(Disclaimer: This article is for scientific use only and the information in the following content has been processed to protect patient privacy)
Abstract: Guillain-Barre syndrome is a type of autoimmune-mediated neurological disease that usually has an acute onset and is often preceded by a history of respiratory or gastrointestinal tract infection or vaccination for 1-3 weeks. In this case, the patient had an acute onset after a cold and developed pain and numbness in both lower limbs, which was progressively aggravated and reached a peak in about 2 weeks.
Basic information】Male, 33 years old
Type of disease】Greenbrier’s syndrome
Hospital】The Second Hospital of Harbin Medical University
Date of consultation】January 2022
Treatment plan】Medication (methylcobalamin injection, intravenous human immunoglobulin (pH4), vitamin B1 tablets, inosine sodium chloride injection)
Treatment period] Hospitalization for 8 days
Effectiveness of treatment] Relief of numbness and weakness of lower limbs and pain
I. Initial consultation
The patient came to our hospital with numbness and painful weakness in both lower limbs after catching a cold 3 days ago. The patient complained of sock-like sensation in both feet, difficulty in lifting the lower extremities, difficulty in bending back the dorsum of the feet, and unbearable pins-and-needles pain, with no special sensation in the upper extremities or hands, no headache, dizziness, nausea, vomiting, difficulty in breathing, difficulty in swallowing, and other symptoms. He had no headache, dizziness, nausea, vomiting, dyspnea, or difficulty in swallowing. He had no significant abnormality in the cranial CT examination. After communicating with the patient and combining the medical history, the patient was initially judged to be suffering from immune-related diseases, and after communicating with the patient and his family, he agreed to be admitted to the hospital.
II. Treatment process
After admission, the patient was examined, which showed that the patient was conscious and could communicate normally, with blood pressure of 120/80 mmHg, heart rate of 70 beats/min, respiratory rate of 18 breaths/min, and no abnormal rales on cardiopulmonary auscultation. Muscle strength examination was performed, and the results showed that the patient had grade III proximal muscle strength and grade II distal muscle strength of both lower limbs. The cranial magnetic resonance examination was completed, and the results showed that the patient had small ischemic foci in the brain. Two days after admission, a lumbar puncture examination was arranged, and the results showed that the patient had a cerebrospinal fluid sugar of 2.77 mmol/L, cerebrospinal fluid chloride of 130.0 mmol/L, cerebrospinal fluid pressure of 150 mmH2O, cerebrospinal fluid albumin of 400 mg/L, and cerebrospinal fluid cell count of 1. Later, a nerve conduction velocity examination was performed, and the results showed that the patient had bilateral peroneal nerve sensory impairment, and the clinical diagnosis was neurological The clinical diagnosis was Grimballi syndrome in neurological disease. The patient was given methylcobalamin injection and vitamin B1 tablets to nourish the nerves, and given an intravenous injection of human immunoglobulin (pH 4) to improve immune function, as well as inosine sodium chloride injection to improve energy metabolism.
The above is the cranial MRI result
III. Treatment effect
After 8 days of aggressive treatment, the patient’s limb numbness and pain weakness was relieved by daily application of intravenous human immunoglobulin (pH4) during the first 5 days. When the patient was admitted to the hospital, he scored 18 on the Hamilton Anxiety Scale and was very nervous and anxious, but after all, he was a young patient who was experiencing this disease for the first time. After a series of patient counseling and treatment, after 8 days, the patient’s muscle strength of both lower limbs reached grade IV and could be lifted freely at the bedside, and the patient’s symptoms of numbness also improved significantly and reached the discharge standard.
IV. Notes
Happily, after a series of treatments, the patient’s muscle strength of both lower extremities was gradually restored, and he was psychologically discharged from the hospital after overcoming his fear and anxiety about the disease. However, since the patient was not completely cured at the time of discharge, the patient still needs to pay attention to the following conditions in daily life.
1. attention should be paid to rest after discharge from the hospital and avoid premature ground activities that may lead to fractures and other dangers.
2. Patients still need to pay attention to their own respiratory condition after discharge, as there is a risk of recurrence of the disease, which may cause respiratory muscle paralysis and reduced oxygen saturation, which is life-threatening. Therefore, once discomfort occurs, they need to go to the hospital promptly for treatment such as oxygen absorption and, if necessary, tracheotomy-assisted ventilation, etc.
3. Since patients still need to continue to be given hormone therapy after discharge, it is necessary to pay attention to the side effects of long-term hormone use, such as femoral head necrosis, and the manifestation of gastrointestinal ulcers such as vomiting blood and blood in stool, and it is necessary to regularly monitor the changes of ions, potassium, sodium and chloride.
V. Personal insight
This patient showed symptoms of peripheral nerve damage during the course of the disease, as well as impaired muscle strength in both lower extremities, manifesting as numbness with pain and weakness in both lower extremities, while the main clinical manifestation of Grinbaris syndrome is multiple nerve root and peripheral nerve damage, so the performance is more typical. Most patients with Grinbarr’s syndrome have cerebrospinal fluid protein-cell separation, and the disease is self-limiting in duration. Due to the disorienting nature of the disease, it needs to be differentiated clinically from brainstem encephalitis, acute extraocular muscle paralysis, brainstem infarction, brainstem hemorrhage, optic neuromyelitis optica, multiple sclerosis, and myasthenia gravis. During the treatment process, the patient in this case had a more serious case of tension and anxiety, which is a human condition. We as health care professionals, while treating the disease, should pay more attention to psychological enlightenment and comforting of the patient, which is more helpful for the subsequent treatment and recovery of the patient.