Clinical and electrophysiological features of post-traumatic Guillain-Barré syndrome.

BACKGROUND: Post-traumatic Guillain-Barré syndrome (GBS) is a rarely described potentially life-threatening cause of weakness. We sought to elucidate the clinical features and electrophysiological patterns of post-traumatic GBS as an aid to diagnosis. METHODS: We retrospectively studied six patients diagnosed with post-traumatic GBS between 2014 and 2016 at Tianjin Medical University General Hospital, China. Clinical features, serum analysis, lumbar puncture results, electrophysiological examinations, and prognosis were assessed. RESULTS: All six patients had different degrees of muscular atrophy at nadir and in two, respiratory muscles were involved. Five also had damaged cranial nerves and four of these had serum antibodies against gangliosides. The most common electrophysiological findings were relatively normal distal latency, prominent reduction of compound muscle action potential amplitude, and absence of F-waves, which are consistent with an axonal form of GBS. CONCLUSIONS: It is often overlooked that GBS can be triggered by non-infectious factors such as trauma and its short-term prognosis is poor. Therefore, it is important to analyze the clinical and electrophysiological features of GBS after trauma. Here we have shown that electrophysiological evaluations are helpful for diagnosing post-traumatic GBS. Early diagnosis may support appropriate treatment to help prevent morbidity and improve prognosis.

Contact heat-evoked potentials as a useful means in patients with Guillain-Barré syndrome.

Few objective methods have been utilized to identify the small myelinated fiber impairment causing neuropathic pain in Guillain-Barré syndrome (GBS). In this study, contact heat-evoked potentials (CHEPs) were applied to study the nociceptive pathway in GBS. Sixty GBS patients and fifty healthy controls were enrolled. The 60 GBS patients were divided into two subgroups presenting with or without subjective lower limb paresthesia (21/39). CHEPs were recorded at Cz and Pz with a peak thermal stimuli of 47 °C applied to the skin of the leg above the internal malleolus (AIM) and of the waist at the anterior superior iliac spine (ASIS) level. The N2 latency and N2-P2 amplitude of CHEPs were compared. When the skin of the leg AIM was stimulated, the N2 latency was significantly postponed (425.23 ± 28.66 vs. 402.30 ± 19.48 ms, P < 0.05) and the N2-P2 amplitude significantly decreased in GBS patients as compared to controls (32.71 ± 7.49 vs. 42.77 ± 8.71 µV, P < 0.05). Slower nerve conduction velocity was observed in GBS patients (11.84 ± 1.45 vs. 13.28 ± 0.66 ms, P < 0.05). However, no differences in N2 latency or N2-P2 amplitude were detected between the two subgroups of GBS patients with or without subjective lower limb paresthesia (P all >0.05). Moreover, there were no differences in N2 latency and N2-P2 amplitude among different groups when the waist was stimulated at the ASIS level. Our study suggested that CHEPs could be utilized as an objective and non-invasive tool to detect small myelinated fiber damage in GBS patients, especially for those without subjective paresthesia.

Neurosyphilis presenting with psychotic symptoms and status epilepticus.

The widespread use of antibiotics in recent years has considerably modified the clinical features of neurosyphilis. Presently, atypical or masked forms of this disease often occur and obscure diagnosis, despite a thorough history and clinical work-up. Here, we report a patient with neurosyphilis presenting with psychotic symptoms who then developed status epilepticus and left limb weakness. Diffusion-weighted magnetic resonance imaging showed hyperintensity involving the right parietal, occipital and temporal lobes and the thalamus. Subsequent serological and cerebrospinal fluid tests confirmed the diagnosis of neurosyphilis. The coexistence of meningovascular syphilis, syphilitic meningitis, and general paresis resulted in the complex manifestation of this patients' condition, as described here in terms of the unusual presentation, evolution, and final diagnosis.

[Clinical features of preeclampsia-eclampsia patients with reversible posterior leukoencephalopathy syndrome].

OBJECTIVE: To investigate the clinical features and specific characteristics of magnetic resonance image (MRI) in preeclampsia-eclampsia patients with reversible posterior leukoencephalopathy syndrome (RPLS). METHODS: The investigators analyzed the combined clinical, laboratory and neuroradiographic features of 20 preeclampsia-eclampsia patients with RPLS and 15 preeclampsia-eclampsia controls with normal MRI findings. RESULTS: Patients with RPLS had more tendency to have headache, seizure, visual disturbance, confusion and altered mental status than controls. Neuroimaging showed diffuse edema predominantly in posterior cerebral white matter bilaterally. Clinical features and neuroradiological alterations disappeared after appropriate treatments were started. Twenty RPLS patients had a significantly higher level of uric acid (442 +/- 77 mmol/L) than those without RPLS (350 +/- 88 mmol/L) (P < 0.05). However no difference was observed for other indices. CONCLUSION: Preeclampsia-eclampsia patients with RPLS have typical clinical and imaging findings, and the syndrome is reversible with appropriate treatment. Perhaps endothelial damage is related to the pathogenesis of RPLS. Monitoring the level of uric acid in patients with preeclampsia-eclampsia is of vital significance to discover RPLS in an early stage.

Progress on Diagnosis of Tuberculous Meningitis.

Central nervous system (CNS) disease caused by Mycobacterium tuberculosis (MTB) is highly devastating. Tuberculous meningitis (TBM) is the most common form of CNS tuberculosis (TB). Rapid, sensitive, and affordable diagnostic tests are not available. Ziehl-Neelsen (ZN) stain has a very low sensitivity in cases of TBM, the sensitivity rates is of about 10-20%.The detection rate can be improved by taking large volume CSF samples (>6 ml) and prolonged slide examination (30 min). Culture of MTB from the CSF is slow and insufficiently sensitive. The sensitivity is different, which varies from 36% to 81.8%. The microscopic observation drug susceptibility (MODS) assay was recommended by the World Health Organization in 2011. The sensitivity is 65%, which is more sensitive and faster than CSF smear. Commercial PCR assays were found to be insensitive at detecting MTB in CSF samples. Many research provided the value of ADA on the TBM diagnosis. Interferon-gamma release assays (IGRAs) are not recommended for diagnosis of active TB disease. Imaging is essential in diagnosis and showing complications of CNS TB. Thwaites criteria and the Lancet consensus scoring system (LCSS) were developed to improve the diagnosis of TBM. Clinicians will continue to make judgment based on clinical examination, inflammatory CSF examinations, imaging studies, and scoring systems.