Guillain-Barré Syndrome: Natural history and prognostic factors: a retrospective review of 106 cases

Abstract

BackgroundGuillain-Barre syndrome (GBS) is characterized by acute onset and progressive course, and is usually associated with a good prognosis. However, there are forms of poor prognosis, needing ventilatory support and major deficits at discharge. With this study we try to identify the factors associated with a worse outcome.Methods106 cases of GBS admitted in our hospital between years 2000–2010 were reviewed. Epidemiological, clinical, therapeutical and evolutionary data were collected.ResultsAt admission 45% had severe deficits, percentage which improves throughout the evolution of the illness, with full recovery or minor deficits in the 87% of patients at the first year review. Ages greater than 55 years, severity at admission (p < 0.001), injured cranial nerves (p = 0.008) and the needing of ventilator support (p = 0.003) were associated with greater sequels at the discharge and at the posterior reviews in the following months. 17% required mechanical ventilation (MV). Values < 250 L/min in the Peak Flow-test are associated with an increased likelihood of requiring MV (p < 0.001).ConclusionsOlder age, severe deficits at onset, injured cranial nerves, requiring MV, and axonal lesion patterns in the NCS were demonstrated as poor prognostic factors. Peak Flow-test is a useful predictive factor of respiratory failure by its easy management.

Human immunodeficiency virus infection presenting as a fatal case of Guillain-Barré syndrome on a background of diabetes mellitus

“…rarely occurs in Nigeria as only 14 cases were recorded over a 17year period in the study done in Ile-Ife, Nigeria [15] making it easy to miss at presentation. This patient presented with an elevated blood sugar level and peripheral neuropathy which made the initial attending physician make a diagnosis of diabetic neuropathy, that was similar to the experience of Jin HY et al [11] A later confirmation of HIV infection in the patient, and a review of the history including the antecedent diarrheal illness 3 weeks prior to admission and symptom presentation of rapid progressive limb weakness and paresthesia, similar with GBS presentation [5,6] made us consider a clinical diagnosis of Guillain-Barré syndrome. Our diagnosis of GBS was made on clinical grounds in line with its typical presentation [5,6] as we were unable to demonstrate the classical cerebrospinal fluid findings of albumino-cytology dissociation.…”

“…Our diagnosis of GBS was made on clinical grounds in line with its typical presentation [5,6] as we were unable to demonstrate the classical cerebrospinal fluid findings of albumino-cytology dissociation. [6] However, albumino-cytology dissociation is only positive in about 80% of patients with GBS making it imperative to consider other clinical signs. [4][5][6] The observed very high fever in the last two days of admission in the patient may suggest an autonomic component in the presentation of GBS as demonstrated by González-Suárez et al [6] Though GBS has been associated with HIV but not commonly with diabetes mellitus.…”

“…[1][2][3][4] While in many people GBS is preceded 3-6weeks prior to onset of neurological symptoms by an infection (upper respiratory tract infection or diarrhea), in a smaller proportion of individuals, no apparent cause may be found. [5,6] Initial symptoms are limb numbness and tingling and pain, alone or in combination followed by progressive leg and arm weakness over several hours to 14 days to reach a maximum. [5] GBS is usually self-limiting and associated with a good prognosis in most patients, but the following are associated with a worse prognosis; older patients, severe neurological deficits at the beginning, cranial nerves involvement, patients requiring ventilation, and axonal lesion patterns in the central nervous system.…”

“…[5] GBS is usually self-limiting and associated with a good prognosis in most patients, but the following are associated with a worse prognosis; older patients, severe neurological deficits at the beginning, cranial nerves involvement, patients requiring ventilation, and axonal lesion patterns in the central nervous system. [6] The pathogenesis of GBS is still undergoing study, but this disease has an important autoimmune component with cellular and humoral activity where antibodies probably are predominantly implicated in association with demyelinization of peripheral nerves. [4,5] A usual preceding history of a viral or bacterial infection such as Herpes Simplex virus (HSV), VaricellaZoster (VZV), cytomegalovirus (CMV), EpsteinBarr virus (EBV), Hepatitis B and C virus, Mycoplasma Pneumoniae, Haemophilus influenzae and Campylobacter jejuni have all been implicated in GBS.…”

“…[4,5] A usual preceding history of a viral or bacterial infection such as Herpes Simplex virus (HSV), VaricellaZoster (VZV), cytomegalovirus (CMV), EpsteinBarr virus (EBV), Hepatitis B and C virus, Mycoplasma Pneumoniae, Haemophilus influenzae and Campylobacter jejuni have all been implicated in GBS. [6] Human immunodeficiency virus (HIV) infection has also been associated with GBS either during seroconversion or in association with central nervous system (CNS) infection in the chronic phase. [7][8][9][10] Also, GBS has been reported as a presentation in association with diabetes mellitus in the setting of diabetic neuropathy, diabetic coma or recent elevation of blood sugar levels.…”