Clinical and electrophysiological features of post-traumatic Guillain-Barré syndrome

Li, Xiaowen; Xiao, Jinting; Ding, Yun; Xu, Jing; Li, Chuanxia; He, Yating; Zhai, Hua‐Jin; Xie, Bin; Hao, Junwei

doi:10.1186/s12883-017-0919-x

Cited by 16 publications

(17 citation statements)

References 27 publications

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“…GBS is an immune-mediated inflammatory polyneuropathy that has long been associated with preceding infections and vaccination ( 1 ). Recently, there is an emerging relationship between GBS and traumatic events, such as surgery, TBI, bone fracture, chest trauma, abortion and intracerebral hemorrhage ( 5 , 10 , 11 ). But high-intensity exercise, excessive fatigue and CPR triggering GBS are not described before.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Delayed Guillain-Barré syndrome following trauma: A case series and manage considerations

Zhang

Huang

et al. 2022

Front. Surg.

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AimTo analyze clinical associations between Guillain-Barré syndrome (GBS) and trauma.Material and MethodsWe retrospectively reviewed the data of eight patients with post-traumatic GBS between July 2011 and December 2018 at the Second Xiangya Hospital, China, and analyzed the triggers, clinical manifestation, examination results, treatment, prognosis, and potential mechanism related to post-traumatic GBS.ResultsThe included patients had GBS preceded by no risk factors other than trauma. Their age ranged from 15 to 60 years (the median age was 52 years), and six patients were males. The potential traumatic triggers included spinal surgery (n = 2), high-intensity exercise (n = 2), traumatic brain injury (n = 1), excessive fatigue (n = 1), ischemic stroke (n = 1), and cardiopulmonary resuscitation (n = 1). The major manifestation was symmetrical limb weakness and/or numbness in all patients. The diagnosis of GBS was based on the results of electromyography, albumino-cytological dissociation, or antiganglioside antibody in cerebrospinal fluid, and other diseases were excluded. Immunotherapy improved symptoms, except in one patient who died.ConclusionsTrauma is a probable risk factor for GBS that is very easily overlooked, thereby leading to misdiagnosis in clinical practice. We emphasize a new concept of post-traumatic GBS to promote doctors' awareness when they meet people with weakness and sensory deficits after trauma, which benefit early diagnosis, timely treatment, and reduced mortality rate of GBS.

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Section: Discussionmentioning

confidence: 99%

Case Report: Delayed Guillain-Barré syndrome following trauma: A case series and manage considerations

Zhang

Huang

et al. 2022

Front. Surg.

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“…Thus, surgery has been identified as a potential risk factor for GBS [ 17 ]. In a study conducted by Li et al, all nine patients exhibited an axonal, rather than demyelinating, form of neuropathy [ 18 ]. Moreover, Hocker et al reported that post-surgical GBS was more common in patients with an active malignancy [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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.

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“…In our case, the patient presented with GBS after spontaneous intraventricular hemorrhage. There are also a few cases that have reported that GBS can be caused by head trauma, neurosurgery, or other cerebral hemorrhagic injury ( Rivas et al, 2008 ; Yardimci et al, 2009 ; Tan et al, 2010 ; Song et al, 2012 ; Mantero et al, 2013 ; Zhang and Li, 2014 ; Wu et al, 2016 ; Li et al, 2017 ). Table 1 reviews the GBS cases that have developed after cerebral hemorrhagic injury (CHI).…”

Section: Discussionmentioning

confidence: 99%

Fulminant Guillain–Barré Syndrome and Spontaneous Intraventricular Hemorrhage: A Case Report and Literature Review

Luo

Wang

et al. 2020

Front. Neurosci.

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Guillain–Barré syndrome (GBS) is an acute, immune-mediated inflammatory peripheral polyneuropathy that is characterized by flaccid paralysis. A few cases have reported that GBS can be caused by head trauma or neurosurgery, but it has never been associated with intraventricular hemorrhage. Here, we report an uncommon case of fulminant GBS that occurred after spontaneous intraventricular hemorrhage. A 73-year-old woman was admitted to the hospital after sudden unconsciousness and vomiting. A head computed tomography (CT) scan following the incident showed a newly developed intraventricular hemorrhage, which led to an immediate ventriculostomy. After 5 days, the endotracheal tube was removed. Two days later, the external ventricular drainage tube was also removed. At this time, the patient was alert and the neurological examination was normal. However, the patient suddenly presented with acute respiratory failure and bilateral limb weakness 3 days later. An analysis of the patient’s cerebrospinal fluid (CSF) revealed that albuminocytologic dissociation was present. The patient was treated with intravenous immunoglobulin (0.4 g/kg/day) for 5 days. Despite timely medical intervention in the hospital, the patient passed away 2 months later. After a cerebral hemorrhagic injury, limb and respiratory muscle weakness can occur on occasion in the ICU. In this context, the potential involvement of GBS should not be ignored. Importantly, the pathogenic mechanism of GBS has been discussed for over a century, and it still remains a mystery. We speculate that the TLR4/NF-κB signaling pathway may be involved in the pathogenesis of GBS following intraventricular hemorrhage. The prognosis of most patients with GBS is usually good, but cerebral hemorrhage and mechanical ventilation may serve as risk factors that exacerbate the condition. This case is reported to remind clinicians to consider the possibility of GBS when patients present limb and respiratory muscle weakness after intraventricular hemorrhage, and to provide a starting point to discuss potential mechanisms of GBS after intraventricular hemorrhage.

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Clinical and electrophysiological features of post-traumatic Guillain-Barré syndrome

Cited by 16 publications

References 27 publications

Case Report: Delayed Guillain-Barré syndrome following trauma: A case series and manage considerations

Case Report: Delayed Guillain-Barré syndrome following trauma: A case series and manage considerations

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

Fulminant Guillain–Barré Syndrome and Spontaneous Intraventricular Hemorrhage: A Case Report and Literature Review

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