Upside down Guillain Barré syndrome
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The incidence of polyneuropathy in critically ill patients F.S.S. Leijten and A.W. de Weer (The Hague) A prospective study was undertaken during one year including all patients at an intensive care unit who were mechanically ventilated and had either ARDS (Adult Respiratory Distress Syndrome) a&/or septic syndrome. According to a protocol, 18 patients were examined neurologically and electromyograp~ically. Pathological studies were done in 4 patients who died. In 90 per cent of cases, a polyneuropathy was found. Its clinical importance lies in the prolonged period of weaning from ventilation and of subsequent revalidation. Upside down Guillain Barr6 syndrome J.P. ter Bruggen (Heerlen), F.G.A. van der Mech6 (Rotterdam), A.E.J. de Jager (Gro- ningen), C.H. Polman (Amsterdam) and J.H.J. Wokke (Utrecht) Twenty six patients with a subacute polyneuritis, starting with cranial nerve dysfunction and meeting the criteria of the Guillain Barre syndrome (GBS) were included in a retrospective multicenter study. The results were compared with those of the Dutch GBS trial (N = 147). The UDGBS was subdivided in an ophthalmopleg- ic (N = 16) and a lower cranial nerve variant (N = 9). Ataxia. areflexia, disturbances of swallowing and other cranial nerves and limb muscles justified the proposed UDGBS subclassification. Both showed a similar pattern of recovery as GBS. The same antecendent infections as GBS, includ- ing Campylobacter, are noted. Age proved to be a signi~cant prognostic factor especially conside~ng the number of patients with artificial respiration (72% over 50 years versus 12% under 50 years) and ADL-independency after 4 weeks (80% versus 25%). On the other hand the relative frequency of the involved cranial nerves is different from that of GBS. In particular the cranial nerves 3,4,6 (GBS 1527%) UDGBS 70-85%) and 10, 11 (CBS 12%, UDGBS 28-33%) were relatively more affected. Remarkable is that the predominant involvement of the short mo- tor cranial nerves and the relatively short nerves to the proximal arm muscles are inconsistent with a random distribution of lesions; it suggests specific but as yet unknown mechanisms. Is dementia a feature of multiple scferosis (MS)? A. Jennekens-Schinkel, J.B.K. Lanser, E.A. van der Velde (Leiden) Transverse studies have suggested global or specific cognitive impairments to be present in rather high percentages of MS patients. ~n~tudinal studies of cognition in MS are. however, scarce. In a neuropsychological follow-up using call-back for patient recruitment, cognition was assessed in 33 MS patients and 18 healthy volunteers matched to the patients for socio-economic status. The interval be- tween the assessments was five years. Salient results are presented. Significant differences in measures of cognition (such as intelligence and memory quotients; language performances; shifting of response set; sensitivity to interference) were found neither between measure- ments nor between groups. Learning vulnerability was present in a small number of MS patients. Move- ment control and other non-cognitive variables had deteriorated further at reassessment and hampered task performances required quickness of visual in- formation gathering and/or of responding. Although cognitive decline was not a general feature of MS, individual patients performed below their estimated premorbid cognitive levels. Illness variables, a.o. physical handicap, duration of MS and course of dis- ease, were unlikely predictors of cognitive perform- ances. 177
Transcript of Upside down Guillain Barré syndrome
The incidence of polyneuropathy in critically ill patients
F.S.S. Leijten and A.W. de Weer (The Hague)
A prospective study was undertaken during one year including all patients at an intensive care unit who were mechanically ventilated and had either ARDS (Adult Respiratory Distress Syndrome) a&/or septic syndrome. According to a protocol, 18 patients were examined neurologically and electromyograp~ically.
Pathological studies were done in 4 patients who died. In 90 per cent of cases, a polyneuropathy was found. Its clinical importance lies in the prolonged period of weaning from ventilation and of subsequent revalidation.
Upside down Guillain Barr6 syndrome
J.P. ter Bruggen (Heerlen), F.G.A. van der Mech6 (Rotterdam), A.E.J. de Jager (Gro- ningen), C.H. Polman (Amsterdam) and J.H.J. Wokke (Utrecht)
Twenty six patients with a subacute polyneuritis, starting with cranial nerve dysfunction and meeting the criteria of the Guillain Barre syndrome (GBS) were included in a retrospective multicenter study. The results were compared with those of the Dutch GBS trial (N = 147).
The UDGBS was subdivided in an ophthalmopleg- ic (N = 16) and a lower cranial nerve variant (N = 9). Ataxia. areflexia, disturbances of swallowing and other cranial nerves and limb muscles justified the proposed UDGBS subclassification. Both showed a similar pattern of recovery as GBS.
The same antecendent infections as GBS, includ- ing Campylobacter, are noted. Age proved to be a
signi~cant prognostic factor especially conside~ng the number of patients with artificial respiration (72% over 50 years versus 12% under 50 years) and ADL-independency after 4 weeks (80% versus 25%).
On the other hand the relative frequency of the involved cranial nerves is different from that of GBS. In particular the cranial nerves 3,4,6 (GBS 1527%) UDGBS 70-85%) and 10, 11 (CBS 12%, UDGBS 28-33%) were relatively more affected. Remarkable is that the predominant involvement of the short mo- tor cranial nerves and the relatively short nerves to the proximal arm muscles are inconsistent with a random distribution of lesions; it suggests specific but as yet unknown mechanisms.
Is dementia a feature of multiple scferosis (MS)?
A. Jennekens-Schinkel, J.B.K. Lanser, E.A. van der Velde (Leiden)
Transverse studies have suggested global or specific cognitive impairments to be present in rather high percentages of MS patients. ~n~tudinal studies of cognition in MS are. however, scarce.
In a neuropsychological follow-up using call-back for patient recruitment, cognition was assessed in 33 MS patients and 18 healthy volunteers matched to the patients for socio-economic status. The interval be- tween the assessments was five years. Salient results are presented.
Significant differences in measures of cognition (such as intelligence and memory quotients; language performances; shifting of response set; sensitivity to
interference) were found neither between measure- ments nor between groups. Learning vulnerability was present in a small number of MS patients. Move- ment control and other non-cognitive variables had deteriorated further at reassessment and hampered task performances required quickness of visual in- formation gathering and/or of responding. Although cognitive decline was not a general feature of MS, individual patients performed below their estimated premorbid cognitive levels. Illness variables, a.o. physical handicap, duration of MS and course of dis- ease, were unlikely predictors of cognitive perform- ances.
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