Lee Kwang Lae, Lim Oh Kyung, Lee Ju Kang, Park Ki Deok
Department of Rehabilitation Medicine, National Rehabilitation Hospital, Seoul 142-884, Korea.
Ann Rehabil Med. 2012 Feb;36(1):148-53. doi: 10.5535/arm.2012.36.1.148. Epub 2012 Feb 29.
A 24-year-old male developed bulbar palsy, ophthalmoplegia, ptosis, and shoulder weakness bilaterally 2 weeks after he had experienced an upper respiratory infection. The electrodiagnostic study demonstrated axonal polyradiculoneuropathy. The repetitive nerve stimulation study (RNS) showed no significant decrement of the compound muscle action potentials (CMAPs). The videofluoroscopic swallowing study (VFSS) showed severe impairment of the pharyngeal phase of swallowing. He was diagnosed as having the pharyngeal-cervical-brachial variant of Guillain-Barré syndrome. The patient's dysphagia was not improved for 3 months. A follow up RNS showed a significant decrement of the CMAPs. Pyridostigmine bromide was tried to improve the dysphagia. The patient showed immediate improvement of his dysphagia on the VFSS after the trial with pyridostigmine bromide. Pyridostigmine bromide was given before each meal for 8 days and he showed continuous improvement of his dysphagia. The follow up VFSS after 3 months showed complete recovery of dysphagia.
一名24岁男性在经历上呼吸道感染2周后，双侧出现延髓麻痹、眼肌麻痹、上睑下垂和肩部无力。电诊断研究显示为轴索性多神经根神经病。重复神经刺激研究（RNS）显示复合肌肉动作电位（CMAP）无明显递减。视频荧光吞咽造影研究（VFSS）显示吞咽咽期严重受损。他被诊断为吉兰-巴雷综合征的咽-颈-臂型。患者吞咽困难3个月未改善。随访RNS显示CMAP明显递减。尝试使用溴吡斯的明改善吞咽困难。试用溴吡斯的明后，患者在VFSS上吞咽困难立即改善。溴吡斯的明在每餐饭前服用，共8天，其吞咽困难持续改善。3个月后的随访VFSS显示吞咽困难完全恢复。
