No abstract

Nearly half of patients with Guillain-Barré syndrome (GBS) have cranial nerve involvement. Ocular muscle weakness or ophthalmoplegia occurs in ~10% of these patients. Patients presenting with bilateral ptosis, with or without ophthalmoplegia, is a rare finding. Anti-GQ1b antibody has been found in Miller Fisher syndrome and GBS with ophthalmoplegia variants. We report a case of GBS in a young boy presenting with rare presentation of tetraplegia, bilateral ptosis, and facial palsy, no ataxia but ophthalmoplegia with seronegative anti-GQ1b antibody. Patient showed recovery in cranial nerves involvement as well as with motor and functional recovery after 3 weeks of inpatient rehabilitation (Barthel Index score improved to 60/100 at the time of discharge from 20/100 at the time of admission). He was independent for most of the activity of daily livings including ambulation at the time of discharge from rehabilitation unit (p < 0.001).

Objectives: Non-invasive assessment of cardiac autonomic dysfunction in spinal cord injury (SCI) by means of heart rate variability analysis (HRV). Also, to assess the effect of postural change on neural outflow. Setting: Rehabilitation research center, Sawai Man Singh Hospital, Jaipur. Participants: 110 patients with SCI were screened, of whom, 12 patients aged between 20 and 30 years with chronic complete SCI and neurological level of T6 or above were included. An equal number of age and sex matched healthy individuals were the controls. Interventions: Five minute ECG recording, first in supine position and then in sitting position was done. Outcome measures: Frequency domain measures of heart rate variability. Results: No significant differences were observed between both the groups in supine rest. On sitting, the absolute power of the low frequency (LF) and high frequency (HF) components were significantly less in the SCI patients than that in the controls. A significantly increased LF-to-HF ratio along with a higher mean heart rate (HR) was observed in the controls on postural change. Conclusion: On change of posture, the controls showed a physiologically patterned response, which was not observed in the SCI patients. The loss of this homeostatic mechanism in the SCI subjects was observed, which may reflect a dysfunctional autonomic nervous system interplay in patients with complete SCI.