exudates and Guillain-Barre-Syndrome

Guillain-Barré Syndrome (GBS) associated with SARS-CoV-2 vaccine administration is very rare. Early recognition of GBS at early stage could prevent extensive nerve damage with potential respiratory and autonomic failure.. We report a case of paraparetic spectrum of GBS in a 53-year-old lady who presented with rapidly progressive acute flaccid paralysis involving both lower extremities with areflexia eight days after the first dose of Sinovac vaccine for SARS-CoV-2 in Malaysia. Cerebrospinal fluid (CSF) albuminocytological dissociation was seen and nerve conduction study (NCS) revealed sensory neuropathy. The diagnosis of GBS was made based on the Brighton criteria. Patient responded well to intravenous immunoglobulin (IVIG).. Though there is currently no convincing evidence of any causation between GBS and SARS- CoV-2 vaccination, clinicians should remain vigilant and consider GBS in the differential diagnosis for patient who presents with weakness with reduced or absent deep tendon reflex after vaccination against SARS-CoV-2.

Topics: COVID-19; COVID-19 Vaccines; Female; Guillain-Barre Syndrome; Humans; Malaysia; Middle Aged; SARS-CoV-2; Vaccination

We aimed to develop a model that can predict the probabilities of acute inflammatory demyelinating polyneuropathy (AIDP) based on nerve conduction studies (NCS) done within eight weeks.. The derivation cohort included 90 Malaysian GBS patients with two sets of NCS performed early (1-20days) and late (3-8 weeks). Potential predictors of AIDP were considered in univariate and multivariate logistic regression models to develop a predictive model. The model was externally validated in 102 Japanese GBS patients.. Median motor conduction velocity (MCV), ulnar distal motor latency (DML) and abnormal ulnar/normal sural pattern were independently associated with AIDP at both timepoints (median MCV: p = 0.038, p = 0.014; ulnar DML: p = 0.002, p = 0.003; sural sparing: p = 0.033, p = 0.009). There was good discrimination of AIDP (area under the curve (AUC) 0.86-0.89) and this was valid in the validation cohort (AUC 0.74-0.94). Scores ranged from 0 to 6, and corresponded to AIDP probabilities of 15-98% at early NCS and 6-100% at late NCS.. The probabilities of AIDP could be reliably predicted based on median MCV, ulnar DML and ulnar/sural sparing pattern that were determined at early and late stages of GBS.. A simple and valid model was developed which can accurately predict the probability of AIDP.

Topics: Adolescent; Adult; Aged; Area Under Curve; Diagnosis, Differential; Female; Guillain-Barre Syndrome; Humans; Malaysia; Male; Median Nerve; Middle Aged; Models, Neurological; Neural Conduction; Probability; Regression Analysis; Reproducibility of Results; Sural Nerve; Time Factors; Ulnar Nerve; Young Adult

We aimed to evaluate the key diagnostic features of Guillain-Barré syndrome (GBS) in Malaysian patients and validate the Brighton criteria. This was a retrospective study of patients presenting with GBS and Miller Fisher syndrome (MFS) between 2010 and 2019. The sensitivity of the Brighton criteria was evaluated. A total of 128 patients (95 GBS, 33 MFS) were included. In the GBS cohort, 92 (97%) patients presented with symmetrical limb weakness. Reflexes were depressed or absent in 90 (95%) patients. Almost all patients (94, 99%) followed a monophasic disease course, with 5 (5%) patients experiencing treatment-related fluctuations. Cerebrospinal fluid (CSF) albuminocytological dissociation was seen in 62/84 (73%) patients. Nerve conduction study (NCS) revealed neuropathy in 90/94 (96%) patients. In GBS patients with complete dataset (84), 56 (67%) patients reached level 1 of the Brighton criteria, 21 (25%) reached level 2, 3 (4%) reached level 3, and 4 (5%) reached level 4. In MFS, the clinical triad was present in 25 (76%) patients. All patients had a monophasic course. CSF albuminocytological dissociation was present in 10/25 (40%) patients. NCS was normal or showed sensory neuropathy in 25/33 (76%) patients. In MFS patients with complete dataset (25), 5 (20%) patients reached level 1 of the Brighton criteria, 14 (56%) reached level 2, 2 (8%) reached level 3, and 4 (16%) reached level 4. Inclusion of antiganglioside antibodies improved the sensitivity of the Brighton criteria in both cohorts. In the Malaysian cohort, the Brighton criteria showed a moderate to high sensitivity in reaching the highest diagnostic certainty of GBS, but the sensitivity was lower in MFS.

Topics: Adolescent; Adult; Aged; Child; Diagnostic Techniques, Neurological; Female; Guillain-Barre Syndrome; Humans; Malaysia; Male; Middle Aged; Miller Fisher Syndrome; Neural Conduction; Practice Guidelines as Topic; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Young Adult

Guillain-Barré syndrome (GBS) is an acute immune-mediated neuropathy that has variable disease course and outcome. The Erasmus GBS outcome score (EGOS), modified EGOS (mEGOS), and Erasmus GBS respiratory insufficiency score (EGRIS) are prognostic models designed to predict the functional outcome of GBS patients at 6 months (EGOS and mEGOS) and the need for mechanical ventilation within a week of admission (EGRIS). The models were primarily developed in the Dutch GBS population, and thus the usefulness of these models in other GBS cohorts is less clear. In the current study, we aimed to validate mEGOS, EGOS, and EGRIS in Malaysian GBS patients. A total of 107 patients with GBS and its variants were consecutively recruited. Patients with GBS and Miller Fisher syndrome (MFS) were analysed separately. In the GBS cohort, high mEGOS and EGOS scores were significantly correlated with poor outcome at 6 months (mEGOS on admission: r = .381, P = .005; mEGOS at day 7 of admission: r = .507, P < .001; EGOS: r = .484, P < .001). However, there were no significant correlations between mEGOS or EGOS and outcome in patients with MFS (mEGOS on admission: r = .152, P = .523; mEGOS at day 7 of admission: r = .008, P = .973; EGOS: r = .110; P = .644). The score of EGRIS for GBS patients with mechanical ventilation was significantly higher than those patients without mechanical ventilation (4 ± 2 vs 3 ± 1; P < .001). We conclude that mEGOS and EGOS are clinically useful and relevant to the Malaysian GBS population but not in patients with classic MFS. EGRIS could be used to predict the need for mechanical ventilation in our local GBS patients.

Topics: Adolescent; Adult; Aged; Female; Guillain-Barre Syndrome; Humans; Malaysia; Male; Middle Aged; Miller Fisher Syndrome; Models, Theoretical; Prognosis; Respiration, Artificial; Young Adult

Topics: Adolescent; Adult; Aged; Comorbidity; Dengue; Female; Guillain-Barre Syndrome; Humans; Malaysia; Male; Middle Aged; Nervous System Diseases; Young Adult

To comprehensively investigate the relationship between antibodies to single glycolipids and their complexes and Guillain-Barré syndrome subtypes and clinical features.. In acute sera from 199 patients with Guillain-Barré syndrome, immunoglobulin G (IgG) antibodies to glycolipids and ganglioside complexes were tested using ELISA against individual antigens from single glycolipids including gangliosides (LM1, GM1, GM1b, GD1a, GalNAc-GD1a, GD1b, GT1a, GT1b, GQ1b) and a neutral glycolipid, asialo-GM1 (GA1), and antigens from the combination of 2 different glycolipids. Based on serial nerve conduction studies, the electrodiagnoses were as follows: 69 demyelinating subtype, 85 axonal subtypes, and 45 unclassified.. Significant associations were detected between acute motor axonal neuropathy subtype and IgG antibodies to GM1, GalNAc-GD1a, GA1, or LM1/GA1 complex. Reversible conduction failure was significantly associated with IgG antibodies to GM1, GalNAc-GD1a, GD1b, or complex of LM1/GA1. No significant association was demonstrated between acute inflammatory demyelinating polyneuropathy and any of the glycolipids or ganglioside complexes. Anti-ganglioside complex antibodies alone were detected in 7 patients (5 axonal subtype).. The current study demonstrates that antibodies to single glycolipids and ganglioside complexes are associated with acute motor axonal neuropathy or acute motor conduction block neuropathy but not acute inflammatory demyelinating polyneuropathy.. This study provides Class II evidence that antibodies to glycolipids are increased in patients with acute motor axonal neuropathy and acute motor conduction block neuropathy but not acute inflammatory demyelinating polyneuropathy.

Topics: Autoantibodies; Cohort Studies; Confidence Intervals; Electrodiagnosis; Enzyme-Linked Immunosorbent Assay; Gangliosides; Glycolipids; Guillain-Barre Syndrome; Humans; Immunoglobulin G; Japan; Malaysia; Motor Neuron Disease; Neural Conduction; Singapore