Open AccessGuillain-Barré Syndrome and Hyperreflexia: a case report
Author(s) -
Gabriel Santaterra Barros,
Ana Paula Ramires Chiminazzo,
Maria Luiza Ricarte Ruggeri,
Maria Luisa Pelaes Stipp,
Helen Maia Tavares de Andrade
Publication year - 2021
Language(s) - English
Resource type - Conference proceedings
DOI - 10.5327/1516-3180.588
Subject(s) - hyperreflexia , hyporeflexia , medicine , reflex , context (archaeology) , neurological examination , weakness , surgery , anesthesia , paleontology , biology
Context: areflexia and hyporeflexia are mandatory clinical criteria for the diagnosis of Guillain-Barré Syndrome (GBS). However there are case reports in literature of GBS that exhibit hyperreflexia. Case report: Male patient, 38 years old, after weakness and pain in lower limbs, after exercise, for 4 days, without alteration of balance and sphincter. A week earlier, he had diarrhea and fever. Previous bariatric surgery. On examination: For both upper limbs, the grade of power was 5/5 in the proximal muscle group and 4/5 in the distal muscle group. For the lower limbs, the grade of power was 4/5 in both proximal and distal muscle groups. The deep tendon reflexes were brisk (+2) throughout all four limbs. Patellar tendon reflex had bigger response (+3). Babinski’s and Hoffmann’s signs were negative. Tactile, painful, vibrating sensitivity and cranial nerves examination were all intact. The presence of reflex in the four limbs with patellar hyperreflexia, made the GBS hypothesis to be disregarded. Laboratory: normal CK, TGO, aldolase, TGP, LDH and vitamin B12. Electroneuromyography (ENMG) revealed the diagnosis of AMAN. After ENMG, cerebrospinal fluid known as leukocytes: 3.1 mm³, proteins: 95.2 mg/dl. Human immunoglobulin (0.4 g/ kg/day) was prescribed for 5 days and the patient recovered in 3 months. Conclusions: The case reported by us shows the importance to take into account the GBS hypothesis in the presence of hyperreflexia, especially in axonal variants, to prevent the treatment from being mistakenly postponed.