Dukkipati Saihari S, Zhou Daniel J, Powers Andria M, Piccione Ezequiel A, Koh Sookyong
Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA.
Department of Radiology, Children's Hospital and Medical Center, Omaha, NE, USA.
Child Neurol Open. 2022 Aug 1;9:2329048X221115476. doi: 10.1177/2329048X221115476. eCollection 2022 Jan-Dec.
We present a case of a 3-year-old girl who rapidly developed bilateral facial palsy, dysphagia, dysphonia, areflexia, and ataxia soon after receiving an influenza vaccine. Brain and spine Magnetic resonance imaging (MRI) scans with and without contrast showed enhancement of cranial nerves III, V, VII, and X, as well as the anterior and posterior cervical spinal and cauda equina roots. cerebrospinal fluid (CSF) studies showed white blood cell count of 19 cells/cm, glucose 81 mg/dL, and protein 116 mg/dL, with negative infectious and autoimmune labs. Serum IgM and IgG antibodies against GM1, GD1a, GD1b, GM2, GT1A, GQ1b were negative. The patient was treated with intravenous immunoglobulin, which led to a full recovery. Upon three-month follow-up, her neurologic examination demonstrated normal cranial nerves, reflexes, and gait. Her presentation was most consistent with the acute bulbar palsy plus (ABPp) variant of Guillain-Barré syndrome (GBS), a rare and challenging diagnosis especially in her age group.
我们报告一例3岁女童，在接种流感疫苗后不久迅速出现双侧面瘫、吞咽困难、发音障碍、反射消失和共济失调。头颅和脊柱磁共振成像（MRI）平扫及增强扫描显示，Ⅲ、Ⅴ、Ⅶ、Ⅹ颅神经以及颈段脊髓前后根和马尾神经根强化。脑脊液（CSF）检查显示白细胞计数为19个/立方厘米，葡萄糖81毫克/分升，蛋白质116毫克/分升，感染性和自身免疫性实验室检查均为阴性。血清抗GM1、GD1a、GD1b、GM2、GT1A、GQ1b IgM和IgG抗体均为阴性。该患者接受静脉注射免疫球蛋白治疗后完全康复。在三个月的随访中，她的神经系统检查显示颅神经、反射和步态均正常。她的表现最符合吉兰-巴雷综合征（GBS）的急性延髓麻痹加（ABPp）变异型，这是一种罕见且具有挑战性的诊断，尤其是在她这个年龄组。
