Çakırgöz Mensure Yılmaz, Duran Esra, Topuz Cem, Kara Deniz, Turgut Namigar, Türkmen Ülkü Aygen, Turanç Bülent, Dolap Mustafa Önder, Hancı Volkan
Department of Anesthesiology and Reanimation, Okmeydani Training and Research Hospital, Istanbul, Turkey.
Şehit Kamil State Hospital, Gaziantep, Turkey.
Braz J Anesthesiol. 2014 May-Jun;64(3):195-8. doi: 10.1016/j.bjane.2013.03.009. Epub 2013 Oct 11.
Guillain-Barré Syndrome is one of the most common causes of acute polyneuropathy in adults. Recently, the occurrence of Guillain-Barré Syndrome after major and minor surgical operations has been increasingly debated. In Guillain-Barré syndrome, syndrome of inappropriate antidiuretic hormone secretion and dysautonomy are generally observed after maximal motor deficit.
A 44-year-old male patient underwent a laparoscopic cholecystectomy for acute cholecystitis. After the development of a severe headache, nausea, diplopia, and attacks of hypertension in the early postoperative period, a computer tomography of the brain was normal. Laboratory tests revealed hyponatremia linked to syndrome of inappropriate antidiuretic hormone secretion, the patient's fluids were restricted, and furosemide and 3% NaCl treatment was initiated. On the second day postoperative, the patient developed numbness moving upward from the hands and feet, loss of strength, difficulty swallowing and respiratory distress. Guillain-Barré syndrome was suspected, and the patient was moved to intensive care. Cerebrospinal fluid examination showed 320 mg/dL protein, and acute motor-sensorial axonal neuropathy was identified by electromyelography. Guillain-Barré syndrome was diagnosed, and intravenous immune globulin treatment (0.4 g/kg/day, 5 days) was initiated. After 10 days in the intensive care unit, at which the respiratory, hemodynamic, neurologic and laboratory results returned to normal, the patient was transferred to the neurology service.
Our case report indicates that although syndrome of inappropriate antidiuretic hormone secretion and autonomic dysfunction are rarely the initial characteristics of Guillain-Barré syndrome, the possibility of postoperative syndrome of inappropriate antidiuretic hormone secretion should be kept in mind. The presence of secondary hyponatremia in this type of clinical presentation may delay diagnosis.
吉兰 - 巴雷综合征是成人急性多发性神经病最常见的病因之一。近来，大、小手术后发生吉兰 - 巴雷综合征的情况一直备受争议。在吉兰 - 巴雷综合征中，抗利尿激素分泌不当综合征和自主神经功能障碍通常在最大运动功能缺损后出现。
一名44岁男性患者因急性胆囊炎接受了腹腔镜胆囊切除术。术后早期出现严重头痛、恶心、复视和高血压发作，脑部计算机断层扫描正常。实验室检查显示低钠血症与抗利尿激素分泌不当综合征有关，限制了患者的液体摄入，并开始使用呋塞米和3%氯化钠治疗。术后第二天，患者出现从手脚向上蔓延的麻木、肌力丧失、吞咽困难和呼吸窘迫。怀疑为吉兰 - 巴雷综合征，患者被转入重症监护病房。脑脊液检查显示蛋白含量为320mg/dL，通过肌电图确定为急性运动感觉轴索性神经病。诊断为吉兰 - 巴雷综合征，并开始静脉注射免疫球蛋白治疗（0.4g/kg/天，共5天）。在重症监护病房住了10天后，患者的呼吸、血流动力学、神经学和实验室检查结果恢复正常，随后被转至神经科。
我们的病例报告表明，尽管抗利尿激素分泌不当综合征和自主神经功能障碍很少是吉兰 - 巴雷综合征的初始特征，但应牢记术后发生抗利尿激素分泌不当综合征的可能性。这种临床表现中继发性低钠血症的存在可能会延迟诊断。
