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Ascending Paralysis in a 51 year old: A Case Report

Tiashi Greer

Northeast Ohio Medical University

Case Presentation: A 51-year old Caucasian male presents to the emergency department with progressive, ascending bilateral lower extremity weakness and numbness for three days. The patient denies any additional symptoms but mentions he experienced a viral illness three weeks prior that has since resolved. The patient’s past medical history includes hyperlipidemia, GERD, coronary artery disease and alcohol abuse. After initial laboratory studies were performed, Neurology was consulted and a nerve conduction study was ordered, showing moderately severe sensory motor peripheral neuropathy with axonal and demyelinating characteristics. The patient was subsequently diagnosed with Guillain-Barre Syndrome (GBS). He was initially admitted to the intensive care unit (ICU) for close monitoring of progression to respiratory failure. During that time, he underwent 6 treatments of plasmapheresis and his symptoms gradually subsided. The patient was discharged 5 days after admission and scheduled to follow up with his PCP in 1 week. Background: GBS is a neurological autoimmune response most often caused by a preceding respiratory or gastrointestinal infection, the most notable being Campylobacter jejuni. Although it is the most common cause of acute onset ascending neuromuscular paralysis in the United States, it is rather rare, having an incidence of about 0.4-2.0 cases per every 100,000 people. GBS has no predilection to gender, age, or race, and most have no sequela if treated effectively. The most common cause of death with GBS is respiratory failure if no treatment is sought. Discussion: The exact pathophysiology for GBS is unknown. It is thought to be a result of molecular mimicry of gangliosides within peripheral nerves, resulting in demyelination that moves in an ascending pattern until reaching the respiratory system when respiratory failure ensues. The hallmark of GBS includes bilateral, ascending flaccid paralysis, that can present up to six weeks after a preceding illness. GBS is primarily a clinical diagnosis and should be treated presumptively if the patient meets the required diagnostic features which include progressive weakness of legs and arms and decreased or absent reflexes in lower weakened lower extremities. Diagnostic studies include lumbar puncture, MRI and electrodiagnostic studies. Treatment for GBS entails three major features: respiratory support in the ICU, in the case of respiratory failure, plasmaphoresis to remove circulatory antibo

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