Mielopathy’s Like Symptom in Guillain Barre Syndrome: Case Report

Ida  Ahadiyati; Djohan  Ardiansyah; Fadil

doi:10.15562/bmj.v11i2.3643

Mielopathy’s Like Symptom in Guillain Barre Syndrome: Case Report

Ida Ahadiyati ,

Djohan Ardiansyah ,

Fadil ,

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DOI: https://doi.org/10.15562/bmj.v11i2.3643 |
Published: 2022-08-12

Abstract

Background: Guillain-Barré syndrome (GBS) is a peripheral nervous system inflammatory disease that is the most prevalent cause of acute flaccid paralysis, with an annual global incidence of 1-2 per 100,000 person-years. GBS typically appears with acute ascending flaccid paralysis and sensory abnormalities in anesthetic glove stockings; paralysis may extend to cranial muscles. Although the disease’s clinical presentation is diverse and there are multiple discrete clinical forms, myelopathy as a sign of GBS is a relatively unusual condition.

Case presentation: GBS is diagnosed in a 29-year-old woman with myelopathy symptoms such as tetraparesis, hypoesthesia below the level of second thoracal myelum, aberrant proprioceptive in lower extremities, retention of urine and anhidrosis. We perform a lumbar puncture, and a cerebrospinal fluid (CSF) examination reveals albumin-cytological dissociation. Cervico-thoracic magnetic resonance imaging (MRI) revealed no abnormalities. Demyelinating polyradiculopathy was discovered using electromyography (EMG) and nerve conduction studies (NCS).

Discussion: The classical presentation of GBS is progressive (ascending) limb weakness with decreased or absent physiological reflexes. Pharyngeal–cervical–brachial variation and face diplegia with paraesthesia are rare variations of GBS. Our patient presented with ascending limb weakness accompanied by a disturbance in the central nervous system but had similiar serological biomarker, which may be another rare variant of GBS.

Conclusion: Diagnosis of GBS is quite challenging. GBS has a wide range of clinical symptoms. EMG-NCV and lumbar puncture are still required in myelopathic individuals with normal MRI, and unusual GBS symptoms should be explored. As a result, the choice of therapy and management becomes more appropriate.

References

Z. Zaeem, Z. A. Siddiqi, and D. W. Zochodne, “Autonomic involvement in Guillain–Barré syndrome: an update,” Clin. Auton. Res., 2019: 29(3): 289–299, 2019, doi: 10.1007/s10286-018-0542-y.
M. Basuki, M. Hamdan, Fidiana, Fadil, and I. R. Marjianto, “Association between transmission season and degree of severity in guillain-barre syndrome,” Res. J. Pharm. Technol., 2020; 13(11): 5345–5348 doi: 10.5958/0974-360X.2020.00934.8.
N. Shahrizaila, H. C. Lehmann, and S. Kuwabara, “Guillain-Barré syndrome,” Lancet, 2021; 397(10280): 1214–1228 doi: 10.1016/S0140-6736(21)00517-1.
I. R. Palupi, F. Fadil, F. Fidiana, and M. Basuki, “Atypical Clinical Features of Guillain Barré syndrome,” 2021; 25(6): 20797–20801.
B. Van Den Berg, C. Walgaard, J. Drenthen, C. Fokke, B. C. Jacobs, and P. A. Van Doorn, “Guillain-Barré syndrome: Pathogenesis, diagnosis, treatment and prognosis,” Nat. Rev. Neurol., 2014; 10(8): 469–482 doi: 10.1038/nrneurol.2014.121.
N. C. Imelda, F. Baktir, . F., H. B. Hidayati, and M. Basuki, “Updates in the management of Guillain Barre Syndrome,” Anaesthesia, Pain Intensive Care, 2019: S54–S57 doi: 10.35975/apic.v22i1.1102.
S. C. Beh, B. M. Greenberg, T. Frohman, and E. M. Frohman, “Transverse Myelitis,” Neurol. Clin., 2013; 31(1): 79–138 doi: 10.1016/j.ncl.2012.09.008.
S. Oji et al., “Guillain–Barré syndrome initially manifesting as motor weakness, urinary dysfunction and hyperreflexia: Case report and literature review,” Clin. Exp. Neuroimmunol., 2018; 9(2): 110–114 doi: 10.1111/cen3.12425.
S. E. Leonhard et al., “Diagnosis and management of Guillain–Barré syndrome in ten steps,” Nat. Rev. Neurol., 2019; 15(11): 671–683 doi: 10.1038/s41582-019-0250-9.
A. Hanifah, M. Basuki, and M. Faizi, “Hubungan antara Kadar HBA1C dengan Hasil Sural Radial Amplitude Ratio (SRAR) pada Pasien DM Tipe 1 dengan Neuropati Diabetik Perifer,” Aksona, 2022; 1(1): 29–33 doi: 10.20473/aksona.v1i1.98.
A. Stoian, A. Motataianu, Z. Bajko, and A. Balasa, “Guillain–Barré and Acute Transverse Myelitis Overlap Syndrome Following Obstetric Surgery,” J. Crit. Care Med., 2020; 6(1): 74–79 doi: 10.2478/jccm-2020-0008.
E. Jodjana and Y. M. I. W. O. Adja, “Sindrom Guillain-Barre dengan Komplikasi ( Gagal Nafas, Henti Jantung dan Sepsis),” Aksona, 2022; 1(2):81–91 doi: 10.20473/aksona.v1i2.147.

[1] Z. Zaeem, Z. A. Siddiqi, and D. W. Zochodne, “Autonomic involvement in Guillain–Barré syndrome: an update,” Clin. Auton. Res., 2019: 29(3): 289–299, 2019, doi: 10.1007/s10286-018-0542-y.

[2] M. Basuki, M. Hamdan, Fidiana, Fadil, and I. R. Marjianto, “Association between transmission season and degree of severity in guillain-barre syndrome,” Res. J. Pharm. Technol., 2020; 13(11): 5345–5348 doi: 10.5958/0974-360X.2020.00934.8.

[3] N. Shahrizaila, H. C. Lehmann, and S. Kuwabara, “Guillain-Barré syndrome,” Lancet, 2021; 397(10280): 1214–1228 doi: 10.1016/S0140-6736(21)00517-1.

[4] I. R. Palupi, F. Fadil, F. Fidiana, and M. Basuki, “Atypical Clinical Features of Guillain Barré syndrome,” 2021; 25(6): 20797–20801.

[5] B. Van Den Berg, C. Walgaard, J. Drenthen, C. Fokke, B. C. Jacobs, and P. A. Van Doorn, “Guillain-Barré syndrome: Pathogenesis, diagnosis, treatment and prognosis,” Nat. Rev. Neurol., 2014; 10(8): 469–482 doi: 10.1038/nrneurol.2014.121.

[6] N. C. Imelda, F. Baktir, . F., H. B. Hidayati, and M. Basuki, “Updates in the management of Guillain Barre Syndrome,” Anaesthesia, Pain Intensive Care, 2019: S54–S57 doi: 10.35975/apic.v22i1.1102.

[7] S. C. Beh, B. M. Greenberg, T. Frohman, and E. M. Frohman, “Transverse Myelitis,” Neurol. Clin., 2013; 31(1): 79–138 doi: 10.1016/j.ncl.2012.09.008.

[8] S. Oji et al., “Guillain–Barré syndrome initially manifesting as motor weakness, urinary dysfunction and hyperreflexia: Case report and literature review,” Clin. Exp. Neuroimmunol., 2018; 9(2): 110–114 doi: 10.1111/cen3.12425.

[9] S. E. Leonhard et al., “Diagnosis and management of Guillain–Barré syndrome in ten steps,” Nat. Rev. Neurol., 2019; 15(11): 671–683 doi: 10.1038/s41582-019-0250-9.

[10] A. Hanifah, M. Basuki, and M. Faizi, “Hubungan antara Kadar HBA1C dengan Hasil Sural Radial Amplitude Ratio (SRAR) pada Pasien DM Tipe 1 dengan Neuropati Diabetik Perifer,” Aksona, 2022; 1(1): 29–33 doi: 10.20473/aksona.v1i1.98.

[11] A. Stoian, A. Motataianu, Z. Bajko, and A. Balasa, “Guillain–Barré and Acute Transverse Myelitis Overlap Syndrome Following Obstetric Surgery,” J. Crit. Care Med., 2020; 6(1): 74–79 doi: 10.2478/jccm-2020-0008.

[12] E. Jodjana and Y. M. I. W. O. Adja, “Sindrom Guillain-Barre dengan Komplikasi ( Gagal Nafas, Henti Jantung dan Sepsis),” Aksona, 2022; 1(2):81–91 doi: 10.20473/aksona.v1i2.147.

Mielopathy’s Like Symptom in Guillain Barre Syndrome: Case Report

Abstract

References

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