Журнал клинических случаев

Guillain-Barre Syndrome in High Tetraplegia Following Spinal Cord Lesion

Abstract

Unika Mulmi

Study design: A case report of Guillain–Barre Syndrome (GBS) variant presenting in a patient with high tetraplegia following cervical spinal cord lesion (C3-C6). Objective: To illustrate a clinical presentation of GBS in an individual with tetraplegia. Setting: Zhongnan Hospital of Wuhan University, Wuhan, China. Case presentation: A 55-year-old male with high spinal cord lesion at the level of C3-C6, following an emergency posterior cervical instrumentation and fusion with decompression of C3-C6 vertebral bodies under general anesthesia, developed urinary incontinence and weakness of the limbs, and was admitted to our facility for tetraplegia. Two months after admission, the patient had a sudden onset of fever (T40.0C) for which blood culture was done, and antibiotics were administered to sub side the fever. A few days later, the patient’s previously noted weakness progressed. A nerve conduction study was performed, which revealed severe axonal polyneuropathy affecting motor and sensory nerve fibers, prompting a diagnosis of acute motor-sensory axonal neuropathy (a variant of Guillian-Barre syndrome). Electromyography (EMG) reports indicated abnormal spontaneous activity in all limb muscles. An emergency Lumbar Puncture (LP) was performed which revealed the classical sign of albuminocytological disassociation of cerebrospinal fluid. GBS was diagnosed, but since the patient had pre-existing tetraplegia, autonomic dysfunction and was ventilated, the diagnosis was overshadowed and unfortunately delayed. Nevertheless, treatment modalities for both tetraplegia and GBS were initiated. There was a significant improvement in all extremities, but the bilateral decrease in the lower limbs muscle tone persisted. However, the patient refused to perform a repeat LP and was discharged three months later, under the requisite for regular follow-up. Conclusion: A careful neurological assessment prompted the diagnosis of acute polyradiculoneuropathy in a chronic patient with tetraplegia. It demonstrates how, in this population, an otherwise uncomplicated diagnosis of GBS can easily be missed. A deeper understanding of the cause and necessity for a subsequent therapeutic intervention in potentially life-threatening autonomic instability was understood via these signs.