Guillain-Barré syndrome (GBS) is a rare, but potentially fatal, immune-mediated disease of the peripheral nerves and nerve roots that is usually triggered by infections. The incidence of GBS can ...therefore increase during outbreaks of infectious diseases, as was seen during the Zika virus epidemics in 2013 in French Polynesia and 2015 in Latin America. Diagnosis and management of GBS can be complicated as its clinical presentation and disease course are heterogeneous, and no international clinical guidelines are currently available. To support clinicians, especially in the context of an outbreak, we have developed a globally applicable guideline for the diagnosis and management of GBS. The guideline is based on current literature and expert consensus, and has a ten-step structure to facilitate its use in clinical practice. We first provide an introduction to the diagnostic criteria, clinical variants and differential diagnoses of GBS. The ten steps then cover early recognition and diagnosis of GBS, admission to the intensive care unit, treatment indication and selection, monitoring and treatment of disease progression, prediction of clinical course and outcome, and management of complications and sequelae.
Highlights • Sural-sparing pattern is seen in axonal and demyelinating forms of Guillain–Barré syndrome (GBS). • It reflects a pathological process that is common to both types of GBS. • Question ...diagnosis of any GBS-subtype if sural is abnormal, whilst sparing median, ulnar sensory potentials.
Author Affiliation: (1) Department of Haematology, Tan Tock Seng Hospital, Singapore, Singapore (2) Department of Laboratory Medicine, Khoo Teck Puat Hospital, Singapore, Singapore (3) Lee Kong Chian ...School of Medicine, Singapore, Singapore (4) Yong Loo Lin School of Medicine, Singapore, Singapore (5) Department of Neurology, National Neuroscience Institute (Tan Tock Seng Hospital Campus), Singapore, Singapore (6) Department of Rehabilitation Medicine, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore (7) Department of Cardiology, Tan Tock Seng Hospital, Singapore, Singapore (8) Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore (9) Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore (10) National Centre for Infectious Diseases, Singapore, Singapore (11) Department of Endocrinology, Tan Tock Seng Hospital, Singapore, Singapore (a) Bingwen_Eugene_Fan@ttsh.com.sg Article History: Registration Date: 10/31/2020 Accepted Date: 10/31/2020 Online Date: 11/07/2020 Byline:
'Killer' open ring in the brain Lim, Gareth; Chong, Lip Leong; Yu, Wai-Yung ...
BMJ case reports,
03/2022, Letnik:
15, Številka:
3
Journal Article
Recenzirano
Odprti dostop
(D) Coronal Fluid Attenuated Inversion Recovery (FLAIR) image: there were also hyperintense lesions in the right thalamus, left basal ganglia and left temporal lobe. Central nervous system ...involvement is extremely rare and often heralds a poor prognosis.4 Learning points Extranodal natural killer/T-cell lymphoma is a rare haematological malignancy that is associated with Epstein-Barr virus infection and can present with central nervous system manifestations. Primary central nervous system extranodal NK/T-cell lymphoma, nasal type: case report and review of the literature.
The earth is neither flat nor round, but rather a pyramid with an apex occupied by the top 10%. At the base are 4 billion people making <8 USD/day. Business, economies and, by extrapolation, medical ...activities largely cater to the upper sections of the pyramid. The circumstances at the bottom are unique; and the strategies employed in the apex seldom work for the base. Using illustrative cases, I shall discuss the key lessons I have gleaned from my limited exposure to peripheral neurology in resource poor settings.
“These unhappy times call for the building of plans that rest upon the forgotten, ...that put faith once more in the forgotten man at the bottom of the economic pyramid” – Franklin D Roosevelt.
Traditional electrodiagnostic (EDX) criteria for Guillain-Barré Syndrome (GBS), e.g. those delineated by Ho et al. and Hadden et al., rely on motor nerve conduction studies (NCS), and focus on ...differentiating GBS subtypes instead of the accurate diagnosis of GBS. Sensory studies, including the sural-sparing pattern, are not routinely used in GBS EDX. We studied the utility of a simplified criterion that utilizes sensory NCS. Motor and sensory NCS abnormalities were defined by comparing against age and height adjusted norms derived from 245 controls. We considered the sural-sparing pattern a positive diagnostic feature. We analyzed 109 prospectively validated GBS patients and graded them as "Definite", "Probable" and "Possible" based on the number of motor and sensory abnormalities detected. Using proposed EDX criteria, 35.8%, 43.1%, 11.9% of all GBS patients were considered "Definite", "Probable" or "Possible" respectively; whereas traditional EDX criteria only diagnosed 49.5% of cases. 27.5%, 35.3% and 21.6% of patients with the Miller-Fisher Syndrome (MFS) subtype of GBS were considered "Definite", "Probable" or "Possible" respectively. In comparison, traditional criteria only detected 15.7% of cases. Our proposed EDX criterion, that includes sensory NCS, improves and grades the diagnostic certainty of GBS, especially MFS.
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