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Submitted: 16 May 2007
HERDIN Record #: PCHRDPC040415

Guillain-barre syndrome in a patient with probable multiple sclerosis.

 Manual, Ma Victoria,
 Colon, Fel Angelie P

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We are reporting a case of a 46 year old male who presented with stroke-like symptoms of right facial asymmetry and numbness, right hemiparesis, dysphagia and slurring of speech. He had elevated blood pressure, polycythemia and hypercholesterolemia, hence was managed as an acute brainstem ischemic stroke. While the facial asymmetry and right hemiparesis resolved after two days, there was persistent glove and stocking numbness of all limbs. He was subsequently transferred to our institution nine days after the ictus, and on admission, was noted to have mild quadriparesis, more severe on the right, glove and stocking numbness, decreased vibration sense over all limbs, and diffuse areflexia. He had a history of recurrent upper respiratory tract infections for the past two months, as well as a vague history of recurrent glove and stocking numbness of the limbs a year earlier
Cranial MRI revealed diffuse periventricular bright signals in the cerebral hemispheres and periventricular areas highly suggestive of Multiple Sclerosis. CSF studies showed markedly elevated protein of 452 mg/dl, CSF 1gG of 62.1 (NV 0.48-5.86 mg/dl), with no white blood cells. EMG-NCV with delayed responses showed severe acute diffuse symmetric sensorimotor polyneuropathy with axonal involvement; focal and segmental demyelination, absent F-wave and H reflexes. This was highly suggestive of an acute inflammatory demyelinating polyneuropathy. Because of the suggestion of multiple sclerosis on MRI complete evoked responses were also done, showing a conduction defect along the right visual pathway anterior to the chiasm, and a bilateral conduction delay along the peripheral components of both somatosensory

Publication Type
Journal
Title
The Philippine Journal of Neurology
Frequency
2002 Dec
Publication Date
Page(s)
0
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