A Case of Axonal Guillain-Barre Syndrome Diagnosed by Electrophysiological Examinations to Distinguish from Sepsis-Related Critical Illness Polyneuropathy

DOI 1 Citations 11 References
  • Kuroda Hiromitsu
    Division of Traumatology and Critical Care Medicine, Sapporo Medical University School of Medicine
  • Imaizumi Hitoshi
    Division of Traumatology and Critical Care Medicine, Sapporo Medical University School of Medicine
  • Masuda Yoshiki
    Division of Traumatology and Critical Care Medicine, Sapporo Medical University School of Medicine
  • Imai Tomihiro
    Department of Neurology, Sapporo Medical University School of Medicine
  • Tatsumi Hiroomi
    Division of Traumatology and Critical Care Medicine, Sapporo Medical University School of Medicine
  • Obama Takuro
    Division of Traumatology and Critical Care Medicine, Sapporo Medical University School of Medicine
  • Asai Yasufumi
    Division of Traumatology and Critical Care Medicine, Sapporo Medical University School of Medicine

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  • Ｃｒｉｔｉｃａｌ　ｉｌｌｎｅｓｓ　ｐｏｌｙｎｅｕｒｏｐａｔｈｙとの鑑別に電気生理学的検査が有用であった敗血症後の軸索型Ｇｕｉｌｌａｉｎ‐Ｂａｒｒｅ症候群の１例

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Abstract

We report a case of axonal Guillain-Barré syndrome (GBS) in which differential diagnosis from critical illness polyneuropathy (CIP) was difficult. A 64-year-old male patient was admitted to the ICU because of sepsis complicated with acute lung injury and acute renal failure after two weeks of oral medication for common cold-like symptoms. On the 7th ICU day, functions of impaired organs had improved, but weaning from mechanical ventilation was impossible because of insufficient volume of spontaneous breathing. On the 15th ICU day, the tracheal tube was extubated, but lack of spontaneous movement of the extremities and an absence of deep tendon reflex were found. On the 21st ICU day, since anti-mycoplasma antibody titer was found to be extremely high (×2, 560) on the 4th ICU day. Electrophysiological studies showed remarkable reduction in muscle action potentials combined with mild reduction of motor nerve conduction velocities (NCV) and normal sensory NCV. He was diagnosed as having acute motor axonal neuropathy type of GBS based on the results of these electrophysiological examinations. When preceding infection develops to sepsis, differential diagnosis of GBS from CIP may be difficult by clinical features. Therefore, differential diagnosis of CIP from GBS should be considered using electrophysiological examination when prolonged neuropathy occurs after sepsis treatment.

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