Variant of Guillain-Barrésyndrome with anti-sulfatide antibody positivity and spinal cord involvement:A case report

BACKGROUND Guillain-Barrésyndrome(GBS)is an acute autoimmune-mediated polyneuropathy.Studies have increasingly reported the presence of anti-sulfatide antibody positivity with varying clinical symptoms in patients with GBS.However,spinal cord involvement is relatively rare in these cases.CASE SUMMARY A 68-year-old woman was admitted to the hospital with weakness of the limb for more than 3 d.Additional symptoms included neck pain,progressive numbness in the distal extremities,urinary and fecal retention,and reduced perception of temperature.She was diagnosed with an anti-sulfatide antibody-positive GBS variant and discharged after treatment with methylprednisolone and intravenous human immunoglobulin pulse therapy.Unlike common cases of anti-sulfatide antibody-positive GBS,this patient had atypical clinical symptoms of spinal cord involvement.No similar cases have previously been reported in China.CONCLUSION Although GBS is associated with a poor prognosis,a prompt diagnosis allows early administration of combined intravenous human immunoglobulin and methylprednisolone pulse therapy.

Diagnosis and Treatment of Diabetic Ketoacidosis Mellitus with Guillain-Barré Syndrome: A Case Report

This article reports the diagnosis and treatment of a case of Diabetic ketoacidosis with Guillain-Barré syndrome. Diabetic ketoacidosis (DKA) is the most common acute diabetes mellitus, often diabetes and infection, insulin withdrawal or interruption of the history of triggers, with hyperglycemia, ketoacidosis, and acid poisoning as the main symptoms, rapid onset of ill-ness, and serious illness. Guillain-Barré syndrome (GBS) is an autoimmune-mediated peripheral neuropathy with frequent respiratory or gastrointestinal tract infections and low clinical incidence before 1 - 3 weeks. This case was characterized by a headache with vomiting acute onset, a relatively clear diagnosis of diabetic ketoacidosis, a symmetrical decrease in muscle strength in the extremities, and recovery of consciousness after aggressive correction of environmental disturbance in electrolytes, but very poor muscle strength in the extremities, protein-cell segregation in cerebrospinal fluid (CSF). Considering Guillain-Barré syndrome, the patient’s muscle strength gradually recovered after treatment with proglobulin shock. At present, the pathogenesis of the two is not clear, but because of its rapid progress, clinicians should raise awareness of diabetic ketoacidosis combined with Guillain-Barré syndrome, early diagnosis, and active treatment. Inform consent has been obtained from the patient for this report.

A Case-control Study on Children with Guillain-barre Syndrome in North China

To explore the risk factors for Guillain-barre syndrome. Methods Case-control study design was used in 51 cases of Guillain-barre syndrome,and 51 matched controls.All of the 51 cases in this study had been examined by electrophysiology. Serum IgG antibodies specific for C. jejuni were determined in all the subjects by ELISA. Each case and control were interviewed using an ad hoc questionnaire, including his/her demographic information,onset of the illness, their personal hygiene and so on. Results The study showed that Guillain-barre syndrome was associated with a few factors, such as polio vaccine immunization before onset of illness (OR=7.27), no hand washing after defecation and before meals (OR=6.15). Infection of C. jejuni was strongly associated with the illness (OR=9.5,P<0.001). Conclusion It is suggested that occurrence of Guillain-barre syndrome may correlate to infection of C. jejuni and poor personal hygiene in children.

Effects of increased human tumor necrosis factor-like molecule 1A expression in peripheral blood of children with acute Guillain-Barre syndrome on interferon-gamma secretion

BACKGROUND： Human tumor necrosis factor-like molecule 1A （hTL1A） is a strong T helper cell type 1 （Thl） co-stimulator. Guillain-Barre syndrome （GBS） is an autoimmune disorder of the nervous system, which is mediated by Thl cells. OBJECTIVE： To determine hTL1A expression in peripheral blood T lymphocytes of acute GBS children and the effects of hTL1A on secretion of interferon-γ. DESIGN, TIME AND SETTING： A randomized, controlled, neuroimmunological in vitro study was performed at the Central Laboratory of First Hospital of Jilin University, China from November 2005 to November 2007. MATERIALS： Venous blood samples were obtained from 6 healthy donors, aged 6-12 years （all routine blood examination items were normal）, and 6 additional children with acute GBS, aged 6-12 years. The GBS children fell ill within 1 week and were not treated with hormones or immunoglobulin Purified recombinant human soluble tumor necrosis factor-like molecule 1A （rhsTL1A, 1 mg/mL, relative molecular mass 22 000, 6× His tag, soluble form） was supplied by the Central Laboratory of First Hospital of Jilin University, China. METHODS： Peripheral blood mononuclear cells were isolated from healthy donors using the standard Ficoll gradient centrifugation and were incubated in 96-well culture plates. The cells were assigned to the following groups： control （2 μg/mL phytohemagglutinin）, 2μg/mL phytohemagglutinin ＋ 25, 100 and 400 ng/mL rhsTL1A. T cell proliferation was quantified using the tritiated thymidine （3H-TdR） method. Serum interferon-γ levels in acute GBS children were detected by enzyme-linked immunosorbent assay （ELISA）. The ratio of hTL1A-positive T cells to CD3-positive T cells in peripheral blood of acute GBS children was determined using flow cytometry. Following in vitro pre-activation of peripheral blood mononuclear cells by 2 μg/mL phytohemagglutinin, the peripheral blood mononuclear cells were treated with 400 ng/mL exogenous rhsTLIA. Finally, peripheral blood mononuclear cell-secreted interferon-γlevels were measured by ELISA. MAIN OUTCOME MEASURES： The following parameters were measured： rhsTLIA stimulation index to stimulate proliferation of T cells; the serum interferon-γ levels in acute GBS children; the ratio of hTL1A-positive cells to CD3-positive cells; the levels of interferon-γ secreted by peripheral blood mononuclear cells in acute GBS children, as well as rhsTL1A-stimulated interferon-γ levels. RESULTS： T cell proliferation assay revealed that the stimulation index in each rhsTL1A group was greater than the control group. The stimulation index of the 400 ng/mL rhsTL1A group was the greatest. Serum interferon-γ levels in acute GBS children were significantly greater than the control group （P 〈 0.05）. The ratio of hTLIA＋ CD3＋ T cells to CD3＋ T cells in acute GBS children was significantly greater than the control group （P 〈 0.01 ）. Phytohemagglutinin stimulated peripheral blood mononuclear cells to a greater extent than 400 ng/mL rhsTL1A in the acute GBS group, and the secreted interferon-γ levels were significantly increased （P 〈 0.05）. CONCLUSION： In T cells pre-activated with 2 μg/mL phytohemagglutinin, proliferation was effectively increased with 400 ng/mL rhsTL1A treatment. Expression of hTLIA was increased in activated T cells from peripheral blood of acute GBS children, followed by increased interferon-γ secretion. These mechanisms are considered to be part of the pathological process that induces the secretion of inflammatory cytokines in GBS syndrome.

Guillain-Barre syndrome associated with peginterferon alfa-2a for chronic hepatitis C: A case report

The recommended therapy for chronic hepatitis C (CHC) infection is the combination of a Pegylated interferon and Ribavirin. Almost all such patients on combination therapy experience one or more adverse events during the course of treatment. Significant neurological side effects are rare. A few cases of Bell's Palsy, chronic inflammatory demyelinating polyneuropathy and even one case of acute demyelinating polyneuropathy with atypical features for Guillain-Barre syndrome (GBS) associated with Interferon therapy have been reported but no report of GBS with typical features has been published. We present a case report of typical GBS associated with Peginterferon alfa-2a and Ribavirin used for treatment of CHC infection.

Association of neuroelectrophysiology and analysis of cerebrospinal fluid immunoglobulin with pathogenetic conditions of patients with Guillain-Barre syndrome

BACKGROUND： Guillain-Barre syndrome （GBS） is an autoimmune disease which is characterized by demyelination of peripheral nerve and nerve root, and inflammatory reaction of lymphocyte and macrophage. Neuroelectrophysiological examination and cerebrospinal fluid （CSF） analysis are of significance for its diagnosis. OBJECTIVE： To study the association of neuroelectrophysiology and cerebrospinal fluid immunoglobulin （CSF-lg） with pathogenetic conditions of patients with GBS. DESIGN： Case control study SETTING： Department of Neurology, Shenzhen Municipal Shekou Group Hospital; Department of Neuroelectrophysiology, People＇s Hospital of Guangdong Province. PARTICIPANTS： A total of 32 GBS patients including 18 males and 14 females who aged from 17 to 72 years were selected as experimental group from the Department of Neurology, People＇s Hospital of Guang- dong Province from January 2004 to December 2005. All cases conformed with GBS diagnostic criteria established by Asbury in 1990 and they were divided into three types according to neurological criteria established by Chinese Neurology and Psychology Journal in 1993： mild, moderate and severe types. Another 30 patients with vascular headache were selected as control group from the same hospital including 14 males and 16 females who aged from 17 to 79 years. METHODS： ① Neuroelectrophysiological examination： Multiple-functional electromyography device provided by Nicolet Company, USA was used to measure nerve conduction velocity （NCV）, including motor nerve conduction velocity （MCV） and sensory nerve conduction velocity （SCV）; meanwhile, electromyologram （EMG）, somatosensory evoked potential （SEP） and electroencephalogram （EEG） were also measured. ② Detection of CSF-lg： Concentrations of IgG, IgA and IgM were measured with immunofixation electrophoresis. ③Follow-up： Among 32 GBS patients, 14 cases received follow-up after treatment and the longest fol- low-up time was 1 year after onset. Among them, 8 cases were reexaminined with neuroelectrophysiological and CSF examinations. MAIN OUTCOME MEASURES： Results of NCV, EMG, SEP and EEG; comparison of CSF-lg content; results of follow-up examinations. RESULTS： All 32 GBS cases and 30 patients with vascular headache were involved in the final analysis. ① Abnormal rate of neuroelectrophysiological test： 75% of NCV, 88% of F-wave, 53% of MCV, 25% of SEP, 47% of EMG and 31% of EEG. There were no significant differences among various types （P 〉 0.05）. ② Results of CSF-lg test： There were no significant differences among various types （P 〉 0.05）; however, abnormalities in experimental group was higher than those in control group （P 〈 0.01）. CONCLUSION ： Results of follow-up study suggest that improvement of clinical symptom is earlier than neuroelectrophysiological recovery; MCV and EMG recoveries are faster than that of NCV; the earlier the abnormality of EMG, the poorer the recovery. CSF4g recovers normally along improvement of clinical symptoms. It is of significance for neuroelectrophysiology and abnormality of CSF-Ig to determine degree of peripheral nerve demyelination and prognosis.

A rare presentation of Guillain-Barre syndrome with GQ1b positivity:A case report

Rationale:To report a case of cervicobrachial variant of acute inflammatory demyelinating polyneuropathy presenting with papilledema and GQ1b positivity.Patient concern:A 35-year-old female,68 days postpartum,presented with headache,vomiting,and gait difficulty in swallowing with bilateral upper limb weakness and difficulty in walking,13 days after ChAdOx1 nCoV-19 vaccination.Diagnosis:Guillain-Barre syndrome with GQ1b positivity.Intervention:Five cycles of plasmapheresis were given.Outcome:The patient’s clinical condition improved.Palatal weakness improved and she could walk without support.There were mild sensory symptoms involving upper limbs which gradually improved.Lessons:AIDP should be considered in case of weakness following ChAdOx1 nCoV-19 vaccination.Albumino-cytological dissociation and anti-GQ1b positivity are needed to confirmed the diagnosis.

Asymmetric limb weakness in Guillain-Barre syndrome:Three case reports

BACKGROUND Guillain-Barrésyndrome(GBS)is an autoimmune-mediated peripheral neuropathy characterized by symmetric weakness.Asymmetric weakness in GBS is uncommon and may be easily confused with other differential diagnoses.We herein present three cases of asymmetric GBS and review the literature on this atypical subtype of GBS in order to describe the characteristics of asymmetric GBS and to provide experience for clinicians.CASE SUMMARY Different from patients in the previous reports,our patients showed persistent asymmetric limb weakness from the onset to recovery phase.All three patients were serologically positive for antecedent infections.Two of the three cases had IgG antibodies against ganglioside GM1.Two patients received immunotherapy including intravenous immunoglobulin and plasma exchange,while one patient received only supportive treatment.Autoantibodies against gangliosides,asymmetry of congenital development of blood-nerve barrier and limb use may contribute to the development of asymmetric limb weakness in GBS.CONCLUSION Asymmetric GBS may be a rare clinical variant and should be considered when a patient develops acute and progressive asymmetric limb weakness.The differences in clinical features and prognosis between asymmetric GBS and classic GBS deserve further investigation in a large study.

Clinically Diagnosed Guillain-Barre Syndrome in Pregnancy: Case Report and Review of Literature

Background: Guillain-Barre syndrome (GBS) is an autoimmune disorder characterized by a heterogeneous group of pathological and clinical entities. It is associated with ascending areflexic paralysis, some autonomic dysfunction and respiratory failure in severe cases and ultimately death if not promptly diagnosed and treated. It may be preceded by an antecedent event in about two-third of cases. This could be an upper respiratory tract infection, viral illness, recent history of vaccination, pregnancy, cancer or even trauma. The condition is exceedingly rare in pregnancy and only few cases have been reported in literature. Case Report: This is a case of a 28-year-old Gravida 3, Para 1+1 and Estimated Gestational Age of 30 weeks and 4 days. There was a history of upper respiratory tract infection eight weeks prior to presentation which spontaneously resolved. On examination, she was a young woman, anxious, weak, afebrile, not pale, the neck could not hold the head upright and there was bilateral non tender pitting pedal oedema extending to her mid-shin. There were no cranial nerve deficits and no sign of meningeal irritation. There were normal muscle bulk with global hypotonia and flaccid quadriparesis, Power was 3/5. The proximal groups of muscles were more affected than the distal parts. Reflexes were diminished globally with plantar flexor response. She had immunoglobulin as treatment. Conclusion: In a low resource setting like ours it is important to have a high index of suspicion of GBS when an apparently healthy gravid woman presents with progressive weakness of the limbs.

Exceptional Association of a Cerebral Sinus Thrombosis and a Guillain-Barre Syndrome: A New Case Report and Review of the Literature

Background: The association of Guillain-Barre syndrome and cerebral sinus thrombosis is uncommon. Case Presentation: We report a 37-year-old patient hospitalized in medical ICU for respiratory distress following a Guillain-Barre syndrome. He had symptomatic treatment in addition to plasma exchange. In the presence of clonic movements, a brain venography magnetic resonance showed a thrombophlebitis of the left lateral sinus, and hence a low-molecular-weight heparin treatment was begun. Immunological, thrombophilia and serological tests were negative. After a favorable evolution, he was transferred to the neurology department. Conclusion: The combination of a Guillain-Barre syndrome and a cerebral sinus thrombosis would suggest a common process. A rigorous investigation, including the use of imaging, is necessary in front of any unusual clinical sign during a GBS.

COVID-19 Infection Presenting as Myalgia, Abnormal Liver Function Tests and the Guillain-Barre Syndrome

The severe acute respiratory syndrome coronavirus 2 infection typically presents with respiratory symptoms. Additionally, there are a number of less frequent neurological manifestations of infection with the coronavirus disease 2019 (COVID-19) with case reports suggesting an association with the Guillain-Barre syndrome. Most patients present with the typical upper respiratory symptoms in association with these neurological symptoms. We present a case of an unvaccinated gentleman with none of the typical respiratory symptoms of COVID-19 who presented with the Guillain Barre syndrome and myalgia. His symptoms settled following treatment with intravenous immunoglobulins. This case highlights the importance of testing for COVID-19 in patients without typical symptoms but who present with neurological illness and supports the use of intravenous immunoglobulin therapy.

Severe lumbar spinal stenosis combined with Guillain-Barrésyndrome:A case report

BACKGROUND Guillain-Barrésyndrome(GBS)is a rare disorder that typically presents with ascending weakness,pain,paraesthesias,and numbness,which mimic the findings in lumbar spinal stenosis.Here,we report a case of severe lumbar spinal stenosis combined with GBS.CASE SUMMARY A 70-year-old man with a history of lumbar spinal stenosis presented to our emergency department with severe lower back pain and lower extremity numbness.Magnetic resonance imaging confirmed the diagnosis of severe lumbar spinal stenosis.However,his symptoms did not improve postoperatively and he developed dysphagia and upper extremity numbness.An electromyogram was performed.Based on his symptoms,physical examination,and electromyogram,he was diagnosed with GBS.After 5 d of intravenous immunoglobulin(0.4 g/kg/d for 5 d)therapy,he gained 4/5 of strength in his upper and lower extremities and denied paraesthesias.He had regained 5/5 of strength in his extremities when he was discharged and had no symptoms during follow-up.CONCLUSION GBS should be considered in the differential diagnosis of spinal disorder,even though magnetic resonance imaging shows severe lumbar spinal stenosis.This case highlights the importance of a careful diagnosis when a patient has a history of a disease and comes to the hospital with the same or similar symptoms.

Guillain-Barré syndrome in a patient with multiple myeloma after bortezomib therapy: A case report

BACKGROUND Bortezomib is a first-line drug approved for patients with multiple myeloma (MM) and has significantly increased their overall survival. However, bortezomib-induced peripheral neuropathy (PN) remains a significant side effect that has led to its discontinuation in some patients. Guillain-Barré syndrome (GBS) is recognized as an immune-mediated PN characterized by the involvement of multiple nerve roots and peripheral nerves and albuminocytologic dissociation in cerebrospinal fluid (CSF) tests. Intravenous immunoglobulin (IVIG) and plasmapheresis are effective. CASE SUMMARY A 45-year-old man diagnosed with stage III MM (λ type) was treated with bortezomib and dexamethasone. Fourteen days after the second course, he complained of intense burning sensation in the lower limbs and hands, loss of tactile sensation, and pain in the distal area of both thighs and in the distal part of both wrist joints. Neurological examination revealed absence of knee and ankle reflexes. CSF examination revealed albuminocytologic dissociation. Nerve conduction studies indicated sensory nerve action potential amplitudes, conduction velocity decrease, and F wave latency prolongation. He was diagnosed as MM complicated with GBS. Subsequently, he was treated with high-dose IVIG (400 mg/kg/d for five days). His symptoms fully resolved without relapse at the 6-month follow-up. CONCLUSION Our case highlights the differential diagnosis and management of complications after bortezomib treatment in MM.

Miller Fisher Syndrome Induced by Chemotherapy in Known Case of Acute Lymphocytic Leukaemia: A Case Report

Introduction: Guillain-Barre Syndrome (GBS) is an acute-onset autoimmune-mediated neuropathy. Guillain-Barre Syndrome can be divided into three subtypes: acute inflammatory demyelinating poly-radiculo-neuropathy (AIDP), acute motor axonal neuropathy (AMAN), and acute motor sensory axonal neuropathy (AMSAN). About 20% of patients with GBS develop respiratory failure and require mechanical ventilation. We are presenting a variant of GBS (Miller Fisher Syndrome, or MFS), which has been confirmed by nerve conduction studies along with the triad of ophthalmoplegia, ataxia, and areflexia. The objective of this study is to present a rare case of chemotherapy-induced GBS. Important clinic findings: A 25-year-old gentleman with acute lymphocytic leukemia on active chemotherapy treatment presented with lower limb weakness. This weakness started after his fifth chemotherapy session. After the sixth chemotherapy, he developed complete paralysis of the left lower limb. Later, he developed right lower limb paralysis. He was also complaining of eye dryness and incomplete closure of both eyes. While inpatient, he developed upper-limb weakness. His chemotherapy consisted of MESNA, cyclophosphamide, doxorubicin, vincristine, cyorabine, and methotrexate. He had ptosis and ophthalmoplegia in the left abducent and right oculomotor regions. He had bilateral facial nerve palsy. He was hypotonic with power grade 3 in the upper limbs and grade 0 in the lower limbs with areflexia. His sensation was intact in the upper limbs but lost in the lower limbs. His planter reflexes were mute. Diagnoses and Management: Intravenous immunoglobulins were given for 5 days. A nerve conduction study showed severe demyelinating sensorimotor polyradoculoneuropathy with secondary axonal loss. The triad of ataxia, ophthalmoplegia, and areflexia was consistent with MFS. The patient improved over the course of the hospital stay but did not reach full recovery. Conclusion: Although GBS is uncommon, it must be taken into account when making a differential diagnosis for any patient presenting with progressive weakness. Drug history is important in all GBS cases.

The Anti-Inflammatory Effects of NaCl with KCl as a Potent Graphene Exfoliator in a Patient with Guillaine-Barré Syndrome and Facial Nerve Palsy

Guillain-Barré syndrome is a rare but fatal autoimmune disease of unknown origin. Infectious disease is the most common etiology of Guillain-Barré syndrome. We had a 75-year-old female patient with Guillain-Barré syndrome and a 90-year-old male patient with facial nerve palsy admitted to our hospital. Both patients experienced recovery from early Guillain-Barré syndrome and peripheral facial nerve palsy after receiving intravenous infusion of NaCl with KCl solution and taking vitamin C.

Magnetic resonance imaging diagnosis of acute Guillain-Barré syndrome in children

The present study examined 24 children with acute Guillain-Barre syndrome using magnetic resonance imaging （MRI） plain scans and fat-suppressed enhanced Tl-weighted imaging （T1WI） scans. Axial MRI plain scans centering on the medullary conus were positive in nine patients （38%）. These displayed variable thickening involving the cauda equina with isointensity on T1WI and isointensity or slight hyperintensity on T2WI. False negatives were obtained in patients with cervical and cranial nerve symptoms. Contrast enhancement of T1WI with fat suppression was positive in all patients in the cauda equina with varied thickening and enhancement centering on the medullary conus. Five patients （36%） were positive in the cervical nerves and 3 patients （50%） were positive in the cranial nerves. These patients had corresponding cervical and cranial nerve symptoms, respectively. Patients with serious clinical symptoms in the lower limbs exhibited obvious involvement of the cauda equina by MRI. Statistical analysis revealed a positive correlation between the extent of enlargement of the cauda equina, centering on the medullary conus, and cerebrospinal fluid protein concentration.

Guillain-Barrésyndrome and hemophagocytic syndrome heralding the diagnosis of diffuse large B cell lymphoma:A case report

BACKGROUND Central nervous system(CNS)lesions and peripheral neuropathy are rare among patients with non-Hodgkin’s lymphoma(NHL).Lymphomatous infiltration or local oppression usually accounts for CNS or peripheral nerve lesions.The incidence of peripheral neuropathy was 5%.Guillain-Barrésyndrome(GBS)is rare and may occur in less than 0.3%of patients with NHL.Hemophagocytic syndrome(HPS)is a rare complication of NHL.It has been reported that 1%of patients with hematological malignancies develop HPS.Diffuse large B-cell lymphoma(DLBCL)combined with GBS has been reported in 10 cases.CASE SUMMARY We report the case of a 53-year-old man who was initially hospitalized because of abnormal feelings in the lower limbs and urinary incontinence.He was finally diagnosed with DLBCL combined with GBS and HPS after 16 d,which was earlier than previously reported.Immunoglobulin pulse therapy,dexamethasone,and etoposide were immediately administered.The neurological symptoms did not improve,but cytopenia was relieved.However,GBS-related clinical symptoms were relieved partially after one cycle of rituximab-cyclophosphamide,hydroxydaunorubicin,vincristine,and prednisone(R-CHOP)chemotherapy and disappeared after six cycles of R-CHOP.CONCLUSION GBS and HPS heralding the diagnosis of Epstein-Barr virus DLBCL are rare.Herein,we report a rare case of DLBCL combined with GBS and HPS,and share our clinical experience.Traditional therapies may be effective if GBS occurs before lymphoma is diagnosed.Rapid diagnosis and treatment of DLBCL are crucial.

Automatic Evaluation of Test Strips for Anti-Ganglioside Antibodies in Patients with Guillain-BarréSyndrome Using EUROLineScan Software

Campylobacter jejuni infection has been implicated in the pathogenesis of Guillain-Barré syndrome (GBS) due to production of humoral immune response against neural antigens. A case-control study was performed in a tertiary care teaching hospital for the estimation of anti-ganglioside antibodies in GBS patients and their controls. Blood samples were collected from 59 GBS cases, 58 neurological controls (NC) and 60 non-neurological control (NNC) patients for automatic estimation of IgG and IgM antibodies to seven gangliosides using EUROLineScan software. Antibodies of IgG class for GM1 were highly significant in GBS (p = 0.000) and NC (p = 0.031) compared to NNC. However GBS group was not significant (p = 0.413) compared to NC. For GM2 ganglioside, GBS and NC groups were significant (p = 0.000) compared to NNC, but GBS group was not significant (p = 0.999) compared to NC. For GM3 ganglioside, GBS and NC groups were significant (p = 0.000) compared to NNC;but GBS group was insignificant (p = 0.858) compared to NC with similar trend for all other ganglioside antibodies. When IgM class of antibodies was evaluated for GM1, GBS group was not significant (p = 0.604) whereas NC group was significant (p = 0.000) compared to NNC. GBS group was not significant compared to NC (p = 0.011). The trend was the same for GM2 antibodies. For GM3, GBS group was significant (p = 0.010) and NC was near significant (p = 0.055) compared to NNC. However GBS group was not significant (p = 0.808) compared to NC. No groups were significant (p > 0.05) in relation to the remaining gangliosides except for GQ1b where GBS group (p = 0.001) and NC group were significant (p = 0.000) compared to NNC. GBS group was also significant (p = 0.001) compared to NC and NNC. Anti-gangliosides antibodies were present in highly significant levels in the GBS group, though they were also present in the non-paralytic neurological control patients compared to the non-neurological control group.

Case report: Treating Guillain-Barré syndrome with acupuncture-moxibustion and traditional Chinese Medicine patent prescription (Jingui Shenqi Pill)

Background:Guillain-Barré syndrome (GBS) is an acute demyelinating polyneuritis in which the immune system attacks part of the peripheral nervous system.About two-thirds of GBS patients have a history of acute infection before developing GBS.Immunotherapy and supportive therapies are widely used to treat GBS;however,one in three patients experiences neurologic sequelae.In China,acupuncture-moxibustion has shown unique benefits for the treatment of neurological diseases and has a wide range of applications in neurology.Case presentation:We treated an elderly Russian female patient diagnosed with GBS.The chief complaints were upper limb weakness,lower limb paralysis,and inability to self-care.The traditional Chinese medicine diagnosis was flaccidity syndrome (Wei Zheng).After 5 weeks of acupuncture and moxibustion combined with Chinese patent medicine treatment,the patient's limb muscle strength was significantly improved and her ability to self-care was largely restored.Conclusion:The present findings demonstrated that acupuncture and moxibustion combined with Chinese patent medicine can alleviate muscle weakness caused by GBS.However,clinical randomized controlled trials are warranted to verify the precise clinical efficacy.

Guillain-Barre综合征合并中枢神经系统脱髓鞘病变的临床研究

目的 探讨Guillain Barre综合征 (GBS)合并中枢神经系统 (CNS)脱髓鞘病变及两者之间的发病关系和可能的发病机制。方法 对 3例合并CNS脱髓鞘病变的GBS患者的临床及实验室资料进行分析。结果 例 1男 ,2 8岁 ,主要表现为全身软瘫和昏迷 ,血气分析结果正常 ,脑脊液有蛋白细胞分离、寡克隆带阳性 ,肌电图提示神经源性损害 ;MRI示双侧脑白质及颈髓广泛多发性脱髓鞘改变 ;应用血浆和免疫球蛋白治疗后好转。例 2女 ,5岁 ,因进行性四肢无力 ,呼吸困难入院 ,应用呼吸机和血浆治疗过程中出现脑干反射障碍 ,后放弃治疗死亡 ;死后行腓肠神经病检示周围神经脱髓鞘病变。例 3男 ,12岁 ,因进行性四肢无力伴大小便困难入院 ;颅脑MRI未见异常 ,脊髓MRI见T5～L4节段广泛脱髓鞘病变 ;脑脊液有蛋白细胞分离 ,寡克隆带阳性 ;肌电图示周围神经传导速度减慢。结论 合并意识障碍的GBS大多病情危重 ,其发病机制不详 。