Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China.
J Int Med Res. 2023 Jul;51(7):3000605231189114. doi: 10.1177/03000605231189114.
Guillain-Barré syndrome (GBS) and Miller Fisher syndrome (MFS) are acute immune-mediated peripheral neuropathies. In addition to their classic presentations, a variety of other signs and symptoms have been reported; however, headache appears to be relatively uncommon. We describe a 53-year-old woman who presented with acute bulbar palsy as the first symptom of overlapping MFS/GBS accompanied by severe headache. The first important clinical impairment of the patient was acute bulbar palsy along with prominent headache, without limb weakness. Although her initial diagnosis was acute bulbar palsy plus, she subsequently developed lower limb diffuse weakness, and her final clinical diagnosis was overlapping MFS/GBS. Anti-ganglioside antibodies were positive for anti-GQ1b and anti-GT1a immunoglobulin G. The patient received intravenous immunoglobulin on day 2 of admission. Early identification of these overlapping syndromes is important for the management of patients, to avoid respiratory failure or severe weakness with axonal degeneration. We therefore remind clinicians of the importance of further examination in patients with headache and acute bulbar palsy of unknown origin.
格林-巴利综合征（GBS）和米勒-费舍尔综合征（MFS）是急性免疫介导的周围神经病。除了它们的典型表现外，还报道了各种其他症状和体征；然而，头痛似乎相对少见。我们描述了一位 53 岁女性，她以重叠的 MFS/GBS 为首发症状出现急性球麻痹，伴有严重头痛。患者的首次重要临床损伤是急性球麻痹伴明显头痛，无肢体无力。尽管她最初的诊断是急性球麻痹综合征伴发症，但随后她出现了下肢弥漫性无力，最终的临床诊断是重叠的 MFS/GBS。抗神经节苷脂抗体对抗-GQ1b 和抗-GT1a 免疫球蛋白 G 呈阳性。患者在入院第 2 天接受了静脉注射免疫球蛋白治疗。早期识别这些重叠综合征对于患者的管理很重要，以避免呼吸衰竭或严重的轴索性变性导致的无力。因此，我们提醒临床医生注意对不明原因头痛和急性球麻痹患者进行进一步检查的重要性。
