Limits...
Progressive bilateral facial weakness.

Carswell C, Northey LC, Davies L, Yuki N, Kiernan MC - Pract Neurol (2014)

View Article: PubMed Central - PubMed

Affiliation: Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

A 72-year-old man presented with sudden onset of right-sided facial muscle weakness and slurred speech and a 3-day history of fevers, myalgia and sore throat... There was mild left hip flexion weakness but preserved deep tendon reflexes... There was reduced sensation to temperature in a glove-and-stocking pattern; joint-position sense, light touch and pain sensation were intact... In the early stage of Guillain–Barré syndrome, absent or prolonged tibial nerve H-reflex responses are common, paralleling the loss of deep tendon reflexes... This is followed by abnormal F-wave responses, temporal dispersion of distal compound muscle action potentials, prolonged distal motor and F-wave latencies and reduced motor conduction velocity... Given that our case had most of these features as well as CSF albuminocytological dissociation, the most likely diagnosis is the ‘bifacial weakness with paraesthesias’ subtype of Guillain–Barré syndrome... Guillain–Barré syndrome has several regional variants, the most common being Miller Fisher syndrome: this presents with external ophthalmoparesis, ataxia and areflexia, associated with the anti-GQ1b antibodies... In 1994, Allan Ropper described four cases of bifacial weakness with paraesthesias, occurring in a postinfective period with a monophasic illness course and other investigations consistent with Guillain–Barré syndrome. ‘Bifacial weakness with paraesthesias’ is now recognised as a localised subtype of Guillain–Barré syndrome, along with a ‘pharyngeal–brachial–cervical weakness’ and ‘paraparetic Guillain–Barré syndrome... In the largest case series to date, Susuki et al investigated 22 cases of bifacial weakness with paraesthesias and found that 86% had a preceding illness, with upper respiratory illness more frequent than diarrhoea... There were IgM antibodies to cytomegalovirus in 30% and to Epstein–Barr virus in 20% (both significantly more frequently than in Guillain–Barré syndrome)... Anti-GM1 or anti-GD1a antibodies can each occur in acute motor axonal neuropathy, an axonal form of Guillain–Barré syndrome... Paraparetic Guillain–Barré syndrome is probably a localised subtype of acute motor axonal neuropathy, since anti-GD1a antibodies sometimes occur in this condition... Following a second induction course, he regained strength over a month... Two months after the onset of his illness, he is independently mobile with mild facial asymmetry.

Show MeSH

Related in: MedlinePlus

Bifacial lower motor neurone weakness (see online supplementary video).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4316867&req=5

PRACTNEUROL2014000989F1: Bifacial lower motor neurone weakness (see online supplementary video).

Mentions: His condition progressed rapidly and on day 2 of admission he developed left-sided facial weakness (figure 1) with bilateral, proximal lower limb weakness. His paraesthesias were more painful. His lower limb deep tendon reflexes were no longer present (see online supplementary video). Spirometry remained normal. He was transferred to a high dependency unit for ongoing monitoring.


Progressive bilateral facial weakness.

Carswell C, Northey LC, Davies L, Yuki N, Kiernan MC - Pract Neurol (2014)

Bifacial lower motor neurone weakness (see online supplementary video).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4316867&req=5

PRACTNEUROL2014000989F1: Bifacial lower motor neurone weakness (see online supplementary video).
Mentions: His condition progressed rapidly and on day 2 of admission he developed left-sided facial weakness (figure 1) with bilateral, proximal lower limb weakness. His paraesthesias were more painful. His lower limb deep tendon reflexes were no longer present (see online supplementary video). Spirometry remained normal. He was transferred to a high dependency unit for ongoing monitoring.

View Article: PubMed Central - PubMed

Affiliation: Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

A 72-year-old man presented with sudden onset of right-sided facial muscle weakness and slurred speech and a 3-day history of fevers, myalgia and sore throat... There was mild left hip flexion weakness but preserved deep tendon reflexes... There was reduced sensation to temperature in a glove-and-stocking pattern; joint-position sense, light touch and pain sensation were intact... In the early stage of Guillain–Barré syndrome, absent or prolonged tibial nerve H-reflex responses are common, paralleling the loss of deep tendon reflexes... This is followed by abnormal F-wave responses, temporal dispersion of distal compound muscle action potentials, prolonged distal motor and F-wave latencies and reduced motor conduction velocity... Given that our case had most of these features as well as CSF albuminocytological dissociation, the most likely diagnosis is the ‘bifacial weakness with paraesthesias’ subtype of Guillain–Barré syndrome... Guillain–Barré syndrome has several regional variants, the most common being Miller Fisher syndrome: this presents with external ophthalmoparesis, ataxia and areflexia, associated with the anti-GQ1b antibodies... In 1994, Allan Ropper described four cases of bifacial weakness with paraesthesias, occurring in a postinfective period with a monophasic illness course and other investigations consistent with Guillain–Barré syndrome. ‘Bifacial weakness with paraesthesias’ is now recognised as a localised subtype of Guillain–Barré syndrome, along with a ‘pharyngeal–brachial–cervical weakness’ and ‘paraparetic Guillain–Barré syndrome... In the largest case series to date, Susuki et al investigated 22 cases of bifacial weakness with paraesthesias and found that 86% had a preceding illness, with upper respiratory illness more frequent than diarrhoea... There were IgM antibodies to cytomegalovirus in 30% and to Epstein–Barr virus in 20% (both significantly more frequently than in Guillain–Barré syndrome)... Anti-GM1 or anti-GD1a antibodies can each occur in acute motor axonal neuropathy, an axonal form of Guillain–Barré syndrome... Paraparetic Guillain–Barré syndrome is probably a localised subtype of acute motor axonal neuropathy, since anti-GD1a antibodies sometimes occur in this condition... Following a second induction course, he regained strength over a month... Two months after the onset of his illness, he is independently mobile with mild facial asymmetry.

Show MeSH
Related in: MedlinePlus