Pain and the Guillain-Barré syndrome in children under 6 years old.

During a 15-year period, 29 children, under the age of 6 years, with acute Guillain-Barré syndrome were seen at our institution. A review of their charts revealed that pain was a symptom in all patients and was present on admission in 79% of cases. Pain was often the most important symptom and led to misdiagnosis in 20 patients (69%). In 11 of these children, symptoms were present for more than a week before the correct diagnosis was made. The most common pain syndrome was back and lower limb pain, present in 83% of patients. Pediatricians should consider Guillain-Barré syndrome in their differential diagnosis when faced with a child who has lower limb pain and areflexia.

Neuroimmunological findings in Guillain Barré syndrome, multiple sclerosis, and idiopathic polyneuropathies.

It is essential to know how the immune system acts in different neurological diseases, some of which are not very well known or are unknown. IgG and albumin were simultaneously quantified in serum and cerebrospinal fluid (CSF) of 47 patients with Guillain Barré Syndrome (GSB), 5 patients with multiple sclerosis (MS), and 14 patients with idiopathic polyneuropathies (IP). IgG local synthesis was observed in all patients, except in patients with IP. These patients showed a decrease in cerebrospinal fluid (CSF) flow.

Polirradiculoneurite e neurocisticercose: relato de caso / Polyradiculoneuretis and neurocysticercosis: a case report

Relata-se o caso de doente com forma hidrocefálica e meningoencefalítica de neurocisticercose que, na primeira semana de tratamento com albendazol, desenvolveu simultaneamente polirradiculoneurite e síndrome de hipertensao intracraniana. Sao relacionados vários agentes etiológicos encontrados na literatura associados à polirradiculoneurite. Comenta-se sobre a possível fisiopatogenia desta entidade na vigência de cisticercose. Faz-se mençao a outro caso que apresentou polirradiculoneurite, do tipo síndrome de Guillain-Barré, como única manifestaçao de provável cisticercose de sistema nervoso. No caso apresentado, além da própria neurocisticercose, o stress cirúrgico e aquele relativo à gravidade do quadro clínico, um possível efeito colateral do albendazol - ou, até mesmo, uma simples coincidência - podem ser considerados como fatores relacionados à presença de polirradiculoneurite nesse doente.

Líquido cefalorraquiano (LCR) na síndrome de Guillain-Barré: análise de 62 casos / Cerebrospinal fluid (CSF) in the Guillain-Barré syndrome: Analysis of 62 cases

Estudamos o LCR de 62 pacientes acometidos por síndrome de Guillain-Barré (SGB) do ponto de vista da celularidade, eletroforese de proteínas e quantificaçäo de imunoglobulinas. Os resultados da primeira amostra foram correlacionados com a escala de Hughes. Constatamos dissociaçäo proteinocitologica em 56,5 por cento das primerias amostras obtidas. A pleocitose, observadas em 12,9 por cento dos casos, foi de no máximo 18 células/mm3 e constituída por linfócitos e monócitos. A mediana foi de 1,6 células/mm3. A taxa inicial de proteínas no LCR variou de 8 a 360mg/100ml, com mediana de 67mg/100ml. A dissociaçäo proteinocitológica esteve prresente, em alguma fase da síndrome, em 47 dos 62 pacientes (75,8 por cento). Näo ficou demonstrado que pleocitose, dissociaçäo proteinocitolólica e níveis de proteinorraquia possuam valor prognóstico. O estudo eletroforético evidenciou aumento da albumina em oito dos 10 casos, com elevaçäo simultânea das gamaglobulinas em dois; o aumento exclusivo das gamaglobulinas foi observado em dois casos. Näo foi constatada a presença de bandas oligoclonais em qualque dos casos. Nos 10 casos havia níveis elevados de IgG e normais de IgM e IgA. Há controvérsias a respeito da presença de bandas oligoclonais e o fato de näo as termos encontrado pode depender da sensibilidade do método que utilizamos. Assinale-se que, mesmo autores que detectaram tais bandas, näo as encontraram em mais de 8 por cento dos casos de SGB. Parece, portando, que os níveis elevados de IgG no LCR resultam, predominante, da passagem de tal tipo de imunoglobulina através de barreira hematoliquórica lesada e näo da síntese intratecal. A denominaçäo dissociaçäo proteinocitológica é mais adequada que dissociaçäo albuminocitológica

Cerebrospinal fluid and serum antiphospholipid antibodies in multiple sclerosis, Guillain-Barré syndrome and systemic lupus erythematosus.

Immunoglobulins isotypes (IgG and IgM) for myelin basic protein (MBP), cerebrosides (CER), gangliosides (GANG) and cardiolipin (CARD) were detected in the cerebrospinal fluid (CSF) from 33 patients with multiple sclerosis (MS), 18 with Guillain-Barré syndrome (GBS) and 30 with systemic lupus erythematosus (SLE). In MS patients occurred positive and significant levels of IgG-MBP in 51.5% (p less than 0.05) and IgM-MBP in only 18.2%, IgG-CARD in 46.2%, as long as CER and GANG were detected in almost 20%. From serum samples of MS patients 20.6% presented IgG-MBP, while 53% showed positive levels for IgM-MBP. The CSF analysis of patients with GBS showed that 56.3% revealed IgG-MBP (p less than 0.05), 53% for IgM-MBP, 38.5% for IgG-CER and 23% for IgM-CER, while 50% of patients had IgG-CARD, as long as 31% also had IgG-GANG. The serum evaluation from 14 patients showed that 18.8% had positive concentrations of IgG-MBP and 56.3% presented IgM-MBP (p less than 0.05). Except for 50% of patients with SLE who presented positive CSF levels of IgG-CARD, only 24.1% had positive levels of IgG-MBP. We believe that the presence of antiphospholipid antibodies in CSF of the above mentioned diseases occurred as immune epiphenomena, but their appearance would permit the maintenance of and perpetuate the immune event.

Guillain-Barré syndrome after varicella-zoster infection. Case report.

The authors report a case of Guillain-Barrè syndrome (GBS) following a varicella infection in a 13 year-old boy. During his admission he developed respiratory insufficiency and dysautonomic events, as well as a severe sensitive peripheral neuropathy. Some aspects related to the etiology and pathogenesis of GBS are discussed.

Polirradiculoneurites inflamatórias / Inflammatory polyradiculoneuritis

Foram estudados retrospectivamente 71 casos de polirradiculoneurites inflamatórias primitivas divididas em dois grupos: grupo I, 48 casos de polirradiculoneurite tipo Guillain-Barré e grupo II, 23 casos de polirradiculoneurite atípica, fora dos limites da conceituaçäo clássica de Guillain-Barré, sem dissociaçäo albumino-citológica (com hipercitose ou com líquido cefalorraquino normal) e/ou com sinais de comprometimento do sistema nervoso central. O material estudado corresponde ao decênio julho 74/junho 84. O estudo demonstrou que tanto as polirradiculoneurites tipo Guillain-Barré como as polirradiculoneurites atípicas tiveram um bom prognóstico em mais de 70% dos casos, näo havendo correlaçäo direta entre a intensidade das alteraçöes liquóricas e a evoluçäo clínica; o emprego da corticoidoterapia näo mostrou-se claramente efetivo na evoluçäo dos casos estudados nesta série

[Neonatal Landry-Guillain-Barré-Strohl syndrome]. / Síndrome de Landry-Guillain-Barré-Strohl neonatal.

Landry-Guillain-Barré-Strohl syndrome found in a three-days-old newborn is presented at the Mexican Navy Medical Center Hospital with an acute state after exchanges transfusion due to incompatibility of blood type was done. The case has the same clinical characteristics, such as those found by other authors in children, even though the statistics in this syndrome during the childhood and in the newborn periods are limited. It is frequent that the child dies before the diagnosis is made because motor and sensitive immaturity are present. This renders even more difficult the appropriate treatment and diagnosis, because the paralysis initiated in an ascending and progressive manner involving the spinal bulb may lead to confusion with other pathology, such as respiratory or neurological distress that may need respiratory mechanical assistance. It is very important to dissociated the relation albumin-citology of the spinal fluid to confirm the diagnosis. Corticoides do not modify the evolution of the clinical picture. In this paper we reviewed the modern ideas on pathogenesis and their possible allergic and immunologic association.

[Guillain-Barré syndrome simulating hernia of lumbar disc. Report of a case]. / Síndrome de Guillain-Barré simulando hernia de disco lombar. Registro de um caso.

The case of a 52 years-old man, with typical findings of lumbar disc disease is reported. The radiological investigation was negative and albuminocytologic dissociation in cerebrospinal fluid was detected. The clinical course was similar to Guillain-Barré syndrome which was completely solved by treatment with steroids. Brief comments on clinical aspects of that syndrome are made.

Sindrome de Guillain-Barre / Guillain-Barre syndrome

Teniendo en cuenta que el Sindrome de Guillain-Barre no es infrecuente en nuestro medio, analizamos el cuadro clinico haciendo un analisis del LCR, la presencia de antecedentes o no y su tratamiento. Estudiamos 50 pacientes con diagnostico de Sindrome de Guillain-Barre en un total de 5601 hospitalizaciones en el FINC entre el 1o de Noviembre de 1973 y 31 de Diciembre de 1979. La frecuencia en pacientes hospitalizados fue de 0.89%. Hubo predominio en el sexo masculino 3,1:1 con una mayor incidencia en la tercera decada. 48 pacientes presentaron el cuadro clinico caracteristico y 2 un sindrome de Miller Fisher. En una tercera parte de los pacientes se encontro el antecedente infeccioso previo. El electromiograma es concluyente a partir de la segunda semana de iniciada la enfermedad. Despues de 15 dias el LCR mostro siempre un aumento significativo de las proteinas sin el correspondiente aumento de las celulas. Sin embargo, no existe relacion entre el nivel de las proteinas y la severidad, forma de iniciacion o de progresion de la enfermedad y el descenlace del sindrome.

[Virological studies in acute polyradiculoneuritis, LGBS type. Various findings in relation to Coxsackie A4 virus]. / Estudios virológicos en las polirradiculoneuritis agudas tipo LGBS. Algunos hallazgos en relación con el virus Coxsackie A4.

Studies of isolated virus in LCR and necropsy material were made (medulla roots and rachi ganglia) in acute cases of polyradiculoneuritis. Landry-Gullain-Barré-Strohl type. Serological studies with prepared sera were also made (at three week intervals). The results were discussed based on the isolation of a Coxsackie A virus in four cases and the corresponding serological findings.