acyclovir and Guillain-Barre-Syndrome

Miller Fisher syndrome (MFS), an acute demyelinating neuropathy, is characterised by a triad of areflexia, ataxia and ophthalmoplegia. It is the most common variant of Guillain-Barre Syndrome (GBS). In about 5.6%-7.1% of MFS cases, patients also suffer from progressive motor weakness of the limbs. This condition is termed MFS/GBS overlap syndrome. Whether it is in MFS or GBS, bilateral vocal cord paralysis (BVCP) is a rare manifestation with limited cases reported in the literature. We report an extremely rare case where a 65-year-old man developed BVCP in an MFS/GBS overlap syndrome. We have also reviewed previous case reports in the literature for comparison.

Topics: Acyclovir; Aged; Antiviral Agents; Chickenpox; Disease Progression; Electrodiagnosis; Guillain-Barre Syndrome; Humans; Immunoglobulins, Intravenous; Immunologic Factors; Male; Miller Fisher Syndrome; Neural Conduction; Tracheostomy; Vocal Cord Paralysis

In this case report, we describe the first PCR-confirmed case of HSV2 myeloradiculitis with a purely motor presentation, occurring in a 68-year-old liver transplant recipient. The patient reported ascending weakness with no sensory nor sphincteric symptoms, thereby resembling acute demyelinating inflammatory neuropathy, or Guillain-Barré syndrome. HSV2 was detected in cerebrospinal fluid by PCR, and the patient was successfully treated with intravenous Acyclovir.

Topics: Acyclovir; Aged; Antiviral Agents; Guillain-Barre Syndrome; Herpes Simplex; Herpesvirus 2, Human; Humans; Liver Transplantation; Male; Treatment Outcome

Viral encephalitis causes an altered level of consciousness, which may be associated with fever, seizures, focal deficits, CSF pleocytosis, and abnormal neuroimaging. Potential pathogens include HSV, VZV, enterovirus, and in some regions, arboviruses. Autoimmune (eg, anti-NMDA receptor) and paraneoplastic encephalitis are responsible for some cases where no pathogen is identified. Indications for ICU admission include coma, status epilepticus and respiratory failure. Timely initiation of anti-viral therapy is crucial while relevant molecular and serological test results are being performed. Supportive care should be directed at the prevention and treatment of cerebral edema and other physiological derangements which may contribute to secondary neurological injury.

Topics: Acyclovir; Adrenal Cortex Hormones; Anticonvulsants; Antiviral Agents; Brain Diseases; Brain Edema; Consciousness Disorders; Encephalitis; Encephalitis, Viral; Encephalomyelitis, Acute Disseminated; Glasgow Coma Scale; Guillain-Barre Syndrome; Hashimoto Disease; Humans; Intensive Care Units; Paraneoplastic Syndromes, Nervous System; Seizures; Status Epilepticus; Viremia

Myelitis and Guillain-Barré syndrome occurring concurrently after varicella infection is very rare. A 34-year-old man presented with progressive flaccid tetraparesis, facial palsy, respiratory failure, sensory loss and urinary incontinence one week after varicella infection. Clinical, imaging and electrodiagnostic studies supported the diagnosis of myelitis and Guillain-Barré syndrome. He improved with intravenous acyclovir and gammaglobulin.

Topics: Acyclovir; Adult; Antiviral Agents; Chickenpox; Drug Therapy, Combination; Electrophysiology; Globins; Guillain-Barre Syndrome; Humans; Magnetic Resonance Imaging; Male; Myelitis; Spinal Cord

A 76-year-old Japanese female who was treated with long-term use of prednisolone at 10 mg/day for interstitial pneumonia developed acute right-dominant lower limb paralysis and then upper limb paralysis with herpes zoster eruptions on the right C7-Th1 dermatomes. On admission, right predominant quadriplegia was observed with sensory symptoms; Hughes functional grade was level 4; the hand grip power was right, 0, and left, 7 kg, the deep tendon reflexes were abolished throughout without pathologic reflexes. Twenty days after the onset of the symptoms, the cerebrospinal fluid (CSF) revealed mild increases of lymphocytes (13 cells/μl) and protein content (73 mg/dl). Varicella-zoster virus (VZV) PCR was negative in the CSF, but an enzyme immunoassay for VZV was positive in her serum and CSF, and the high titers were prolonged. Peripheral nerve conduction and F wave studies suggested right-dominant demyelinating polyradiculoneuropathy. A T

Topics: Acyclovir; Aged; Antibodies, Viral; Antiviral Agents; Biomarkers; Diffusion Magnetic Resonance Imaging; Female; Guillain-Barre Syndrome; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompromised Host; Immunoglobulins, Intravenous; Oxadiazoles; Polyradiculoneuropathy; Quadriplegia; Varicella Zoster Virus Infection

Zika virus (ZIKV) is an emerging flavivirus which has been linked to a number of neurologic manifestations such as Guillain-Barré syndrome (GBS), transverse myelitis, and meningo-encephalitis. Ophthalmologic manifestations are increasingly being reported; however, ocular dyskinesias have not been described in this context to date. Herein, we report a case of a 22-year-old female who presented with ocular flutter and associated Guillain-Barré syndrome following acute ZIKV infection. We speculate that although such symptoms may have originated from a direct viral insult, a post-infectious autoimmune mechanism may not be excluded. Physicians should include ZIKV as well as other flaviviruses in their diagnostic workup for all patients with ocular flutter/opsoclonus, after excluding other non-infectious causes of central nervous system pathology. To the best of our knowledge, this is the first report on the association of ocular flutter, GBS, and ZIKV infection.

Topics: Acyclovir; Antibodies, Viral; Antiviral Agents; Ataxia; Female; Guillain-Barre Syndrome; Humans; Immunoglobulins, Intravenous; Ocular Motility Disorders; Young Adult; Zika Virus; Zika Virus Infection

We herein report the case of a 19-year-old woman with facial diplegia and paresthesias (FDP) preceded by flu-like symptoms. We diagnosed the patient with a regional variant of Guillain-Barré syndrome due to decreased tendon reflexes, albuminocytological dissociation in the cerebrospinal fluid and demyelinating features on nerve conduction studies. The patient also had IgM anti-GalNAc-GD1a antibodies, and treatment with glucocorticoids was effective for treating the facial diplegia, but not paresthesia. Therefore, facial palsy may have a different pathophysiology from paresthesia or other symptoms of FDP, which responds to glucocorticoid therapy.

Topics: Acyclovir; Adult; Antiviral Agents; Autoantibodies; Facial Paralysis; Female; Gangliosides; Glucocorticoids; Guillain-Barre Syndrome; Humans; Immunoglobulin M; Methylprednisolone; Paresthesia; Recovery of Function; Treatment Outcome; Valacyclovir; Valine

Topics: Acyclovir; Aged; Antiviral Agents; Guillain-Barre Syndrome; Herpes Zoster; Herpesvirus 3, Human; Humans; Kidney Transplantation; Male

A 77-year-old woman developed progressive dysesthesia, hypesthesia and weakness in four extremities immediately after improvement of herpes zoster in the left Th10 dermatome area. Examination of the cerebrospinal fluid (CSF) showed an increase in protein concentrations. Evidence of demyelinating polyneuropathy was demonstrated by nerve conduction studies. Her hypesthesia and weakness in the extremities were gradually improved following intravenous immunoglobulin therapy (IVIg). Varicella zoster virus (VZV) titer levels in CSF well correlated both with neurological symptoms and CSF protein concentrations. VZV DNA in the CSF was not detectable. These findings suggested autoimmune Guillain-Barré syndrome (GBS) associated with herpes zoster. An interesting finding in the present patient is that one day after the completion of IVIg, when the neurological symptoms in the extremities were apparently ameliorating, the herpes zoster eruptions again emerged in the left L3 dermatome area. By treatment with intravenous acyclovir, the vesicular eruptions were improved. We assume that IVIg might suppress the immune response against VZV and promote the recurrence of eruptions.

Topics: Acyclovir; Aged; Antiviral Agents; Female; Guillain-Barre Syndrome; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunoglobulins, Intravenous; Immunologic Factors; Injections, Intravenous; Recurrence

This report presents a case of infectious mononucleosis with severe neurological complications in a previously healthy young female. Both peripheral and cranial nerves were affected causing paralysis and need for assisted ventilation. There was a clear correlation between the symptoms and the serological findings, indicating that the causative agent was Epstein-Barr virus. The patient was treated with acyclovir, methylprednisolone and immunoglobulins. Two months later she had recovered completely. Epstein-Barr virus infection must be considered among the possible causes in patients with cranial nerve affection or Guillain-Barré syndrome.

Topics: Acyclovir; Adolescent; Anti-Inflammatory Agents; Antiviral Agents; Cranial Nerve Diseases; Epstein-Barr Virus Infections; Female; Guillain-Barre Syndrome; Humans; Immunoglobulins, Intravenous; Methylprednisolone; Valacyclovir; Valine