Long-term impact after fulminant Guillain-Barré syndrome, case report and literature review

Figures & data

Table 1 Clinical characteristics

Study	Age/Sex	Patterns of deficit	History	Pathogen	Time to nadir (days)
Carroll and Mastaglia,^Citation24 1979	45/M	Generalized tetraparesis	Rhinopharyngitis		5
Kotsoris et al,^Citation25 1984	44/M	Generalized ascending tetraparesis	NR		2
Al-din et al,^Citation26 1985	45/M	NR	NR		3
Drury et al,^Citation6 1987	63/M	Generalized tetraparesis	Rhinopharyngitis		2
Kanda et al,^Citation9 1989	47/M	Generalized ascending tetraparesis	Rhinopharyngitis		6
Coad and Byrne,^Citation27 1990	43/M	Diplopia followed by generalized tetraparesis	Rhinopharyngitis		4
Hassan and Mumford,^Citation28 1991	45/M	Muscle weakness, diplopia	Diarrhea		3
Fuller et al,^Citation3 1992	63/M	Generalized tetraparesis	NR		2
Marti-Masso et al,^Citation22 1993	58/F	Dysphonia followed by generalized tetraparesis	NR		2
Tan and Chee,^Citation7 1995	50/F	Muscle weakness followed by generalized tetraparesis	Diarrhea		2
Bakshi et al,^Citation8 1997	6/M	Generalized tetraparesis	Diarrhea		2
Berciano et al,^Citation10 1997	67/M	Dyspnea followed by generalized tetraparesis	Diarrhea	C. jejunii	2
Bohlega et al,^Citation17 1997	45/M	Generalized ascending tetraparesis	NR		3
Hughes and McGuire,^Citation29 1997	27/M	Difficulty swallowing followed by generalized tetraparesis	Rhinopharyngitis		5
Thomas,^Citation30 2000	36/M	Generalized ascending tetraparesis	Rhinopharyngitis		2
Vargas et al,^Citation4 2000	45/F	Generalized tetraparesis	Rhinopharyngitis		1
Ragazzoni et al,^Citation31 2000	40/M	Generalized ascending tetraparesis	Rhinopharyngitis		2
Stojkovic et al,^Citation32 2001		Generalized tetraparesis	Cranial trauma		2
Saito,^Citation12 2002	21/M	Dysarthria	Diarrhea	C. jejunii	4
Friedman et al,^Citation11 2003	57/F	Distal paresthesias in lower limbs	NR		6
Friedman et al,^Citation11 2003	27/M	Diplopia, difficulty swallowing then tetraparesis	Cranial trauma	C. jejunii	3
Moussouttas et al,^Citation33 2004	47/F	Distal paresthesias in lower limbs	Cranial trauma		5
Kang and Kim,^Citation21 2007	32/M	Distal paresthesias in lower limbs, facial diplegia	Diarrhea	Hepatitis A	4
Tagami et al,^Citation34 2008	65/M	NR	NR	H. influenzae	NR
Rivas et al,^Citation35 2008	55/M	Generalized tetraparesis	Cranial trauma		7
Joshi et al,^Citation36 2008	34/M	Generalized tetraparesis	NR		2
Joshi et al,^Citation36 2008	59/M	Generalized ascending tetraparesis	NR		10
Rigamonti et al,^Citation37 2009	61/F	Muscle weakness followed by tetraparesis	Diarrhea		1
Tan et al,^Citation38 2010	44/M	Distal paresthesias in lower limbs	Cranial trauma		2
Bernard et al,^Citation39 2010	73/F	NR	NR		NR
Sevketoglu et al,^Citation40 2010	5/M	Dysphonia, difficulty swallowing	NR		1
Medici et al,^Citation41 2011	5/M	Dysarthria, facial diplegia	NR		1
Medici et al,^Citation41 2011	3 months/M	Facial diplegia	Tetanus–diphtheria vaccination		1
Medici et al,^Citation41 2011	8/M	Diplopia, dysarthria, tetraparesis	Diarrhea		1

Abbreviation: NR, not reported.

Table 2 Paraclinical characteristics

Study	Lumbar puncture	Protein concentration (mg/dL)	NCS	EEG	Biopsy
Carroll and Mastaglia,^Citation24 1979	Dissociation	42		Alpha
Kotsoris et al,^Citation25 1984	Dissociation	462	Inexcitability	Alpha
Drury et al,^Citation6 1987	Dissociation	58	Inexcitability	Alpha reactive
Kanda et al,^Citation9 1989	Dissociation	58			Demyelination
Coad and Byrne,^Citation27 1990	Dissociation	200	Inexcitability	Alpha
Hassan and Mumford,^Citation28 1991	Normal	25	Inexcitability	Alpha reactive
Fuller et al,^Citation3 1992	Dissociation	75	Inexcitability	Alpha waves and diffuse beta activity	Primary demyelination, axonal degeneration
Marti-Masso et al,^Citation22 1993	Dissociation	75	Axonopathy	Alpha nonreactive
Tan and Chee,^Citation7 1995	Normal	20	Inexcitability	Alpha reactive
Bakshi et al,^Citation8 1997	Dissociation	167	Inexcitability	Reactive theta activity, sleep	Demyelination
Berciano et al,^Citation10 1997	Pleocytosis	198	Inexcitability	Alpha reactive	Primary demyelination, axonal degeneration
Bohlega et al,^Citation17 1997	Dissociation	605	Inexcitability		Primary demyelination, axonal degeneration
Hughes and McGuire,^Citation29 1997	Dissociation	58	Demyelination with axonal loss	Sleep	Primary demyelination, axonal degeneration
Vargas et al,^Citation4 2000	Dissociation	90	Inexcitability	Alpha	Primary demyelination, axonal degeneration
Ragazzoni et al,^Citation31 2000	Dissociation	70	Inexcitability	Reactive
Stojkovic et al,^Citation32 2001		197	Demyelination
Saito,^Citation12 2002		65	Axonopathy
Friedman et al,^Citation11 2003	Dissociation		Inexcitability	Theta	Axonal degeneration
Friedman et al,^Citation11 2003	Dissociation	58	Axonopathy	Alpha reactive
Moussouttas et al,^Citation33 2004	Dissociation		Inexcitability	Nonspecific slowing
Kang and Kim,^Citation21 2007	Dissociation	115	Axonopathy	Alpha
Rivas et al,^Citation35 2008	Dissociation		Inexcitability	Alpha	Axonal degeneration
Joshi et al,^Citation36 2008	Dissociation		Inexcitability	Nonspecific slowing reactive
Joshi et al,^Citation36 2008			Inexcitability	Nonspecific slowing reactive
Rigamonti et al,^Citation37 2009	Dissociation	85	Inexcitability	Nonspecific slowing
Tan et al,^Citation38 2010	Dissociation	182			Macrophages
Bernard et al,^Citation39 2010	Dissociation		Axonopathy	Nonspecific slowing reactive
Sevketoglu et al,^Citation40 2010	Dissociation	70	Axonopathy
Medici et al,^Citation41 2011	Dissociation	117	Axonopathy
Medici et al,^Citation41 2011	Dissociation	260	Axonopathy
Medici et al,^Citation41 2011	Dissociation	180	Axonopathy

Abbreviations: NCS, nerve conduction study; EEG, electroencephalogram.

Table 3 Treatments and outcomes

Study	Treatment	Dysautonomia	“Brain death” (days)	Mortality	Other	Outcome
Carroll and Mastaglia,^Citation24 1979					Amnesia	Walks with assistance (crutches)
Kotsoris et al,^Citation25 1984			6			Handicapped, partial motor recovery
Al-din et al,^Citation26 1985			5			Severe weakness (after 3 months)
Drury et al,^Citation6 1987			46		Amnesia
Kanda et al,^Citation9 1989	PE	CA	7 (death)	CA day 5
Coad and Byrne,^Citation27 1990			5			Complete gradual recovery
Hassan and Mumford,^Citation28 1991						6 months of mechanical ventilation, wheelchair
Fuller et al,^Citation3 1992	PE/corticosteroids	Arrythmia, CA	7	CA day 28
Marti-Masso et al,^Citation22 1993	PE(6)	Arrythmia	13		Amnesia	Can walk unaided after 1 year
Tan and Chee,^Citation7 1995	Gamma globulin		12	Day 98	Amnesia	Significant sequelae after 2 months
Bakshi et al,^Citation8 1997	Gamma globulin		“Few weeks”			Significant sequelae, walks with assistance after 1 year
Berciano et al,^Citation10 1997	PE/corticosteroids	CA		CA day 18
Bohlega et al,^Citation17 1997	PE/gamma globulin		31			Severe handicap, proximal recovery after 30 months
Hughes and McGuire,^Citation29 1997	Gamma globulin					Significant sequelae after 6 months
Vargas et al,^Citation4 2000	PE					Severe handicap
Ragazzoni et al,^Citation31 2000	PE				Amnesia
Stojkovic et al,^Citation32 2001	Gamma globulin
Saito,^Citation12 2002	PE/Gamma globulin(2)	Tachycardia				Significant sequelae predominantly in lower limbs
Friedman et al,^Citation11 2003			16			4/5 Motor sequelae in upper limbs, 3/5 in lower limbs
Friedman et al,^Citation11 2003	Gamma globulin				Amnesia	Partial proximal recovery, 3/5 in lower limbs
Moussouttas et al,^Citation33 2004	PE/gamma globulin					Complete recovery
Kang and Kim,^Citation21 2007	Gamma globulin/corticosteroids	Bradycardia				Good recovery and ability to walk
Tagami et al,^Citation34 2008	PE/gamma globulin				Depression	Major sequelae
Rivas et al,^Citation35 2008						Handicapped
Joshi et al,^Citation36 2008						Handicapped
Joshi et al,^Citation36 2008						Handicapped
Rigamonti et al,^Citation37 2009	Gamma globulin	Tachycardia	15			Walks with assistance (crutches)
Tan et al,^Citation38 2010	Gamma globulin(2)	Blood pressure lability
Bernard et al,^Citation39 2010	Gamma globulin		12	Septic shock day 158
Sevketoglu et al,^Citation40 2010	PE/gamma globulin(2)					Partial motor recovery
Medici et al,^Citation41 2011	PE/gamma globulin/corticosteroids		7			Complete recovery
Medici et al,^Citation41 2011	Gamma globulin		15			Handicapped, partial recovery
Medici et al,^Citation41 2011	Gamma globulin		5

Abbreviations: PE, plasma exchange; CA, cardiac arrest.

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