脑外伤后合并格林巴利综合征1例并文献复习

Guillain-Barré syndrome after traumatic brain injury (a case report and review of literature)

目的探讨脑外伤后格林巴利综合征的临床特点、发病机制、治疗及预后。方法回顾分析1例脑外伤后格林巴利综合征患者的临床资料;并结合复习脑外伤后格林综合征的相关文献进行分析。结果患者脑外伤后10 d出现四肢无力、腱反射消失,颅神经麻痹,呼吸衰竭。颈椎CT三维重建未见异常;脑脊液检查呈蛋白-细胞分离。发病后7 d诊断为格林巴利综合征,予免疫球蛋白10 g/d静脉滴注5 d,患者未见好转,约1个月后仍无好转,自动出院。结论脑外伤后合并格林巴利综合征的特点为,脑外伤1～2周出现多发性周围神经瘫痪,发病机制不明。两者有些症状相像;应尽早诊断、尽早治疗,可改善患者的预后。

Objective To explore the clinical characteristics,pathogenesis,treatment and prognosis of GuillainBarré syndrome（ GBS） after traumatic brain injury. Methods The clinical characteristics,laboratory examination,diagnosis and treatment of a patient with GBS after traumatic brain injury were analyzed retrospectively. Literatures about GBS after traumatic brain injury at home and abroad are reviewed. Results The main symptoms of the patient were limb weakness,cranial nerve paralysis,respiratory failure and deep cervical reflex. Three-dimensional reconstruction of the CT examination showed normal. Cerebrospinal fluid（ CSF） studies showed albumincytologic dissociation protein cell separation. The diagnosis of GBS was made after 7 days. A 5 d course of IVIg was completed,and there was no obvious improvement after 1 month when he was discharged. Conclusions GBS has multiple peripheral nerve paralysis after 1 or 2 weeks,especially after traumatic brain injury,the mechanism after traumatic brain injury is unknown. Traumatic brain injury and GBS are similar. Early diagnosis and treatment could improve the curative prognosis of patients.