Emergency Department, Akron General Medical Center, Akron, OH 44307, USA.
Emergency Department Research, Akron General Medical Center, Akron, OH 44307, USA.
Am J Emerg Med. 2014 Jan;32(1):110.e5-6. doi: 10.1016/j.ajem.2013.08.025. Epub 2013 Sep 17.
A 10-month-old male infant presented to the emergency department (ED) with a chief complaint of weakness, decreased mobility, and regression of motor milestones over a period of 6 days. Significant medical history included a Roseola infection 5 weeks before ED presentation. The patient's pediatrician and chiropractor had both previously diagnosed the patient with strains and sprains. After progression of symptoms, the patient presented to the ED and was discharged home to follow up as an outpatient. The patient subsequently returned to the ED and was admitted to neurology with concern for Guillain-Barré syndrome, which was later confirmed after inpatient workup. The patient was successfully treated and released. Guillain-Barré represents a spectrum of acute immune mediated polyneuropathies. There are several variant forms provoked by infection that precedes the onset of symptoms. Diagnosis and management of Guillain-Barré in the ED will be reviewed, along with the importance of early pediatric intensive care involvement for children presenting with signs of flaccid quadriparesis; rapidly progressive weakness; impending respiratory failure; bulbar palsy; and, most importantly, autonomic cardiovascular instability. Guillain-Barré is rare in children younger than 2 years; however, it must be considered in the differential diagnosis of any patient who presents with progressive weakness and history of a recent infection. It is important to recognize the variety and severity of neurologic symptoms associated with Guillain-Barré across a spectrum, especially with the diagnostic difficulties associated with the pediatric population.
一名 10 个月大的男婴因主诉虚弱、活动能力下降和运动发育里程碑倒退，于 6 天前到急诊科就诊。重要的既往史包括 ED 就诊前 5 周的幼儿急疹感染史。患儿的儿科医生和脊椎按摩师之前都诊断过患儿为拉伤和扭伤。症状进展后，患儿到 ED 就诊，出院后作为门诊患者进行随访。随后，患儿再次到 ED 就诊，并因怀疑吉兰-巴雷综合征而收入神经内科，住院检查后得到确诊。患儿成功接受治疗并出院。吉兰-巴雷综合征是一组急性免疫介导的多发性神经病。有几种变异型由感染引发，且在症状出现之前。本文将对 ED 中吉兰-巴雷综合征的诊断和管理进行回顾，并强调对出现弛缓性四肢瘫痪、迅速进展的无力、即将发生的呼吸衰竭、延髓性麻痹和最重要的自主心血管不稳定等症状的患儿，早期转入儿科重症监护室的重要性。2 岁以下儿童中吉兰-巴雷综合征罕见，但对于任何出现进行性无力且有近期感染史的患者，都必须考虑该病在鉴别诊断中的可能性。重要的是要认识到吉兰-巴雷综合征在整个疾病谱中具有多种表现和严重程度的神经症状，尤其是与儿科人群相关的诊断困难。
