Guillain-Barre Syndrome - Postprocedure

9/28/00 (Franco)

Question: What is the association between Guillain-Barre syndrome and diagnostic and/or operative procedures?

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[Link Directly to Fulltext Article in OVID]

Unique Identifier: 20405491 / PubMed Identifier: 10947755

Authors: Brooks H. Christian AS. May AE.

Institution: Consultant in Obstetric Anaesthesia, Leicester Royal Infirmary, Infirmary Square, Leicester LE1 5WW, UK.

Abstract: Two case histories of pregnant women with Guillain Barre syndrome (acute demyelinating polyradiculoneuritis) are reported. The first required anaesthesia during the second trimester for a minor surgical procedure. The second woman was admitted to the Intensive Care Unit in the first trimester and was ventilated for 18 weeks. Both babies were carried to term and delivered by Caesarean section. A review of the management of Guillain Barre syndrome in pregnancy discusses anaesthetic management, intensive care and the use of plasmapheresis and gamma-globulins. The care of pregnant women recovered from Guillain Barre syndrome is also discussed.

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[Link Directly to Fulltext Article in OVID]

Unique Identifier: 21267653 / PubMed Identifier: 11374420

Authors: Bulsara KR. Baron PW. Tuttle-Newhall JE. Clavien PA. Morgenlander J.

Institution: Division of Neurosurgery, Duke University Medical Center, North Carolina 27705, USA.

Abstract: BACKGROUND: Guillain-Barre Syndrome (GBS) is believed to be caused by autoimmune mechanisms that are predominantly T-cell mediated. We report GBS in organ transplant patients and bone marrow transplant patients, both of whom have iatrogenically suppressed T-cell function. METHODS: We reviewed the Duke University Medical Center database from 1989-1999 for all patients who met the criteria for GBS. There were a total of 212 patients. Of these patients, two had undergone organ transplantation and two had undergone autologous bone marrow transplantation. RESULTS: Our report supports the notion that the humoral immune system is involved in the pathogenesis of GBS. Contrary to previous reports, however, functional recovery can occur without return of T-cell function. CONCLUSIONS: This suggests that in organ transplant patients, GBS may be humorally mediated and, even more importantly, responds well to treatment.

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Unique Identifier: 21187332 / PubMed Identifier: 11291988

Authors: Udawat H. Chaudhary HR. Goyal RK. Chaudhary VK. Mathur R.

Institution: PSM Department, JLN Medical College and AG Hospital, Ajmer.

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Unique Identifier: 21120811 / PubMed Identifier: 11273154

Authors: Udawat H. Nayak R. Chaudhary HR. Goyal RK.

Institution: Department of Medicine, JLN Medical College and AG Hospitals, Ajmer.

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Unique Identifier: 99188918 / PubMed Identifier: 10090509

Authors: Kanjalkar M. Karnad DR. Narayana RV. Shah PU.

Institution: Department of Neurology, King Edward Memorial Hospital, Parel, Mumbai, India.

Abstract: Two adult males were admitted with acute are flexic quadriplegia and bifacial and bulbar weakness 2 weeks after an acute episode of malaria, one due to Plasmodium falciparum infection (patient 1) and the other due to Plasmodium vivax (patient 2). Cerebrospinal fluid analysis and nerve conduction studies confirmed the diagnosis of Guillain-Barre syndrome (GBS). Patient 1 progressed to develop respiratory paralysis and required mechanical ventilation. He received intravenous immunoglobulins for the GBS and made a complete recovery in 6 weeks. A review of 11 cases of GBS (nine previously reported and the present two) revealed that eight patients had preceding falciparum malaria and three had vivax infection. All but two patients had distal symmetric sensory deficits. Paralysis was mild in seven cases (three due to P. vivax and four due to P. falciparum) and recovered completely in 2-6 weeks without any specific treatment. Four patients with falciparum malaria developed severe paralysis with respiratory failure, and three patients died. One patient who received intravenous immunoglobulins recovered completely (patient 1 in this report). [References: 14]

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[Link Directly to Fulltext Article in OVID]

Unique Identifier: 98231951 / PubMed Identifier: 9572240

Authors: Lacomis D. Petrella JT. Giuliani MJ.

Institution: Department of Neurology, University of Pittsburgh School of Medicine, Presbyterian University Hospital, Pennsylvania 15213, USA.

Abstract: The spectrum of neuromuscular disorders among intensive care unit (ICU) patients has shifted toward disorders acquired within the ICU and away from "traditional" neuromuscular disorders that lead to ICU admission. We sought to assess this spectrum by determining the causes and relative frequencies of neuromuscular disorders that led to electromyography (EMG) examinations in our ICU population. Ninety-two patients were studied over a 4 1/2-year period. Twenty-six (28%) had neuromuscular disorders (mainly Guillain-Barre syndrome, myopathy, and motor neuron disease) that led to ICU admission. Among patients who developed weakness in the ICU, there was a predominance of organ transplant patients and patients with the systemic inflammatory response syndrome and multiorgan dysfunction. Thirty-nine (42%) developed acute myopathy (consistent with critical illness myopathy in most), and 13% developed acute axonal sensorimotor polyneuropathy (mainly critical illness polyneuropathy). Patients with acute myopathy and acute axonal sensorimotor polyneuropathy had similar functional outcomes. We conclude that among patients who underwent EMG in our ICU population, acute myopathy is three times as common as acute axonal polyneuropathy, and the outcomes from acute myopathy and acute axonal polyneuropathy may be similar.

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Unique Identifier: 20234402 / PubMed Identifier: 10771907

Authors: Kakar A. Sethi PK.

Institution: Department of Medicine, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi.

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[Link Directly to Fulltext Article in OVID]

Unique Identifier: 98093330 / PubMed Identifier: 9431302

Authors: Tuttle J. Chen RT. Rantala H. Cherry JD. Rhodes PH. Hadler S.

Institution: National Immunization Program, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.

Abstract: OBJECTIVES: This study examined whether there is a risk that tetanus-toxoid-containing vaccines could cause Guillain-Barre syndrome and, if so, how large the risk is. METHODS: This study was based on previous active surveillance epidemiological studies of Guillain-Barre syndrome and vaccination history. RESULTS: A background rate of 0.3 cases of Guillain-Barre syndrome per million person-weeks has been estimated. By chance, 2.2 people with the syndrome would have received tetanus-toxoid-containing vaccine within the 6 weeks before onset, yet only 1 person had done so. Data on children show similar results. CONCLUSIONS: If an association exists, it must be extremely rare and not of public health significance. [References: 17]

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[Link Directly to Fulltext Article in OVID]

Unique Identifier: 98073840 / PubMed Identifier: 9409375

Authors: Wen PY. Alyea EP. Simon D. Herbst RS. Soiffer RJ. Antin JH.

Institution: Department of Neurology, Brigham and Women's Hospital, Boston, MA 02115, USA.

Abstract: We describe four patients who developed Guillain-Barre syndrome (GBS) following allogeneic bone marrow transplantation (BMT). All four patients had a febrile illness before developing GBS. Two patients had mild graft-versus-host disease but did not require immunosuppression. These patients add to the increasing number of BMT patients whose courses have been complicated by GBS and raise the possibility that BMT patients, especially those undergoing allogeneic BMT, may have a higher risk of developing GBS. [References: 10]

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Unique Identifier: 97051277 / PubMed Identifier: 8896016

Authors: Rosenberg SK. Stacey BR.

Institution: Department of Anesthesiology, Case Western Reserve School of Medicine, Cleveland, Ohio, USA.

Abstract: BACKGROUND AND OBJECTIVES: A 58-year-old man developed progressive neurologic symptoms following a surgical procedure and postoperative epidural analgesia. METHODS: Neurologic evaluation, magnetic resonance imaging, computed tomography, and electromyography indicated the presence of both arachnoiditis and Guillain-Barre syndrome. The patient was treated with plasmapheresis and methylprednisone. RESULTS: The patient began to show clinical and electromyographic recovery but was lost to follow-up after his transfer to a rehabilitation facility. CONCLUSIONS: Anesthesiologists should be aware of the possible postoperative occurrence of rare neurologic disorders, both in patients who have received epidural analgesia and in those who have not, but they should not be deterred from using epidural analgesia by this isolated case.

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Unique Identifier: 96431986 / PubMed Identifier: 8835052

Authors: Awong IE. Dandurand KR. Keeys CA. Maung-Gyi FA.

Institution: Clinical Pharmacy Associates, Beltsville, MD 20705, USA.

Abstract: OBJECTIVE: To present an overview of reported drug-associated Guillain-Barre syndrome (GBS) and current management of the disease. DATA SOURCES: Case reports and reviews of drug-associated GBS published in the English-language literature from 1982 through 1994 were retrieved from MEDLINE. An additional search was done through the Iowa Drug Information System for the same period. This search yielded incidents that occurred as early as 1976. The key search terms were GBS, polyneuropathy, chemically induced polyradiculoneuropathy, and etiology of GBS. The searches were limited to human subjects. DATA SYNTHESIS: Drugs that have been associated with GBS are presented, and although no definite relationships have been established, selected reports attempt to show an increased incidence of GBS after drug therapy. Outcome of medical management of GBS has been variable; however, death occurs in less than 10% of those affected. CONCLUSIONS: GBS and clinically similar states have been reported to occur with a variety of drugs and biologics; however, because of the paucity of available data a well-defined cause and effect relationship has not been established between GBS and any drug. There appears to be no treatment of choice for this disorder. Further comparative studies should be done to determine the therapy with the most consistent outcome. [References: 43]

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Unique Identifier: 96288481 / PubMed Identifier: 8670005

Authors: Chuang TY. Lin SW. Chan RC.

Institution: Department of Physical Medicine and Rehabilitation, National Yang-Ming University School of Medicine, Taipei, Taiwan ROC.

Abstract: The mortality rate of the Formosan krait bite has been reported to be 23%; death is from respiratory paralysis caused by neuromuscular junctions being blocked by bungarotoxin. This article presents the first case report of Guillain-Barre syndrome after snake envenomization. The patient presented with symmetric paresis and sensory signs in the upper and lower limbs, autonomic dysfunction, facial nerve involvement, and mild elevated cerebrospinal fluid protein at about 4 weeks after the bite. Electrodiagnostic studies revealed profound sensory and motor polyneuropathy. Repeated electrophysiologic findings confirmed nerve regeneration. The patient reached satisfactory functional outcome after a short-term intensive rehabilitation program despite severe axonal degeneration. This article also discusses the possible mechanism of immunopathogenesis of Guillain-Barre syndrome after krait bite.

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Unique Identifier: 95182934 / PubMed Identifier: 7877546

Authors: Taylor BV. Mastaglia FL. Stell R.

Institution: Department of Neurology, Sir Charles Gairdner Hospital, Perth, WA.

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Unique Identifier: 94258101 / PubMed Identifier: 8199578

Authors: Myers SE. Williams SF.

Institution: Bone Marrow Transplant Program, University of Chicago Medical Center, IL 60637.

Abstract: Guillain-Barre syndrome appeared in two patients following autologous bone marrow transplantation for metastatic breast cancer. In one case, the patient responded to plasmapheresis and became ambulatory. In the second case, the patient died of an unrelated complication: intracerebral hemorrhage. Although Guillain-Barre syndrome is associated with hematologic malignancies, it has not been previously reported in patients with solid tumors undergoing autologous bone marrow transplantation. Because both patients were in remission at the time of the autograft, Guillain-Barre syndrome may emerge as a rare complication of altered immune function and/or viral infection after marrow transplantation.

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Unique Identifier: 93223725 / PubMed Identifier: 8467824

Authors: Ormerod IE. Cockerell OC.

Institution: Department of Neurology, St Thomas' Hospital, London, UK.

Abstract: We report 2 patients with Guillain-Barre syndrome following infection with the varicella-zoster virus. Evidence from neurophysiological studies is provided and the literature is reviewed on the association between these conditions. [References: 38]

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Unique Identifier: 91229075 / PubMed Identifier: 1851395

Authors: Safranek TJ. Lawrence DN. Kurland LT. Culver DH. Wiederholt WC. Hayner NS. Osterholm MT. O'Brien P. Hughes JM.

Institution: Hospital Infections Program, Centers for Disease Control, Atlanta, GA.

Abstract: Although the original Centers for Disease Control study of the relation between A/New Jersey/8/76 (swine flu) vaccine and Guillain-Barre syndrome (polyradiculoneuritis) demonstrated a statistical association and suggested a causal relation between the two events, controversy has persisted. To reassess this association, the authors obtained medical records of all previously reported adult patients with Guillain-Barre syndrome in Michigan and Minnesota from October 1, 1976 through January 31, 1977. To identify previously unreported hospitalized cases with onset of symptoms during this period, the authors surveyed medical care facilities. A group of expert neurologists formulated diagnostic criteria for Guillain-Barre syndrome and then reviewed the clinical records in a blinded fashion. Of the 98 adult patients from the original Centers for Disease Control study eligible for consideration, three were found to have been misclassified by date of onset and were excluded. Of the remaining 95, the 28 (29%) who did not meet the diagnostic criteria were equally distributed between the vaccinated group (18 of 60, 30%) and the unvaccinated group (10 of 35, 29%). In addition to the 67 remaining cases who met the diagnostic criteria, six previously unreported cases (three of whom had been vaccinated) were found and included in this analysis. The relative risk of developing Guillain-Barre syndrome in the vaccinated population of these two states during the 6 weeks following vaccination was 7.10, comparable to the relative risk of 7.60 found in the original study. These findings suggest that there was an increased risk of developing Guillain-Barre syndrome during the 6 weeks following vaccination in adults. The excess cases of Guillain-Barre syndrome during the first 6 weeks attributed to the vaccine was 8.6 per million vaccinees in Michigan and 9.7 per million vaccinees in Minnesota. No increase in relative risk for Guillain-Barre syndrome was noted beyond 6 weeks after vaccination.

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Unique Identifier: 90223144 / PubMed Identifier: 2326697

Authors: Stambough JL. Quinlan JG. Swanson JD.

Institution: Department of Orthopaedic Surgery, University of Cincinnati Medical Center, Ohio.

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Unique Identifier: 81085568 / PubMed Identifier: 6255911

Authors: Bale JF. Rote NS. Bloomer LC. Bray PF.

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Unique Identifier: 81020719 / PubMed Identifier: 7417062

Authors: Kelley RE. Daroff RB. Sheremata WA. McCormick JR.

Abstract: A clinical constellation of aseptic meningitis, arachnoiditis, communicating hydrocephalus, and a Guillain-Barre syndrome occurred following lumbar myelography with metrizamide. To our knowledge, Guillain-Barre syndrome has not been previously described following myelography with any contrast agent. Meningeal reactions and hydrocephalus have been reported with other agents, but this is the first instance with metrizamide.

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Unique Identifier: 73042547 / PubMed Identifier: 4508222

Authors: Shuert GT. Gamble JW.

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Unique Identifier: 71155079 / PubMed Identifier: 4927795

Authors: Elstein M. Legg NJ. Murphy M. Park DM. Sutcliffe MM.