Guillain-Barré syndrome after brachial plexus trauma: case report

Abstract

-The Guilllain-Barré syndrome (GBS) is an acute predominantly demyelinating polyneuro p a t h y. In many cases GBS is preceding by infection, immunization, surgery or trauma. Although there are a few re p o rts of GBS after head trauma, there is no re p o rt of this syndrome after brachial plexus injury. We re p o rt on a 51 years-old man who presented GBS fifteen days after a brachial plexus trauma. The polineuro p athy resolved completely in a few weeks. We believe that GBS was triggered by the trauma that evoked an immune mediated disorder producing inflammation and demyelination of the peripheral nerves.KEY WORDS: Guillain-Barré syndrome, polyradiculoneuropathy, brachial plexus, trauma.Síndrome de Guillain-Barré após traumatismo de plexo braquial: relato de caso RESUMO -A síndrome de Guillain-Barré (SGB) é uma polineuropatia predominantemente desmielinizante, que ocorre na maioria das vezes após uma infecção, vacinação, cirurgia ou traumatismo. Embora tenham sido descritos alguns casos após traumatismo crânio encefálico, ainda não foi referido caso de SGB após traumatismo do plexo braquial. Relatamos o caso de um homem de 51 anos que 15 dias após ter apre s e ntado paralisia traumática do plexo braquial, desenvolveu SGB. Recuperou-se inteiramente em algumas semanas. Achamos que em nosso caso a SGB foi desencadeada pelo traumatismo, que provocou distúrbios imunológicos com conseqüente acometimento dos nervos periféricos. PALAVRAS-CHAVE: síndrome de Guillain-Barré, polirradiculoneuropatia, plexo braquial, traumatismo.The Guillain-Barré syndrome (GBS) is the most common cause of acute generalized weakness. Its incidence is 1-2/100000 people 1 . It is an acute inflamm a t o ry demyelinating polyradiculoneuropathy due to an immunological reaction directed at the peripheral nerves. The major clinical manifestation is an ascendant symmetrical weakness with reduced or absent tendon reflexes, minimal sensory loss and cranial nerve palsies. It may be preceded by infectious illness, immunization, surg e ry and trauma 2 . Although there were a few cases of GBS described after head i n j u ry 3 , 4 , there is no re p o rt of GBS triggered by peripheral nerve trauma.We re p o rted a case that presented GBS syndro m e after a trauma of the brachial plexus. CASEA 51-year-old man suffered a traumatic superior right brachial palsy after lifting a bar of 100 kg. Fifteen days after he felt weakness and had paresthesias in the four limbs that progressed in two days, and soon after he presented a bilateral facial palsy. There was a predominantly distal weakness in legs and arms and severe weakness of right biceps, deltoid, supinator longus, supraspinatus and infraspinatus with absent tendon reflexes and mild objective s e n s o ry loss in the four extremities. The cutaneous plantar reflexes were indiff e rent. There was a bilateral peripheral facial palsy. The other cranial nerves were normal. He had no radicular symptoms. His blood pre s s u rewas 130/80, pulse was 80/min, breath rate 22/min and he was apyretic.The b...

Post-Traumatic brain injury (TBI) presenting with Guillain-Barre syndrome and elevated anti-ganglioside antibodies: a case report and review of the literature

“…To date there are six reports of GBS after TBI with two additional reports after traumatic injury to the brachial plexus [22] and spinal cord [23]. In this presentation, the diagnosis of GBS was confirmed based on clinical findings, CSF and serology analysis and electrodiagnostic studies.…”

Guillain-Barré syndrome following thoracic spinal cord trauma

“…[1][2][3][4] The characteristic clinical features of GBS include rapidly ascending weakness associated with areflexia. The weakness generally plateaus within four weeks of onset.…”

Akute Polyneuritiden und Polyradikuloneuritiden: Ungewöhnliche Ursachen und deren Pathomechanismen

“…So werden in der Literatur, wenn auch z. T. umstritten, verschiedenste nicht infektiöse Auslöser von akuten Immunneuropathien genannt, wie z. B. Impfungen mit inaktivierten Impfstoffen (insbesondere Influenza, aber auch Tetanus, Masern, und Polio [9]), Leukämien und Knochenmarkstransplantationen [11], nach Entbindungen [12], chirurgischen Eingriffen [13], Epiduralanästhesien [14] sowie nach Schädel-Hirn- [15] oder anderen Traumata [16]. Den akuten Polyneuritiden, die keiner der eingeführten GBS-Varianten entsprechen, scheint gemein, dass sie seltener infektassoziiert auftreten und häufiger mit ungewöhnlichen Ursachen und Auslö-sern assoziiert sind.…”