Department of Neurosurgery, Advocate BroMenn Medical Center, Normal, Illinois, USA.
Department of Neurosurgery, Advocate Christ Medical Center, Oak Lawn, Illinois, USA.
World Neurosurg. 2020 Jul;139:175-178. doi: 10.1016/j.wneu.2020.04.054. Epub 2020 Apr 18.
Guillain-Barré syndrome (GBS) is a rare but well-documented cause of paralysis, often occurring after infection. Few cases have been reported in association with spinal cord injury (SCI), which masks the characteristic ascending paralysis. To our knowledge, this is the first reported case of confirmed GBS during the clinical course of thoracic paraplegia due to a gunshot wound (GSW).
A 23-year-old male presented with a GSW to the right axilla that lodged in the spinal canal at the level of T4, causing right hemothorax and American Spinal Injury Association A paraplegia. He had full strength in bilateral upper extremities until 2 weeks after the injury, at which time he developed progressive weakness in the arms with associated paresthesias and dyspnea. Within 5 days, he was intubated and nearly quadriplegic. Cerebrospinal fluid analysis and electromyography led to a diagnosis of GBS. He was treated with plasmapheresis and experienced rapid and marked recovery in respiratory and upper extremity motor function.
The differential diagnosis for new-onset weakness in patients with GSW-induced SCI is complicated by the inability to obtain magnetic resonance imaging. This unique case of GBS in a patient with T4 paraplegia highlights the importance of obtaining a thorough history and using diagnostic tools to explore possibilities beyond surgery.
吉兰-巴雷综合征（GBS）是一种罕见但有充分记录的瘫痪原因，常发生在感染后。有少数病例与脊髓损伤（SCI）有关，这掩盖了特征性的上升性瘫痪。据我们所知，这是首例因枪击伤（GSW）导致胸段截瘫临床过程中确诊的 GBS 病例。
一名 23 岁男性因右侧腋窝处的 GSW 就诊，子弹嵌入 T4 水平的椎管，导致右侧血胸和美国脊髓损伤协会 A 级截瘫。受伤后 2 周前，他的双上肢仍有完全肌力，此时他出现手臂进行性无力，伴有感觉异常和呼吸困难。在 5 天内，他被气管插管，几乎四肢瘫痪。脑脊液分析和肌电图检查提示 GBS 诊断。他接受了血浆置换治疗，呼吸和上肢运动功能迅速显著恢复。
新发 SCI 合并 GSW 患者的新发性无力的鉴别诊断因无法获得磁共振成像而变得复杂。本例 T4 截瘫患者发生 GBS 是一个独特的病例，强调了获取详细病史和使用诊断工具探索除手术之外可能性的重要性。
