García Antonio, Sedano María J, Álvarez-Paradelo Silvia, Berciano José
Service of Clinical Neurophysiology, University Hospital "Marqués de Valdecilla (IDIVAL)" and "Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED)", Santander, Spain.
Service of Neurology, University Hospital "Marqués de Valdecilla (IDIVAL)", University of Cantabria and "Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED)", Santander, Spain.
Clin Neurophysiol Pract. 2018 Nov 3;3:159-163. doi: 10.1016/j.cnp.2018.09.001. eCollection 2018.
To describe the case of a patient with Guillain-Barré syndrome (GBS) showing early reversible conduction failure (RCF) detected by means of serial deep tendon reflex response (T-reflex) study.
A 36-year-old woman had a 5-day history of foot and hand paresthesias ascending to thighs and arms, throbbing interscapular and neck pain, mild to moderate tetraparesis, and areflexia. Nerve conduction studies (NCS) were performed on days 7 and 33 after onset.
NCS showed an equivocal electrophysiologic pattern, just an isolated distal RCF being detected on the right radial nerve at initial examination. Motor latency on deltoid muscle after Erb's point stimulation was preserved. Sensory conduction velocities were normal or slightly slowed. Somatosensory evoked potentials from median and tibial nerves were normal. Initially, F-wave study demonstrated reversible abnormalities, consisting of multiple A waves and low F-wave persistence, minimal F-wave latencies being preserved. Biceps brachii T-reflex was normal, whereas Achilles T-reflex was absent bilaterally, appearing on the second study with normal T-wave morphology and latency, thus conforming to the requirements for RCF diagnosis. Soleus H-reflex was also initially absent.
Serial T-reflex study is a useful technique for detecting early RCF of proximal nerve trunks in early GBS.
T-reflex is useful tool for GBS in association with NCS.
描述1例吉兰 - 巴雷综合征(GBS)患者的病例,该患者通过系列深部腱反射反应(T反射)研究检测出早期可逆性传导衰竭(RCF)。
一名36岁女性有5天的手足感觉异常病史,感觉异常向上蔓延至大腿和手臂,伴有肩胛间和颈部搏动性疼痛、轻度至中度四肢轻瘫及腱反射消失。在发病后第7天和第33天进行了神经传导研究(NCS)。
NCS显示出一种不明确的电生理模式,初次检查时仅在右侧桡神经检测到孤立的远端RCF。Erb点刺激后三角肌的运动潜伏期正常。感觉传导速度正常或略有减慢。正中神经和胫神经的体感诱发电位正常。最初,F波研究显示可逆性异常,包括多个A波和低F波持久性,最小F波潜伏期正常。肱二头肌T反射正常,而双侧跟腱T反射消失,在第二次研究中出现,T波形态和潜伏期正常,因此符合RCF诊断标准。比目鱼肌H反射最初也消失。
系列T反射研究是检测早期GBS近端神经干早期RCF的有用技术。
T反射是GBS联合NCS的有用工具。