Anımsatma: Guillain-Barré Sendromunda Kuvvet Kaybı Asimetrik Olabilir

Öz

Guillain-Barré sendromu GBS hızlı progresyon gösteren, simetrik ve aşağıdan yukarı doğru ilerleyen güçsüzlük ve arefleksi ile karakterize olan akut, demiyelinizan, inflama- tuvar bir polinöropatidir 1 . Kraniyal nöropati ve otonomik semptomlar bu tabloya eşlik edebilir 2 . Bu makalede, bila- teral alt ekstremitelerde şiddetli ağrıları ve sol alt ekstremi- te proksimalinde kuvvet kaybı sağa göre daha belirgin olan ve idrar inkontinansı gelişen bir vaka sunulmuştur. Elektromiyografi bulguları akut motor duysal aksonal nöropati AMSAN lehine değerlendirilmiş ve beyin-omirlik sıvısı analizi ve spinal manyetik rezonans görüntüleme ile de tanı desteklenmiştir. İntravenöz immunglobulin IVIG tedavisinden iki hafta sonra klinik düzelme görülmüş ve fizik tedavi ve rehabilitasyon programına alınmıştır. Asimetrik kuvvet kaybı ile presente olan GBS vakaları lite- ratürde ender olarak bildirilmektedir

Anahtar Kelimeler

• Guillain-Barré sendromu,güçsüzlük,arefleksi

Reminder: Loss of Strength in Guillain-Barré Syndrome May Be Asymmetric

Öz

Guillain-Barré syndrome GBS is a rapidly progressive, symmetrical and ascending acute demyelinating inflamma- tory polyneuropathy which is characterized by progressive weakness and areflexia. Cranial neuropathy and autonomic symptoms may accompany the clinical picture. In this paper, a case with severe pain in the bilateral lower extremities and left lower limb proximal muscle weakness which is signifi- cantly more marked than the right side and urinary inconti- nence was presented. Electromyography EMG findings were evaluated in favour of acute motor sensory axonal neuropathy AMSAN and the diagnosis was supported by cerebrospinal fluid analysis and magnetic resonance ima- ging. Two weeks after the intravenous immunoglobulin IVIG treatment clinical improvement was observed and the patient was included in physical therapy and rehabilitation program. GBS cases who present with asymmetric weakness have been rarely reported in the literature

Anahtar Kelimeler

• Guillain-Barré syndrome,weakness,areflexia

Kaynakça

1. Asbury AK, Cornblath dr. Assessment of current diagnos- tic criteria for Guillain-Barré syndrome. Ann Neurol 1990;27 (Suppl.):S21-4. http://dx.doi.org/10.1002/ana.410270707
2. Visser LH, van der meche FG, meulstee J, et al. Cytomegalovirus infection and Guillain-Barré syndrome: The clinical, electrophysiologic, and prognostic features. Dutch Guillain-Barré Study Group. Neurology 1996;47:668-73. http://dx.doi.org/10.1212/WNL.47.3.668
3. Van der meché FG, Van doorn PA, meulstee J, Jennekens FG. GBS Consensus Group of the Dutch Neuromuscular Research Support Centre. Diagnostic and classification crite- ria for the Guillain-Barré syndrome. Eur Neurol 2001;45: 133-9. http://dx.doi.org/10.1159/000052111
4. Korinthenberg r, Schessl J, Kirschner J. Clinical presenta- tion and course of childhood Guillain-Barré syndrome: a prospective multicentre study. Neuropediatrics 2007;38:10-7. http://dx.doi.org/10.1055/s-2007-981686
5. rabie m, nevo y. Childhood acute and chronic immune- mediated polyradiculoneuropathies. Eur J Paediatr Neurol 2009;13:209-18. http://dx.doi.org/10.1016/j.ejpn.2008.04.009
6. Van doorn PA, ruts L, Jacobs BC. Clinical features, patho- genesis, and treatment of Guillain-Barré syndrome. Lancet Neurol 2008;7:939-50. http://dx.doi.org/10.1016/S1474-4422(08)70215-1
7. Logullo F, manicone m, di Bella P, Provinciali L. Asymmetric Guillain-Barré Syndrome. Neurological Sciences 2006;27(5):355-9. http://dx.doi.org/10.1007/s10072-006-0710-z
8. nagashima T, Koga m, Odaka m, et al. Continuous Spectrum of Pharyngeal-Cervical-Brachial Variant of Guillain- Barré Syndrome. Arch Neurol 2007;64(10):1519-23. http://dx.doi.org/10.1001/archneur.64.10.1519

9. ruts L, drenthen J, Jongen JL, Hop WC, Visser GH, Jacobs BC, et al. Pain in Guillain-Barré syndrome: a long- term follow-up study. Neurology 2010;75(16):1439-47. http://dx.doi.org/10.1212/WNL.0b013e3181f88345
10. Forsberg A, et al. Impairment in Guillain-Barré syndrome during the first 2 years after onset: a prospective study. Journal of the Neurological Sciences 2004;227:131-8.
11. Lin JJ et al. Clinical Variants of Guillain-Barré Syndrome in Children. Pediatric Neurology 2012;47:91-6. http://dx.doi.org/10.1016/j.pediatrneurol.2012.05.011
12. yikilmaz A, doganay S, Gumus H, Per H, Kumandas S, Coskun A. Magnetic resonance imaging of childhood Guillain-Barre syndrome. Childs Nerv Syst 2010;26:1103-8. http://dx.doi.org/10.1007/s00381-010-1197-8