Severe Guillain-Barré syndrome after surgery for multiple fractures: a rare case report with a 5-year follow-up and a brief review of the literature.

BACKGROUND: Guillain-Barré syndrome (GBS) is the most common and serious acute paralytic neuropathy and is usually caused by infection. It is thought to be the result of an aberrant response of the immune system. To our knowledge, GBS, especially severe GBS, after orthopaedic surgery has rarely been reported. CASE PRESENTATION: We herein report the case of a 58-year-old man who developed quadriplegia and respiratory failure on the 6th day after surgery for multiple fractures. The patient had no symptoms of respiratory or gastrointestinal tract infection within 4 weeks before the onset. The white blood cell count was normal, and there was no redness, swelling, heat or pain in the surgical incision. Brain, cervical and thoracic magnetic resonance imaging were normal, albuminocytological dissociation was found on cerebrospinal fluid examination, and electrophysiological examination showed that sensory and motor nerve evoked potentials could not be elicited. A diagnosis of post-traumatic GBS was made, and the patient was treated with intravenous immunoglobulin and plasma exchange, as well as supportive care and rehabilitation exercise. The length of stay was 18 months, and the in-hospital-related costs amounted to $127,171. At the last follow-up, the patient had recovered only grade 3 power in the upper limbs and grade 2 power in the lower limbs. CONCLUSIONS: Severe GBS is a rare complication after orthopaedic surgery. When progressive weakness occurs in trauma patients, the possibility of GBS should be considered, and cerebrospinal fluid and electrophysiological examinations should be performed in a timely manner. For patients with severe GBS after trauma, the treatment costs may be high, and the prognosis may be poor.

Visualizing intraoperative transcranial motor-evoked potentials during glioma surgery for predicting postoperative paralysis prognosis.

PURPOSE: The primary goals of glioma surgery are maximal tumor resection and preservation of brain function. Intraoperative motor-evoked potential (MEP) monitoring is commonly used to predict and minimize postoperative paralysis. However, studies on intraoperative MEP trends and postoperative paralysis are scarce. This study aimed to determine the relationship between intraoperative MEP trends and postoperative paralysis. METHODS: This retrospective study evaluated 229 patients with supratentorial glioma without preoperative paralysis who underwent tumor resection surgery under general anesthesia at our institution between October 2019 and December 2022. Intraoperative transcranial MEP monitoring was performed, and the entire MEP trends on affected and unaffected sides was visualized. Postoperative paralysis and patient-related factors were analyzed. RESULTS: Postoperative paralysis occurred in 36 patients, with the paralysis improving over time and being permanent in 30 and 6 patients, respectively. In the improvement group, the temporary decrease in transcranial MEP rapidly improved. Even when the MEPs were <50% of the control value, fluctuations indicating improvement were observed after the decrease. However, in the permanent paralysis group, transcranial MEP remained consistently <50% of the control value until the end of surgery, after its initial decrease. The significant factors contributing to permanent paralysis were tumor localization close to the pyramidal tract (p = 0.0304) and postoperative cerebral infarction in the pyramidal tract (p = 0.0009). CONCLUSIONS: The overall intraoperative MEP trend can reflect the risk of postoperative paralysis during glioma surgery. Thus, visualizing this trend can provide a better understanding of the prognosis of postoperative paralysis.