Clinical Features Of Post-traumatic Guillain-Barré Syndrome

Objective:1、To explore the clinical features of post-traumatic Guillain-Barré syndrome from our hospital including epidemiological characteristics,clinical manifestations,results of auxiliary examinations,treatments and short-term prognosis.2、To compare the clinical features of post-traumatic GBS from our hospital and PubMed,in order to reveal the characteristics of patients between the two groups.3、To compare the clinical characteristics between post-traumatic GBS from our hospital and PubMed and post-infectious GBS from our hospital,in order to reveal the features of patients between the two groups.Methods:1、6 post-traumatic GBS patients from Tianjin medical university general hospital during the period January 2014 to January 2018 were enrolled.The clinical data of epidemiological characteristics,clinical manifestations,results of auxiliary examinations,treatments and short-term prognosis were collected and evaluated to explore the clinical features of post-traumatic GBS from our hospital.2、Case reports with post-traumatic GBS from PubMed in recent years were retrospectively reviewed and compared with patients from our hospital in order to search for the characteristics of patients between the two groups.3、32 patients with post-traumatic GBS from our hospital and PubMed were collected,analysed and compared with 20 post-infectious GBS patients from our hospital over the same time period in order to reveal the features of patients between the two groups.Results:1、The clinical features of post-traumatic GBS from our hospitalThere were 6 cases in our study,enrolled in Orthopedics,Gynecology and obstetrics,and Neurosurgical department and involved in craniofacial,thoracoabdominal and limb trauma.The enrolled patients contained 2 men and 4 women with the average age being 42.50±12.06 years old.The initial clinical manifestation was numbness and weakness of the limbs with hyporeflexia or areflexia.During the following 7.00±2.45 days,these symptoms rapidly worsened.The principal clinical presentation was progressive symmetrical weakness with varying degrees of muscle atrophy.5 patients exhibited cranial nerve involvement and 2 patients had respiratory paralysis.5 patients were subjected to the anti-ganglioside antibodies screening and positive results were obtained in 4 cases.The most common electrophysiological findings were relatively normal distal latency,prominent reduction of compound muscle action potential amplitude,and absence of F-waves.Although treatment with immunotherapy provided clinical improvement,recovery was incomplete at discharge,with 3 patients walking with assistance and 3 bedridden patients.2、Comparative studies on the clinical features of post-traumatic GBS from our hospital and PubMedTrauma type,involved departments,age at onset and gender distribution did not differ significantly between the two groups.Neither the interval from trauma to the onset of disease nor the frequency of the initial symptoms and limb dysfunctions differed significantly for the two groups.In addition,there were no significant differences in the incidence of facial paralysis and dysphagia and the positive rate of serum anti-ganglioside antibodies and albumin-cytologic dissociation in CSF between the two groups.A more common frequency of diplopia appeared in patients from our hospital.Compared with post-traumatic GBS aboard,a significantly higher incidence of nerve axon damage could be found at home.There was no significant difference between the groups in the improvement rate after immunotherapy,however,a significantly lower HFGS score at discharge could be found in patients from our hospital.3、Comparative studies on the clinical features between post-traumatic GBS from our hospital and PubMed and post-infectious GBS from our hospitalCompared with post-infectious GBS,patients with post-traumatic GBS had an older age at onset.The gender distribution did not differ significantly between the two groups.Neither the interval from trauma to the onset of disease nor the frequency of the initial symptoms and cranial nerve dysfunction differed significantly for the two groups.A more elevated HFGS score at nadir and higher incidence of respiratory failure was common among patients with post-traumatic GBS.There was no significant difference in positive rate of serum anti-ganglioside antibodies,albumin-cytologic dissociation in CSF and the axonal GBS subtype between the two groups.After immunotherapy,a longer hospital stay and a higher HFGS score at discharge could be found in post-traumatic GBS patients from our hospital.Conclusions:1、The features of post-traumatic GBS from our hospital were: 1)involved in various types of trauma and multiple departments and frequently involved among middle-aged individuals;2)often initially manifested by numbness and weakness of the limbs with hyporeflexia or areflexia;3)rapidly progressive disease course and severe neurological deficits at nadir often involved in facial paralysis,diplopia and respiratory failure;4)common abnormal examination results with positive anti-ganglioside antibodies,albumino-cytological dissociation in CSF and the electrophysiological features of nerve axon damage;5)Although active immunotherapy could provide clinical improvement,short-term prognosis was poor.2 、 Compared with post-traumatic GBS from PubMed,the patients with post-traumatic GBS from our hospital had a higher incidence of diplopia and a worse short-term prognosis.A significantly higher incidence of nerve axon damage could be found at home,when compared with post-traumatic GBS aboard.3、Compared with post-infectious GBS from our hospital,the patients with post-traumatic GBS had an older age at onset,a higher proportion of respiratory paralysis and a severe neurological deficits at nadir.After immunotherapy,a longer hospital stay and a higher HFGS score at discharge could be found in post-traumatic GBS patients from our hospital.