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547 Clinical Particularities in 2 Cases with Polyradiculoneuropathy
  1. SI Iurian1,
  2. S Iurian2,
  3. G Gradinariu3,
  4. A Vidrighin3,
  5. B Mehedintu3
  1. 1Research Department, Pediatric Clinic, Lucian Blaga University
  2. 2Clinical Laboratory, Pediatric Hospital
  3. 3Pediatric Clinic, Sibiu, Romania

Abstract

Background and Aims Guillain-Barré syndrome (GBS) is an acute polyradiculoneuropathy with weakness and diminished reflexes. The authors present clinical peculiarities in 2 cases diagnosed with GBS.

Methods The authors present 2 cases: a 18 month-old male admitted because of unstable walking (1st case) and severe lower extremities pain for the 2nd case (5 year-old boy).

Cases history: upper respiratory tract illness 3 weeks before symptoms onset; no vaccinations, surgical procedures or trauma prior to disease.

Clinical exam:

  1. 1st case presented respiratory signs (dysphonia, slurred speech, short breath);

  2. 2nd case was admitted for severe legs pain.

In addition, both cases were characterized by symmetrical extremities weakness, legs sensory changes (paresthesias, numbness), intense nuchal rigidity, positive Brudzinski sign, abolished osteo-tendinous reflexes in both upper/lower limbs and no abdominal reflexes. There were performed electromyography (EMG), nerve conduction velocity tests (NCT), serologic and cerebrospinal fluid (CSF) analysis.

Results CSF analysis identified albumino-cytologic dissociation: elevation of CSF protein with normal white blood cells count. The serologic studies shown normal titers for cytomegalovirus, Epstein-Barr virus and Mycoplasma. The NCT and EMG have proved severe demyelinating neuropathy and distal conduction block. Differential diagnosis: authors excluded meningitis, myopathies, poliomyelitis, polymyositis and myasthenic syndromes. The patients were treated with intravenous immunoglobulins with good clinical evolution.

Conclusions The authors presented 2 cases with GBS secondary to respiratory infections. Cases peculiarities.

  1. Even though small children have the lowest risk, 1st case presented very early onset;

  2. Both cases presented intense nuchal rigidity.

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