Nota Clínica

Atypical Guillain-Barré syndrome clustering: is it necessary to reconsider the diagnostic criteria and microbiological protocol?

A. Domínguez-Mayoral, C. Gutiérrez, J.M. López-Domínguez, S. Eichau, J. Abril-Jaramillo, G. Navarro-Mascarell, M.A. Quesada-García, M. Ramos, M. Álvarez-López, C. Menéndez-De León, G. Izquierdo [REV NEUROL 2017;64:407-412] PMID: 28444683 DOI: https://doi.org/10.33588/rn.6409.2016505

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Volumen 64 | Number 09 | Nº of views of the article 8.725 | Nº of PDF downloads 676 | Article publication date 01/05/2017

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ABSTRACT

INTRODUCTION Guillain-Barré syndrome is classically defined as a symmetrical ascending acute polyradiculoneuropathy, although there are atypical variants that make diagnosis difficult. CASE REPORTS. The medical data of six patients in our hospital area are collected during the first quarter of 2013. Lumbar punctures, imaging, neurophysiological studies, ganglioside antibodies and serologies have been proposed in all cases. We focus on the atypical features as late hyporeflexia, increased frequency of asymmetry and distal paresis and initial fever. From a neurophysiological point of view, all patients presented sensorimotor axonal forms. The most consistent datas in early studies is the F waves alteration. A Miller Fisher variant associated with faciocervicobraquial paresis and cerebral reversible vasoconstriction syndrome has been detected. A bilateral brachial paresis and lumbar polyradiculopathy in the context of influenza A infection is other interesting case. The saltatory variant with cranial nerve involvement and lower limbs paresis has been demonstrated in one patient. Bands in cerebrospinal fluid are positive in three cases and anti-ganglioside antibodies in one patient. The syndrome of inappropriate secretion of antidiuretic hormone may explain some of the hyponatremias registered. The first line of treatment are inmunoglobulins in all patients. Plasmapheresis exchanges has been used as an additional therapy in four cases.

CONCLUSIONS These clusters of six axonal cases with atypical clinical features justifies the need for knowledge of these variants in order to achieve an early treatment. Late hyporeflexia and brachialfaciocervico, saltatory and lumbar forms should be considered in the spectrum of Guillain-Barré syndrome. The etiological study should rule out a lots of pathogens as influenza A. KeywordsAtypical Guillain-Barré syndrome Axonal acute polyradiculopathy Cerebral reversible vasoconstriction syndrome Influenza A Miller Fisher Saltatory variant CategoriesNervios periféricos, unión neuromuscular y músculo

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Nota Clínica

Atypical Guillain-Barré syndrome clustering: is it necessary to reconsider the diagnostic criteria and microbiological protocol?

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