scholarly journals Guillain-Barré syndrome triggered by surgery in a Chinese population: a multicenter retrospective study

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Qiaoyu Gong ◽  
Shuping Liu ◽  
Yin Liu ◽  
Jiajia Yao ◽  
Xiujuan Fu ◽  
...  
Keyword(s):  
Clinical Features ◽  
Orthopedic Surgery ◽  
Southern China ◽  
Axonal Neuropathy ◽  
Trigger Factor ◽  
Guillain Barre Syndrome ◽  
Initial Symptoms ◽  
Guillain Barré Syndrome ◽  
Potential Trigger ◽  
Guillain Barré

Abstract Background Surgery is a potential trigger of Guillain-Barré syndrome (GBS), a disorder which leads to an autoimmune-mediated attack of peripheral nerves. The present study was designed to explore clinical features of post-surgical GBS compared with those of general GBS in order to provide better clinical advice to patients undergoing surgery. Methods The medical records of GBS patients who were seen at 31 tertiary hospitals in southern China between January 1, 2013 and September 30, 2016 were retrospectively analyzed. Post-surgical GBS was defined as symptoms of GBS within 6 weeks after surgery. Clinical features of post-surgical GBS are described and are compared with general GBS. Results Among the 1001 GBS patient cases examined in this study, 45 (4.5%) patient cases exhibited symptoms of GBS within 6 weeks of undergoing surgery. Within this group, 36 (80.0%) patients developed initial symptoms of limb weakness. The average interval between surgery and symptom onset was 13.31 days. The most common type of surgery which triggered GBS was orthopedic surgery, followed by neurological surgery. Compared to general GBS, post-surgical GBS was characterized by a higher proportion of severe patients (Hughes functional grading scale (HFGS) score ≥ 3) upon admission and at nadir, higher HFGS scores at discharge, and longer hospital stays. Post-surgical GBS patients also had a significantly higher frequency of the acute motor axonal neuropathy subtype (37.9 vs. 14.2, respectively; P = 0.001). Conclusion Surgery is probably a potential trigger factor for GBS, especially orthopedic surgery. Infections secondary to surgery may play a role. The possibility of preceding (post-operative) infections was not excluded in this study. Clinical presentation of post-surgical GBS is characterized by a more severe course and poorer prognosis, and should be closely monitored. Trial registration chicTR-RRc-17,014,152.

scholarly journals Guillain-Barré Syndrome Triggered by Surgery in Chinese population: Towards a Multicenter Retrospective Study

2020 ◽  
Author(s):  
Qiaoyu Gong ◽  
Shuping Liu ◽  
Yin Liu ◽  
Jiajia Yao ◽  
Xiujuan Fu ◽  
...  
Keyword(s):  
Symptom Onset ◽  
Orthopedic Surgery ◽  
Southern China ◽  
Trigger Factor ◽  
Guillain Barre Syndrome ◽  
Clinical Feature ◽  
Initial Symptoms ◽  
Guillain Barré Syndrome ◽  
Potential Trigger ◽  
Guillain Barré

Abstract BackgroundSurgery is described as a potential trigger of Guillain-Barré syndrome (GBS). The present study was designed to explore the clinical feature of post-surgical GBS compared with those of general GBS, to give better clinical advice to patients undergoing surgery. MethodsWe retrospectively analyzed medical records of GBS patients in 31 representative tertiary hospitals, located in 14 provinces in southern China, between 1 January 2013 and 30 September 2016. Post-surgical GBS was defined as symptoms of GBS within 6 weeks after surgery. We described clinical feature of post-surgical GBS, and assessed the difference between post-surgical GBS and the general GBS.ResultsOf the 1001 GBS patients enrolled, 45 patients (4.5%) had undergone surgery within 6 weeks before GBS symptom onset. Among them, 36 patients (80.0%) developed initial symptoms of limb weakness. The average interval between surgery and symptom onset was 13.31 days. The most common type of surgery triggering GBS was orthopedic surgery, followed by neurological surgery. Compared to the general GBS, post-surgical GBS was characterized by higher proportion of severe patients (HFGS ≥3) on admission and at nadir, higher HFGS score at discharge, and longer hospital stays. Besides, the post-surgical GBS patients had a significantly higher frequency of the subtype of AMAN (37.9 vs 14.2, P=0.001).ConclusionSurgery was a potential trigger factor for GBS, especially in orthopedic surgery. The clinical presentation of postsurgical GBS was characterized by a more severe course and poorer prognosis. Clinical trial registrationchicTR-RRc-17014152.

scholarly journals Clinical features and outcome of Guillain–Barre syndrome in Saudi Arabia: a multicenter, retrospective study

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mohammed H. Alanazy ◽  
Sawsan S. Bakry ◽  
Afnan Alqahtani ◽  
Norah S. AlAkeel ◽  
Naael Alazwary ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Clinical Features ◽  
Axonal Neuropathy ◽  
Guillain Barre Syndrome ◽  
Upper Respiratory Tract ◽  
Arab Population ◽  
Acute Motor Axonal Neuropathy ◽  
Facial Diplegia ◽  
Guillain Barré Syndrome ◽  
Guillain Barré

Abstract Background Guillain–Barre syndrome (GBS) is an inflammatory polyradiculoneuropathy characterized by rapidly evolving weakness and areflexia, reaching nadir within 4 weeks. Data on the characteristic of GBS in Saudi Arabia are limited. This study aimed to describe the clinical, electrophysiological, and laboratory characteristics and outcome of a multicenter cohort of patients with GBS. Methods This is a retrospective multicenter nationwide study. Patients who had GBS, identified through Brighton Criteria, between January 2015 and December 2019 were included. Data collected included demographics, clinical features, cerebrospinal fluid profile, reported electrophysiological patterns, treatment, and outcome. Reported GBS subtypes were compared using chi-square, Fisher's exact, or Mann–Whitney U tests, as appropriate. Results A total of 156 patients with GBS were included (men, 61.5%), with a median age of 38 (interquartile range, 26.25–53.5) years. The most commonly reported antecedent illnesses were upper respiratory tract infection (39.1%) and diarrhea (27.8%). All but two patients (98.7%) had weakness, 64.1% had sensory symptoms, 43.1% had facial diplegia, 33.8% had oropharyngeal weakness, 12.4% had ophthalmoplegia, and 26.3% needed mechanical ventilation. Cytoalbuminological dissociation was observed in 69.1% of the patients. GBS-specific therapy was administered in 96.8% of the patients, of whom 88.1% had intravenous immunoglobulin, and 11.9% had plasmapheresis. Approximately half of the patients were able to walk independently within 9 months after discharge, and a third regained the ability to walk independently thereafter. Death of one patient was caused by septicemia. Acute inflammatory demyelinating polyradiculoneuropathy was the most commonly reported GBS subtype (37.7%), followed by acute motor axonal neuropathy (29.5%), and acute motor-sensory axonal neuropathy (19.2%). Conclusion The clinical and laboratory characteristics and outcome of GBS in the Arab population of Saudi Arabia are similar to the international cohorts. The overall prognosis is favorable.

scholarly journals Clinical features of Guillain–Barré syndrome patients with elevated serum creatine kinase levels

2020 ◽  
Author(s):  
Takafumi Hosokawa ◽  
Hideto Nakajima ◽  
Taiki Sawai ◽  
Yoshitsugu Nakamura ◽  
Eri Sano ◽  
...  
Keyword(s):  
Creatine Kinase ◽  
Clinical Features ◽  
Axonal Neuropathy ◽  
Elevated Serum ◽  
Serum Creatine Kinase ◽  
Guillain Barre Syndrome ◽  
Guillain Barré Syndrome ◽  
Conduction Failure ◽  
Electrophysiological Examination ◽  
Guillain Barré

Abstract Background: It is not well defined whether Guillain–Barré syndrome (GBS) patients with elevated serum creatine kinase (CK) levels have characteristic clinical features and are related to the subgroups of GBS. Methods: We retrospectively studied 51 consecutive patients with GBS, who visited our hospital, and compared clinical, laboratory and electrophysiological findings between patients with and without elevated CK levels. Results: Of 51 patients, 14 patients (27%) showed an elevation of serum CK levels. When compared with patients with the normal CK levels, the ratios of male, antecedent infections, and anti-GM1 antibody positivity were significantly higher in patients with elevated CK levels. The ratios of hypoesthesia, cranial nerve involvement, and urinary retention were significantly less in patients with elevated CK levels. There were no significant differences in disability at peak between two groups. In the electrophysiological examination, sensory nerve abnormalities were not observed. Although some patients with elevated CK levels showed prolongation of distal motor latencies (DMLs) and increase of durations in the initial examination, development of the prolongation of DMLs and increase of durations was not observed in the follow-up examinations. The findings were consistent with acute motor axonal neuropathy (AMAN) with reversible conduction failure (RCF) but not acute inflammatory demyelinating polyneuropathy (AIDP). Conclusions: The results suggest that the GBS patients with elevated CK levels represent not a group of AIDP but a group of AMAN with axonal degeneration or RCF even though the initial electrophysiological examination shows AIDP pattern. Key words: Creatine kinase, Guillain-Barré syndrome, AIDP, AMAN, reversible conduction failure

scholarly journals Clinical features of Guillain–Barré syndrome patients with elevated serum creatine kinase levels

2020 ◽  
Author(s):  
Takafumi Hosokawa ◽  
Hideto Nakajima ◽  
Taiki Sawai ◽  
Yoshitsugu Nakamura ◽  
Eri Sano ◽  
...  
Keyword(s):  
Creatine Kinase ◽  
Clinical Features ◽  
Axonal Neuropathy ◽  
Elevated Serum ◽  
Sensory Nerve ◽  
Serum Creatine Kinase ◽  
Guillain Barre Syndrome ◽  
Guillain Barré Syndrome ◽  
Electrophysiological Examination ◽  
Guillain Barré

Abstract Background: It is not well defined whether Guillain–Barré syndrome (GBS) patients with elevated serum creatine kinase (CK) levels have characteristic clinical features and are related to the subgroups of GBS. Methods: We retrospectively studied 51 consecutive patients with GBS, who visited our hospital, and compared clinical, laboratory and electrophysiological findings between patients with and without elevated CK levels. Results: Of 51 patients, 14 patients (27%) showed an elevation of serum CK levels. When compared with patients with the normal CK levels, the ratios of male, antecedent infections, and anti-GM1 antibody positivity were significantly higher in patients with elevated CK levels. The ratios of hypoesthesia, cranial nerve involvement, and urinary retention were significantly less in patients with elevated CK levels. There were no significant differences in disability at peak between two groups. In the electrophysiological examination, sensory nerve abnormalities were not observed. Although some patients with elevated CK levels showed prolongation of distal motor latencies (DMLs) and increase of durations in the initial examination, development of the prolongation of DMLs and increase of durations was not observed in the follow-up examinations. The findings were consistent with acute motor axonal neuropathy (AMAN) with reversible conduction failure (RCF) but not acute inflammatory demyelinating polyneuropathy (AIDP). Conclusions: The results suggest that the GBS patients with elevated CK levels represent not a group of AIDP but a group of AMAN with axonal degeneration or RCF even though the initial electrophysiological examination shows AIDP pattern.

Guillain-Barré syndrome in southern China: retrospective analysis of hospitalised patients from 14 provinces in the area south of the Huaihe River

2018 ◽  
Vol 89 (6) ◽  
pp. 618-626 ◽  
Author(s):  
Shuping Liu ◽  
Zheman Xiao ◽  
Min Lou ◽  
Fang Ji ◽  
Bei Shao ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Southern China ◽  
Axonal Neuropathy ◽  
The Elderly ◽  
Guillain Barre Syndrome ◽  
Severe Illness ◽  
Fisher Syndrome ◽  
Hospitalised Patients ◽  
Guillain Barré Syndrome ◽  
Guillain Barré

ObjectivesThe clinical and epidemiological profiles of Guillain-Barré syndrome (GBS) in southern China have yet to be fully recognised. We aimed to investigate the subtypes of GBS in southern China, compare the clinical features of demyelinating form with that of axonal form and test whether preceding infections and age have influence on the clinical phenotype, disease course and severity of GBS.MethodsMedical records of patients with a diagnosis of GBS admitted to 31 tertiary hospitals, located in 14 provinces in southern China, from 1 January 2013 to 30 September 2016, were collected and retrospectively reviewed.ResultsFinally. 1056 patients, including 887 classic GBS and 169 variants, were enrolled. The 661 classic patients with available electromyographic data were grouped as having acute inflammatory demyelinating polyneuropathy (AIDP, 49.0%), acute motor axonal neuropathy (AMAN, 18.8%), inexcitable (0.9%) and equivocal (31.3%). In contrast to AIDP, patients with AMAN were characterised by earlier nadir (P=0.000), higher Hughes score at nadir (P=0.003) and at discharge (P=0.000). Preceding upper respiratory infections were identified in 369 (34.9%) patients, who were more inclined to develop AIDP (P=0.000) and Miller-Fisher syndrome (P=0.027), whereas gastrointestinal infection were found in 89 (8.4%) patients, who were more prone to develop AMAN (P=0.000), with more severe illness (P=0.001) and longer hospital stay (P=0.009). Children (≤15 years) and the elderly (≥56 years) were more severe at nadir, the elderly had the longest hospital stay (P=0.023).ConclusionAIDP is the predominant form in southern China, which is different from data of northern China. The different subtypes, preceding infection and age of onset can partially determine the disease progression, severity and short-term recovery speed of GBS.Clinical trial registrationChiCTR-RRC-17014152.

scholarly journals A Case of Acute Motor Sensory Axonal Neuropathy: A Variant of Guillain-Barré Syndrome, with Possible Syndrome of Irreversible Lithium-Effectuated Neurotoxicity

2020 ◽  
Vol 2020 ◽  
pp. 1-4 ◽  
Author(s):  
David Y. Liu ◽  
Jessica R. Hollenbach ◽  
Jason A. Gregorin ◽  
Jonathan H. Wynbrandt
Keyword(s):  
Prolonged Mechanical Ventilation ◽  
Axonal Neuropathy ◽  
Guillain Barre Syndrome ◽  
Respiratory Compromise ◽  
Term Care ◽  
Fluid Analysis ◽  
Guillain Barré Syndrome ◽  
Immune Globulins ◽  
Prolonged Recovery ◽  
Guillain Barré

Acute Motor Sensory Axonal Neuropathy (AMSAN) is a rare and severe variant of Guillain-Barré syndrome (GBS) that has a prolonged recovery course. GBS is often suspected due to ascending muscle weakness, sensation difficulties, respiratory compromise, and antecedent diarrhea. The diagnosis of GBS is supported by cerebrospinal fluid analysis showing albuminocytologic dissociation. Electromyogram and nerve conduction study confirm the diagnosis and allow for further classification by variant. Treatment involves either IV immune globulins or plasmapheresis, and patients typically recover. However, depending on the variant and severity, patients may ultimately require prolonged mechanical ventilation with tracheostomy. In these cases, they may continue to have persistent muscle and sensation abnormalities requiring long-term care. We present a unique case of a 38-year-old female patient with decade-long use of lithium for bipolar disorder that presented with acute lithium toxicity. Though she was ultimately diagnosed with AMSAN, the Syndrome of Irreversible Lithium-Effectuated Neurotoxicity (SILENT) may have also contributed to her persistent neurological sequelae.

scholarly journals Clinical features and prognosis with Guillain-Barré syndrome

2011 ◽  
Vol 14 (2) ◽  
pp. 98 ◽  
Author(s):  
Sinan Akbayram ◽  
Cihangir Akgün ◽  
Refah Sayin ◽  
Mehmet-Selçuk Bektas ◽  
Murat Dogan ◽  
...  
Keyword(s):  
Clinical Features ◽  
Guillain Barre Syndrome ◽  
Guillain Barré Syndrome ◽  
Guillain Barré

Acute Motor-Sensory Axonal Neuropathy With Hyperreflexia in Guillain-Barré Syndrome

2014 ◽  
Vol 30 (5) ◽  
pp. 637-640 ◽  
Author(s):  
Ayşe Tosun ◽  
Şiar Dursun ◽  
Utku Ogan Akyildiz ◽  
Seçil Oktay ◽  
Cengiz Tataroğlu
Keyword(s):  
Axonal Neuropathy ◽  
Guillain Barre Syndrome ◽  
Guillain Barré Syndrome ◽  
Guillain Barré

scholarly journals Fulminant Guillain-Barré syndrome in a patient with systemic lupus erythematosus

2019 ◽  
Vol 12 (1) ◽  
pp. bcr-2018-226634 ◽  
Author(s):  
Eric Anthony Coomes ◽  
Hourmazd Haghbayan ◽  
Jenna Spring ◽  
Sangeeta Mehta
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Axonal Neuropathy ◽  
Guillain Barre Syndrome ◽  
Systemic Lupus ◽  
Outward Appearance ◽  
Intravenous Immunoglobulin Therapy ◽  
Neuropsychiatric Manifestation ◽  
Guillain Barré Syndrome ◽  
Guillain Barré

A 45-year-old man with a history of systemic lupus erythematosus presented with progressive weakness and areflexia. Electromyogram revealed reduced motor and sensory amplitudes without demyelinating features. He was clinically diagnosed with the acute motor and sensory axonal neuropathy variant of Guillain-Barré syndrome. Despite intravenous immunoglobulin therapy, he deteriorated with loss of all voluntary motor function and cranial nerve reflexes. Concomitant investigations revealed class V lupus nephritis. Therapy was initiated with plasma exchange, glucocorticoids and further immunosuppression, with gradual neurological recovery. We present the first documented case of fulminant Guillain-Barré syndrome as a neuropsychiatric manifestation of systemic lupus erythematosus, highlighting how immune-mediated polyneuropathy via diffuse deafferentation may mimic the outward appearance of brain death. While glucocorticoids are not indicated in idiopathic Guillain-Barré, when this neurological disorder is a consequence of systemic lupus erythematosus, immunomodulatory treatment should be initiated to prevent neurological deterioration.

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