Dy M, Leshner R L, Crawford J R
Department of Pediatrics, University of California, San Diego and Rady Children's Hospital, USA.
Case Rep Neurol Med. 2013;2013:356157. doi: 10.1155/2013/356157. Epub 2013 Apr 28.
We present a case of a previously healthy 17-year-old girl with history of Guillain-Barre Syndrome 5 years after initial presentation who presented with bilateral lower extremity pain, worsening dysphagia, subsequent weakness, and decreased reflexes. Cerebrospinal fluid analysis had a prominent lymphocytic pleocytosis. MRI of spine showed significant anterior nerve root enhancement. Electromyogram demonstrated a mild axonal greater than demyelinating motor polyneuropathy and intact sensory responses, with no evidence of conduction block or temporal dispersion, unlike her first presentation that revealed a demyelinating polyneuropathy. The patient recovered with mild subjective weakness following 5 days of intravenous immunoglobulin treatment. This case represents a recurrence of a predominantly motor variant polyradiculoneuropathy distinct from the initial presentation with a lymphocytic predominant CSF pleocytosis, nerve root enhancement on MRI spine, and rapid recovery following treatment with intravenous immunoglobulin.
我们报告一例既往健康的17岁女孩,在首次出现格林-巴利综合征5年后再次发病,此次表现为双侧下肢疼痛、吞咽困难加重、随后出现肌无力以及反射减弱。脑脊液分析显示淋巴细胞显著增多。脊柱MRI显示前神经根明显强化。肌电图显示为轻度轴索性大于脱髓鞘性运动性多发性神经病,感觉反应正常,无传导阻滞或时间离散的证据,与她首次发病时表现为脱髓鞘性多发性神经病不同。经5天静脉注射免疫球蛋白治疗后,患者恢复,遗留轻度主观肌无力。该病例代表了一种主要为运动型的多神经根神经病复发,与首次发病不同,此次脑脊液以淋巴细胞为主,脊柱MRI显示神经根强化,静脉注射免疫球蛋白治疗后恢复迅速。