevated homocysteine. A magnetic resonance imaging (MRI) of her spine showed abnormal signal involving the bilateral dorsal columns. Nerve conduction studies were suggestive of severe axonal sensorimotor polyneuropathy. This patient demonstrates concurrent multifactorial neurologic injury as a result of nitrous oxide abuse. She had a functional vitamin B12 deficiency as indicated by the elevated homocysteine, leading to a subacute combined degeneration that was evident on the MRI. In addition, she had evidence of direct neurotoxicity leading to axonal injury and sensorimotor polyneuropathy reminiscent of Guillain-Barré syndrome. This clinical picture is a serious but seldom reported possible complication if nitrous oxide abuse and should be considered in patients presenting with a clinical picture suspicious for Guillain-Barré syndrome or its variants.

scholarly journals A horse and a zebra: an atypical clinical picture including Guillain-Barré syndrome, recurrent fever and mesenteric lymphadenopathy caused by two concomitant infections

Infection ◽  
2020 ◽  
Vol 48 (3) ◽  
pp. 471-475
Author(s):  
Felix Amereller ◽  
Christian Lottspeich ◽  
Grete Buchholz ◽  
Karl Dichtl
Keyword(s):  
Clinical Picture ◽  
Yersinia Pseudotuberculosis ◽  
Guillain Barre Syndrome ◽  
Recurrent Fever ◽  
Course Of Disease ◽  
Abdominal Symptoms ◽  
Guillain Barré Syndrome ◽  
Bacterial Gastroenteritis ◽  
Underlying Risk Factor ◽  
Guillain Barré

Abstract Background While Campylobacter jejuni represents the most common cause of bacterial gastroenteritis, Yersinia pseudotuberculosis infections are very rarely diagnosed in adults. Case We report on a previously healthy patient who presented several times at our hospital with fever, Guillain-Barré syndrome, recurrent abdominal symptoms and distinct mesenteric lymphadenopathy, respectively. This complicated and diagnostically challenging course of disease was caused by a C. jejuni and Y. pseudotuberculosis coinfection. Antibiotic treatment with doxycycline was effective. Conclusion Broad serology testing was crucial to discover that two concomitant infections were causing the symptoms. This case demonstrates that when a clinical picture is not fully explained by one known infection, another infection with the same underlying risk factor has to be considered, hence “a horse and a zebra”.

scholarly journals Cytomegalovirus infection in Guillain-Barré syndrome: a retrospective study in Brazil

2021 ◽  
Vol 79 (7) ◽  
pp. 607-611
Author(s):  
Mario Emilio Teixeira Dourado Junior ◽  
Bruno Fernandes de Sousa ◽  
Nathaly M. Coelho da Costa ◽  
Selma Maria Bezerra Jeronimo
Keyword(s):  
Bacterial Infections ◽  
Respiratory Infections ◽  
Northeastern Brazil ◽  
Guillain Barre Syndrome ◽  
Sensory Loss ◽  
Cmv Infection ◽  
Guillain Barré Syndrome ◽  
Health Initiatives ◽  
Epidemiological Profile ◽  
Guillain Barré

ABSTRACT Background: Guillain-Barré syndrome (GBS) is currently the most common cause of acute flaccid paralysis worldwide. Risk factors for GBS include previous viral or bacterial infections or vaccination. Recently, an outbreak of Zika virus led to an outbreak of GBS in Latin America, mostly in Brazil, concomitant to continuous circulation of dengue virus serotypes. However, there is no study about cytomegalovirus (CMV) infection as a risk for GBS in Brazil. Objectives: In this study, we report a series of cases of GBS with the aim of determining the prevalence of CMV and the characteristics associated with the infection. Methods: A cohort of 111 GBS cases diagnosed between 2011 and 2017 in Natal, northeastern Brazil, was studied. Presence of CMV IgM antibodies was determined by means of electrochemiluminescence. The analysis was performed considering CMV infection status and the clinical outcome. Results: We found seroprevalence of 15.3% (n = 17) for CMV. CMV patients were younger (26 vs. 40; p = 0.016), with no apparent gastrointestinal (p = 0.762) or upper respiratory infections (p = 0.779) or sensory loss (p = 0.03). They presented more often with a classic GBS sensorimotor variant (p = 0.02) and with a demyelinating pattern in electrophysiological studies (p < 0.001). Conclusion: In Brazil, the clinical-epidemiological profile of GBS associated with CMV infection is similar to that described in other countries. Better understanding of the relationship between infectious processes and GBS is a key component of the research agenda and assistance strategy for global health initiatives relating to peripheral neuropathic conditions.

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

Subacute Combined Degeneration Caused by Nitrous Oxide Abuse Mimicking Guillain-Barré Syndrome

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Omar Al Omari ◽  
Alaaeldin Ahmed ◽  
Dipesh Patel ◽  
Chinmay Jani ◽  
Harpreet Singh ◽  
...  
Keyword(s):  
Nitrous Oxide ◽  
Guillain Barre Syndrome ◽  
Subacute Combined Degeneration ◽  
Guillain Barré Syndrome ◽  
Guillain Barré

A Case of Peripheral Neuropathy Combined with Leukoencephalopathy after Injection with Intrathecal Methotrexate and Vincristine.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4348-4348
Author(s):  
Hae-sang Lee ◽  
Hyun Joo Jung ◽  
Jun Eun Park
Keyword(s):  
Peripheral Neuropathy ◽  
Acute Lymphocytic Leukemia ◽  
Deep Tendon Reflex ◽  
Lymphocytic Leukemia ◽  
Guillain Barre Syndrome ◽  
Sensory Loss ◽  
Intrathecal Methotrexate ◽  
Gradual Improvement ◽  
Guillain Barré Syndrome ◽  
Guillain Barré

Abstract Vincristine and methotrexate are the anchor drugs in the treatment of acute lymphocytic leukemia. The neurological complications caused by either vincristine or methotrexate have been well documented. A 10 year-old girl diagnosed acute lymphocytic leukemia without central nervous involvement and treated with CCG 1882 based therapy. She suffered from ascending paralysis from lower extremities without seizure or mental change three days after the fifth dose of vincristine and the fifth dose of intrathecal methotrexate during consolidation chemotherapy composed of 3-drug(vincristine, methotrexate, and L-asparaginase). Two days later, she developed dysarthria and respiratory discomfort. Her neurological examination showed a symmetric, flaccid, quadriparesis with loss of deep tendon reflex. But, she did not have sensory loss. We thought Guillain-Barre syndrome as first impression and carried out diagnostic evaluation. Viral study revealed no abnormality and cerebrospinal fluid study was not consistent with Guillain-Barre syndrome or infectious disease. Diffusion weighted magnetic resonance imaging showed a well-demarcated area of moderately high signal intensity in the white mater of the both parietal lobes. Neuromuscular conduction test revealed severe amplitude reduction in motor nerve action potential meaning on peripheral polyneuropathy. These findings were corresponded with drug-induced peripheral neuropathy and chemotherapy-related leukoencephalopathy that was detected incidentally. She did not receive further doses of vincristine and intrathecal methotrexate during the consolidation phase. There was gradual improvement of the weakness in the both lower and upper limbs for 3 months. She was recovery to walk with minimal support. We report peripheral neuropathy combined with subclinical leukoencephalopahty after injection with intrathecal methotrexate and vincristine.

scholarly journals A 50-Year-Old Patient with Guillain–Barré Syndrome after COVID-19: A Case Report

Medicina ◽  
2021 ◽  
Vol 57 (8) ◽  
pp. 775
Author(s):  
Tomasz Chmiela ◽  
Michalina Rzepka ◽  
Ewa Krzystanek ◽  
Agnieszka Gorzkowska
Keyword(s):  
Neurological Complications ◽  
Guillain Barre Syndrome ◽  
Sensorimotor Polyneuropathy ◽  
Csf Analysis ◽  
First Case ◽  
Guillain Barré Syndrome ◽  
Sensory Disturbances ◽  
History Of ◽  
Diagnostic Work ◽  
Guillain Barré

Severe acute respiratory syndrome coronavirus 2, or SARS-CoV-2, causes acute respiratory disease (coronavirus disease 2019; COVID-19). However, the involvement of other mechanisms is also possible, and neurological complications are being diagnosed more frequently. Here, we would like to present a case of a Polish patient with Guillain–Barré syndrome (GBS), after a documented history of COVID-19: A 50-year-old man, 18 days after the onset of COVID-19 symptoms, had progressive quadriparesis preceded by 1-day sensory disturbances. Based on the clinical picture, the results of diagnostic work-up including a nerve conduction study (ENG) that revealed a demyelinating and axonal sensorimotor polyneuropathy, and cerebrospinal fluid (CSF) analysis that showed albumin–cytological dissociation, an acute inflammatory demyelinating polyneuropathy was confirmed, consistent with GBS. Upon a therapeutic plasma exchange (TPE), the patient’s condition improved. The presented case of GBS in a patient after mild COVID-19 is the first case in Poland that has supplemented those already described in the global literature. Attention should be drawn to the possibility of GBS occurring after SARS-CoV-2 infection, even when it has a mild course.

Guillain-Barré syndrome without sensory loss (acute motor neuropathy)

Brain ◽  
1995 ◽  
Vol 118 (4) ◽  
pp. 841-847 ◽  
Author(s):  
L. H. Visser ◽  
F. G. A. Van Der Meché ◽  
P. A. Van Doorn ◽  
J. Meulstee ◽  
B. C. Jacobs ◽  
...  
Keyword(s):  
Guillain Barre Syndrome ◽  
Sensory Loss ◽  
Motor Neuropathy ◽  
Guillain Barré Syndrome ◽  
Guillain Barré

Guillain-Barré syndrome presenting as bilateral vocal cord paralysis

2000 ◽  
Vol 122 (2) ◽  
pp. 269-270 ◽  
Author(s):  
ADI Yoskovitch ◽  
Daniel J. Enepekides ◽  
Michael P. Hier ◽  
Martin J. Black
Keyword(s):  
Vocal Cord ◽  
Vocal Cord Paralysis ◽  
Guillain Barre Syndrome ◽  
Sensory Loss ◽  
Muscular Weakness ◽  
Demyelinating Neuropathy ◽  
Bilateral Vocal Cord Paralysis ◽  
Guillain Barré Syndrome ◽  
Guillain Barré ◽  
Acute Idiopathic Polyneuritis

Guillain-Barré syndrome (GBS), also known as acute idiopathic polyneuritis, is the most common acquired demyelinating neuropathy, characterized by muscular weakness and mild distal sensory loss. GBS presenting as bilateral vocal cord paralysis (BVCP) is extremely rare, with only 1 other case reported in the literature. 1 The following is a case of BVCP as the presenting symptom of GBS in an elderly man.

scholarly journals The importance of clinical picture in the diagnosis of Guillain-Barré syndrome

2019 ◽  
Vol 22 (4) ◽  
pp. 160-164
Author(s):  
Tudorita-Gabriela Paranga ◽  
◽  
Maria Obreja ◽  
Claudia-Elena Plesca ◽  
Daniela Leca ◽  
...  
Keyword(s):  
Clinical Picture ◽  
Guillain Barre Syndrome ◽  
Guillain Barré Syndrome ◽  
Guillain Barré

scholarly journals CLINICAL-EPIDEMIOLOGICAL CHARACTERIZATION OF GUILLAIN BARRÉ SYNDROME IN A CUBAN CASE SERIE.

2021 ◽  
Vol 2 (2) ◽  
Author(s):  
Zurina Lestayo ◽  
Sistach-Vega Vivian ◽  
Bismary Rodriguez Álvarez ◽  
Adarilis Hoya González
Keyword(s):  
Autoimmune Disease ◽  
Clinical Picture ◽  
Climatic Conditions ◽  
Personal History ◽  
Guillain Barre Syndrome ◽  
Motor Disorder ◽  
Heterogeneous Distribution ◽  
Guillain Barré Syndrome ◽  
History Of ◽  
Guillain Barré

Background: The broad spectrum of Guillain Barré Syndrome (GBS) includes different pathological phenotypes, with a heterogeneous distribution. The reports, by country and region, have shown its great variability and clarified its behavior.Objective: Characterize GBS and define the most frequent phenotypes.Methods: A time series was constructed to analyze the epidemiological behavior of GBS. The demographic, epidemiological, clinical and complementary aspects of 167 patients were retrospectively described. The severity was analyzed and the patients were classified.Results: The mean age was 33 years, 22.8% were children. The incidence decreased with age and a seasonal preference was seen for the month of August, that usually coincides with higher rates of respiratory and digestive infections. Dengue preceded some GBS outbreaks. The Acute Inflammatory Demyelinating Polyradiculopathy (AIDP) variant predominated and was most severe. Regional variants, a recurrent GBS and a family one were detected. Age, personal history of autoimmune disease, preceding infectious phenomenon, latency between the preceding phenomenon and the onset of the clinical picture, the extent of the motor disorder, facial involvement, gait impairment, ventilatory compromise, and degradation of the osteotendinous reflexes, significantly correlated with the severity.Conclusions: The predominance of AIDP coincides with some countries in the area, with varying geographical location and climatic conditions. The incidence decreases with age. The relationship between the severity and the personal history of autoimmune disease, the preceding infectious phenomenon, and the latency between the preceding phenomenon and the onset of the clinical picture, could be reflecting an underlying autoimmune mechanism in each case.

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