General Medicine, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India.
General Medicine, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
BMJ Case Rep. 2021 Feb 4;14(2):e239133. doi: 10.1136/bcr-2020-239133.
Presentation of severe pain syndromes prior to onset of motor weakness is an uncommon but documented finding in patients with Guillain-Barré syndrome (GBS). Sciatica in GBS is a difficult diagnosis when patients present with acute radiculopathy caused by herniated disc or spondylolysis. A middle-aged woman was admitted for severe low back pain, symptomatic hyponatraemia, vomiting and constipation. On further investigation, she was diagnosed with radiculopathy, and appropriate treatment was initiated. Brief symptomatic improvement was followed by new-onset weakness in lower limbs, which progressed to involve upper limbs and right extraocular muscles. With progressive, ascending, new-onset motor and sensory deficits and laboratory evidence of demyelination by Nerve Conduction Study, a diagnosis of variant GBS was made. She was treated with intravenous immunoglobulin 2 g/kg over 5 days. The presentation of severe low back pain that was masking an existing aetiology and possible dysautonomia and the unilateral right extraocular muscles instead of bilateral make our case unique and rare.
在运动无力出现之前出现严重疼痛综合征是吉兰-巴雷综合征（GBS）患者的一种罕见但有记录的发现。当患者出现由椎间盘突出或脊椎裂引起的急性神经根病变时，GBS 中的坐骨神经痛是一个难以诊断的问题。一名中年妇女因严重腰痛、症状性低钠血症、呕吐和便秘入院。进一步检查后，她被诊断为神经根病变，并开始进行适当的治疗。短暂的症状改善后，下肢出现新的无力，随后累及上肢和右眼外肌。随着运动和感觉功能逐渐恶化，新出现的感觉缺失，神经传导研究显示脱髓鞘的实验室证据，诊断为变异型 GBS。她接受了 5 天 2g/kg 的静脉注射免疫球蛋白治疗。严重腰痛的表现掩盖了潜在的病因和可能的自主神经功能紊乱，以及单侧右眼外肌而不是双侧眼外肌，使我们的病例独特且罕见。
