“Diagnóstico y manejo adecuado del sindrome de guillain barré atípico”

Abstract

Guillain-Barré syndrome (GBS) is an acute inflammatory polyradiculoneuropathy induced by immunity, it was mentioned for the first time in 1916. It was described as a "benign" form of limb weakness with full recovery, but it is now known that GBS is a prolonged neuromuscular disease, incapacitating, usually demyelinating, inflammatory, monophasic, with respiratory difficulties in almost a third of patients. The best-known variant is the ataxic form of the senses, the Miller Fisher syndrome. Various pathological mechanisms lead to demyelination, axonal damage or both. The predominant infectious agents are Campylobacter jejuni, cytomegalovirus and Epstein-Barr virus. Its incidence is 0.40 - 3.25 cases per 100 000 people. The treatment is mainly supportive. Plasmapheresis or intravenous immunoglobulin accelerate recovery. One in 3 patients will need intensive care or assisted breathing. Total recovery is frequent, but up to 10% of patients will be disabled. Neurointensive treatment consists of treating acute respiratory failure due to diaphragmatic weakness and severe dysautonomia, which manifests as cardiac arrhythmias, lability of blood pressure or paralytic ileus. The present work describes the case of a 23-year-old patient with no significant pathological history who presented a progressive decrease in muscle strength of 72 hours of evolution, initially affecting the upper limbs and then continuing with lower limbs, which causes difficulty for the patient walking, so go to the Health Center, examining evidence of patellar areflexia, and muscle strength of 2/5 in upper limbs and 4/5 in lower limbs and decide to refer to the hospital. In emergency, it is evaluated by doctors of the service and by the Neurosurgeon, who performs a lumbar puncture for the cytochemical study of cerebrospinal fluid and requests reference to the third level. The patient is hospitalized with presumptive diagnosis of Polirradiculoneuritis and initiate treatment with corticosteroids and B complex during the hospitalization muscle strength decreased to hinder the swallowing of solid foods, did not spread to the muscles of respiration. Subsequently, supportive treatment with physical therapy is initiated, to initiate a recovery of muscular strength.