Guillain Barre Syndrome: A Single Center Experience.

OBJECTIVES: To investigate the clinical, electrophysiological and epidemiological features of the patients who were diagnosed as Guillain Barre Syndrome (GBS) in our clinic. METHODS: The clinical and demographical properties of 30 patients with GBS who were hospitalized in our neurology clinic between March 2013 and August 2017 were retrospectively examined in this study. Patients were divided into two groups according to the requirement of stay in the intensive care unit (ICU). RESULTS: Patients were between 18-71 years range with 46.9 and 19.61 mean age. Seven of 30 patients (23.3%) were female, and 23 of them (76.7%) were male. Males were more dominant in the ICU (-) group (81% and 62%). A recent infection was found in 86.7% of patients. Upper respiratory tract infection (URTI) was more common in ICU (+) group whereas lower respiratory tract infection (LRTI) and acute gastroenteritis (AGE) were more common in the ICU (-) patients (p=0.007). Lower limb weakness was more frequent in the ICU (+) group (p=0.011). ICU (+) patients were lack of diplopia and dysarthria. Ataxia and dysphagia were relatively frequent in the ICU (+) group. Electrophysiological examinations revealed demyelinating polyneuropathy (26.7%), acute axonal polyneuropathy (30.1%) and acute sensorial polyneuropathy (13.3%). Demyelinating polyneuropathy was more common in the ICU (-) group, whereas acute motor and sensorial polyneuropathy (AMSAN) was more frequent in the ICU (+) group. In this study, 26.7 % of study patients required mechanical ventilation, and mortality rate was 6.8 %. CONCLUSION: URTI in ICU (+), LRTI and AGE in ICU (-) patients might be major trigger factors of GBS. Ascending weakness, dysphagia and ataxia was more frequent in ICU (+) GBS patients. Demyelinating PNP was predominant in the ICU (-) group, whereas AMSAN was more frequent in the ICU (+) patients. Multicenter randomized studies would be more useful for highlining the epidemiology of GBS.

Optic Nerve Head Changes in Patients with Optic Neuritis Secondary to Multiple Sclerosis: A Comparison of the Affected and Fellow Healthy Eyes.

OBJECTIVE: To evaluate the thickness of lamina cribrosa (LC) in patients with multiple sclerosis (MS) using optical coherence tomography (OCT) and the effect of optic neuritis (ON) attack on these measurements during the remission period. METHODS: The study included 20 cases diagnosed with relapsing-remitting MS with a history of ON attacks affecting one eye and in remission of MS and ON attacks for at least three months, and 28 randomly selected eyes of age- and sex-matched healthy controls. In the MS group, the eyes affected by ON attack were assigned as Group 1 (MS+ON), their fellow unaffected eyes as Group 2 (MS-ON), and healthy control eyes as Group 3. The LC, peripapillary retinal nerve fiber layer (ppRNFL), and subfoveal choroidal thickness measurements were made by using OCT in all cases, and results were compared between the groups. RESULTS: The mean LC thickness in MS+ON and MS-ON groups was significantly lower than the control group (p<0.001). There was no significant difference between MS+ON and MS-ON groups in terms of mean LC thickness (p=0.073). The mean ppRNFL in the MS+ON and MS-ON groups was statistically significantly lower than the control group (p=0.003, p=0.035, respectively). CONCLUSIONS: It is noteworthy that LC is significantly affected in eyes with MS who have not had a history of ON attack. Evaluation of the LC measurements can be important for early detection of optic nerve damage in patients with MS.

Benign neurological recovery with low recurrence and low peridural fibrosis rate in pediatric disc herniations after lumbar microdiscectomy.

Lumbar disc herniation (LDH) is a very rare clinical entity in the pediatric age group, therefore only a few clinical studies have until now investigated the clinical behavior of pediatric LDH. The natural clinical history, postoperative neurological recovery with radiological follow-up and quality of life related to the disorder continue to be unknown. We prospectively planned and designed two groups of LDH patients scheduled for surgery in this study. The operations were performed by the same surgeon in a randomized fashion. The first group consisted of pediatric patients and the second group of adult patients. Both groups contained 32 cases. Postoperative neurological recovery was assessed using the visual analog scale and Aberdeen Low Back Pain Scale. Postoperative peridural fibrosis was also evaluated in postcontrast magnetic resonance sections. After 3 years of follow-up, all parameters were significantly better in the pediatric LDH group with no recurrence of the disease. The pediatric LDH group was postoperatively better than the adult group both clinically and radiologically. Although LDH seems a catastrophic disease in the pediatric age group, the clinical picture and neurological recovery have a significantly more benign course than in adult patients even in operated cases.