A CASE OF WEAKNESS REVISITED

DrAhlam Aboobaker* Dr Dhanush Thomas** Dr Sumesh Raj***

Junior Residen*t Assistant Professor** Professor***

59 year old female with h/o thyroidectomy on thyroxine replacement and h/o hysterectomy ,known case of systemic hypertension x7 years now came with complaints of
weakness of right upper and lower limb more than left for 6 days .She woke up normally ,developed numbness of right hand with weakness in the form of difficulty in making
bolus of food and bringing food to mouth. She had asymmetrical weakness of left upper limb also. Diagnosed as hypocalcemia and treated ,had initial symptom relief followed
by worsening Had sudden onset assymetrical weakness right > left .H/O loose stools 2 weeks prior to onset of weakness .No h/o fever/recent vaccinations .On examination
conscious ,oriented extraocular movements –full.power-bilateral upper limb 3+,bilateral lower limb 3- .Tone – normal.pain ,temperature ,position,vibration sense –normal.
Deep tendon reflexes – absent .On investigation ,serum calcium -6 mg/dl,MRI Brain showed no evidence of infarct -?metabolic /neurodegerative changes.MRI C Spine
showed no obvious compressive lesion.Minimal disc bulge in multiple levels.CSF study was normal.Nerve conduction study is suggestive of features of demyelinating
predominantly motor polyneuropathy –consistent with AIDP.Serology –HIV ,HbsAg,HCV,VDRL are negative ANA was negative Patient improved after a course of
plasmapheresis and she was able to walk with support, had complaints of fatigue which improved gradually overtime

DISCUSSION

Guillai Barre Syndrome is an acute,autoimmune ,fulminant polyradiculoneuropathy manifesting as rapidly evolving areflexic ascending motor paralysis occurring after 1-3
weeks of acute respiratory or gastrointestinal infection ,may need ventilatory support if associated with a rapid progression – presence of facial and bulbar weakness in 1st
week of illness.Electrodiagnostic feautures may be minimal and CSF protein level donot rise until end of 1st week.If diagnosis is strongly suspected ,treatment should be
initiated without waiting for evolution of characteristic findings.