A study of Guillain–Barré syndrome with reference to cranial neuropathy and its prognostic implication

Abstract

Background:Focused studies on cranial neuropathy in Guillain–Barré syndrome (GBS) and its prognostic implication are not done previously.Aim:To study the clinical profile of GBS patients with special reference to cranial neuropathy and its prognostic implication.Materials and Methods:The study included 61 patients with GB syndrome, fulfilling Asbury Cornblath's criteria for GB syndrome. A pre-designed semi-structured questionnaire was used to obtain data regarding demographic profile and clinical profile. All patients underwent detailed neurological examination, investigations including nerve conduction studies and CSF examination and treated according to the severity of the illness. Patients were followed up for 6 months. During analysis two groups were made depending on cranial nerve involvement, and compared with respect to various parameters.Results:Out of 61 patients 38 (62.3%) patients had cranial nerve palsies, in that 25 had multiple cranial nerve palsies, and 13 had single isolated nerve palsy. A majority of 30 (49.2%) had bulbar palsy, 28 (46%) had facial nerve palsy, and all had bilateral involvement except 3 patients who had unilateral palsy. Hypoglossal nerve involvement was seen in six (10%) patients and four (6.5%) patients had ophthalmoplegia. Only one had bilateral vestibulocochlear nerve palsy. On comparing various clinico-electrophysiological parameters among patients of GB syndrome with and without cranial nerve involvement, the presence of respiratory paralysis, IVIg and ventilatory support requirement had significant association with cranial nerve involvement in GBS.Conclusion:Our study found a correlation between cranial nerve palsies and severity of the illness. Cranial nerve innervated muscles recover earlier as compared to distal limb muscles. No association was found between outcome at 6 months and cranial nerve involvement.

Guillain-Barré syndrome: Clinical profile and Consensus to revise Hughes grade 5

“…CSF protein levels were increased in 27 (81.8%). Similar finding were reported by Bhargava et al 10 Mean CSF protein was 80.27mg/dl and is comparable to studies by Chio et al 21 and Corston et al 22 Mortality in GBS is associated with respiratory failure requiring mechanical ventilation that prolongs hospital stay. To detect early respiratory failure, all cases with Hughes grade 4 and those with MRC sum score suggestive of moderate (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) and severe (0-10) motor deficit were assessed intensively for early respiratory failure.…”

“…Sex ratio showed a slight male preponderance in most of the studies. [10][11][12][13] In the present study also, this trend was observed with males constituting 21 (58.3%) of the GBS cases. Rainy (June -September) predominance 14 (38.8%) was noted in our study followed by winter (December-February) 11 (30.5%), even 46 years in demyelinating and 35 years in axonal variant of GBS.…”

“…This is comparable to previous studies. 10,11,13,20 Early arrival (<1 week) to hospital, initiation of intravenous Immunoglobulin and intensive care helped to achieve complete recovery in our study. Axonal form of GBS recovered more slowly than those with demyelinating form but outcome at 12 months appear to be equally favorable in two groups.…”

“…The study was an attempt to identify the clinical and epidemiological profile of GBS in adults and to compare with previous clinical studies. [10][11][12][13][14][15] (Table 5). Most of the studies were conducted either in children or both adults and children.…”

“…Our study supports the previous study. 10,11,15 Overall preponderance (51.2%) was noted in axonal forms (AMAN+ AMSAN) of GBS. Tekqul H et al 20 reported similar findings in children.…”