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Orthopaedic manifestations and diagnostic clues in children with Guillain-Barré syndrome.

Matsushita M, Kitoh H, Itomi K, Kitakoji T, Iwata K, Mishima K, Ishiguro N, Hattori T - J Child Orthop (2013)

Bottom Line: Loss of deep tendon reflexes was seen in all patients.Anti-ganglioside antibodies were positive in three and protein levels of cerebrospinal fluid were elevated in five patients.Six patients recovered completely after intravenous immunoglobulin (IVIG) treatment, while one patient who had not undergone IVIG treatment showed minor residual disability.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8550 Japan.

ABSTRACT

Introduction: Guillain-Barré syndrome (GBS) is an acute inflammatory demyelinating polyneuropathy characterized by symmetric limb weakness. Children with GBS sometimes consult the orthopaedists because of limb pain and gait disturbance. The orthopaedists, however, are unfamiliar with GBS, since it has rarely been delineated in detail in the orthopaedic literature. In the present study, we specifically describe orthopaedic manifestations and diagnostic clues in pediatric GBS.

Methods: We reviewed seven patients with pediatric GBS in regard to age, gender, clinical symptoms, department at the first medical consultation, initial diagnosis, physical and laboratory findings, medical interventions, and the latest clinical outcome.

Results: There were five boys and two girls, with a mean age at presentation of 7.2 years. Gait disturbance associated with lower limb pain and weakness was the most frequent early clinical symptom. Among the five patients who presented initially at the orthopaedic department, three were misdiagnosed. Loss of deep tendon reflexes was seen in all patients. Anti-ganglioside antibodies were positive in three and protein levels of cerebrospinal fluid were elevated in five patients. Six patients recovered completely after intravenous immunoglobulin (IVIG) treatment, while one patient who had not undergone IVIG treatment showed minor residual disability.

Conclusions: Acute symmetrical limb pain and gait disturbance associated with loss of tendon reflexes were important clinical manifestations of pediatric GBS. Early diagnosis is essential to prevent delayed recovery, long-term weakness, and permanent functional disabilities.

No MeSH data available.


Related in: MedlinePlus

Orthopaedic manifestations and diagnostic clues in pediatric patients with Guillain–Barré syndrome
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Fig2: Orthopaedic manifestations and diagnostic clues in pediatric patients with Guillain–Barré syndrome

Mentions: In conclusion, orthopaedic manifestations of pediatric GBS include: (1) gait disturbances, walking and standing difficulties; (2) symmetrical lower limb pain, back pain, and neck pain; (3) symmetrical lower limb weakness; (4) areflexia or hyporeflexia of deep tendon reflexes; and (5) less frequently positive SLR test (Fig. 2). Thus, GBS should be considered in the differential diagnosis of any child presenting with acute limb pain and weakness associated with loss of deep tendon reflexes. Orthopaedists should refer to the pediatric neurologists for definitive diagnosis and prompt treatment when other musculoskeletal diseases analogous to GBS are excluded.Fig. 2


Orthopaedic manifestations and diagnostic clues in children with Guillain-Barré syndrome.

Matsushita M, Kitoh H, Itomi K, Kitakoji T, Iwata K, Mishima K, Ishiguro N, Hattori T - J Child Orthop (2013)

Orthopaedic manifestations and diagnostic clues in pediatric patients with Guillain–Barré syndrome
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3672464&req=5

Fig2: Orthopaedic manifestations and diagnostic clues in pediatric patients with Guillain–Barré syndrome
Mentions: In conclusion, orthopaedic manifestations of pediatric GBS include: (1) gait disturbances, walking and standing difficulties; (2) symmetrical lower limb pain, back pain, and neck pain; (3) symmetrical lower limb weakness; (4) areflexia or hyporeflexia of deep tendon reflexes; and (5) less frequently positive SLR test (Fig. 2). Thus, GBS should be considered in the differential diagnosis of any child presenting with acute limb pain and weakness associated with loss of deep tendon reflexes. Orthopaedists should refer to the pediatric neurologists for definitive diagnosis and prompt treatment when other musculoskeletal diseases analogous to GBS are excluded.Fig. 2

Bottom Line: Loss of deep tendon reflexes was seen in all patients.Anti-ganglioside antibodies were positive in three and protein levels of cerebrospinal fluid were elevated in five patients.Six patients recovered completely after intravenous immunoglobulin (IVIG) treatment, while one patient who had not undergone IVIG treatment showed minor residual disability.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8550 Japan.

ABSTRACT

Introduction: Guillain-Barré syndrome (GBS) is an acute inflammatory demyelinating polyneuropathy characterized by symmetric limb weakness. Children with GBS sometimes consult the orthopaedists because of limb pain and gait disturbance. The orthopaedists, however, are unfamiliar with GBS, since it has rarely been delineated in detail in the orthopaedic literature. In the present study, we specifically describe orthopaedic manifestations and diagnostic clues in pediatric GBS.

Methods: We reviewed seven patients with pediatric GBS in regard to age, gender, clinical symptoms, department at the first medical consultation, initial diagnosis, physical and laboratory findings, medical interventions, and the latest clinical outcome.

Results: There were five boys and two girls, with a mean age at presentation of 7.2 years. Gait disturbance associated with lower limb pain and weakness was the most frequent early clinical symptom. Among the five patients who presented initially at the orthopaedic department, three were misdiagnosed. Loss of deep tendon reflexes was seen in all patients. Anti-ganglioside antibodies were positive in three and protein levels of cerebrospinal fluid were elevated in five patients. Six patients recovered completely after intravenous immunoglobulin (IVIG) treatment, while one patient who had not undergone IVIG treatment showed minor residual disability.

Conclusions: Acute symmetrical limb pain and gait disturbance associated with loss of tendon reflexes were important clinical manifestations of pediatric GBS. Early diagnosis is essential to prevent delayed recovery, long-term weakness, and permanent functional disabilities.

No MeSH data available.


Related in: MedlinePlus