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Acute oropharyngeal palsy with localized sensory impairment resembling symptom distribution of acute pharyngeal-cervical-brachial variant in a patient with Guillain-Barré syndrome.
MedLine Citation:
PMID:  23965855     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
We present the case of a 40-year-old woman who experienced dysarthria and, numbness in her upper extremities and posterior region of her neck. Upon admission to our hospital, neurological examination revealed rhinolalia aperta and an incomplete palatoplegia; however, muscle strength in the neck and limbs was satisfactorily preserved, tendon reflexes were normal, and pathological reflexes were not observed. Cerebrospinal fluid and electrophysiological test results were also normal. On day 3 of hospitalization, a slight backflow of fluid into the nasal cavity was observed upon deglutition, and vibration perception was also impaired in the bilateral arms. Her serum tested positive for immunoglobulin G antibodies against such gangliosides as GT1a, GQ1b, GT1b, and GD1a. Despite normal tendon reflexes, she was diagnosed with a subtype of Guillain-Barré syndrome (GBS), and was treated with intravenous immunoglobulin therapy. Subsequently, her symptoms improved. Due to the combination of oropharyngeal palsy and sensory impairment, it was more likely the GBS subtype in this patient was acute oropharyngeal palsy (AOP) rather than pharyngeal-cervical-brachial (PCB) variant; though interestingly, the patient's sensory disturbance was limited to the posterior neck and upper extremities, which resembles the distribution of motor symptoms in PCB variant. The present case was a rare and important phenotype, demonstrating diversities of GBS variants. We also believe that GBS subtypes may represent a continuum of pathological conditions and not just one static condition. However, further studies involving serological characteristics of anti-ganglioside antibodies and clinical features for GBS are needed to clarify this possibility.
Authors:
Nobuhito Nakajima; Masayuki Ueda; Koichi Nomura; Susumu Kusunoki; Yasuo Katayama
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Rinshō shinkeigaku = Clinical neurology     Volume:  53     ISSN:  1882-0654     ISO Abbreviation:  Rinsho Shinkeigaku     Publication Date:  2013  
Date Detail:
Created Date:  2013-08-22     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0417466     Medline TA:  Rinsho Shinkeigaku     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  630-3     Citation Subset:  IM    
Affiliation:
Department of Neurology, Kitamurayama Public Hospital.
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