Guillain-Barre
Patient Presentation
E.K., a 35 year old female presented to a local ER with a few days of nausea
and vomiting as well as general lethargy. Patient was given IV fluids and
sent home with diagnosis of a GI bug. A few days later the patient woke up
with tingling and weakness of lower extremities and called 911. She was
admitted to the hospital on a general medicine floor for a neurology work
up. Patient continued to have weakness progressing up to her torso and
upper extremities and was placed on oxygen when she began to have difficulty
breathing. The patient was then transferred to the ICU and was intubated due
to paralysis ascending through her body. After intubation, she was unable
to move any extremities other than a slight twitch of a muscle in one arm
and one leg and could nod her head yes or no. Patient remained on the
ventilator with full vent support and required a continuous fentanyl drip
and Ativan® drip for pain and ventilator comfort.
Differential Diagnosis
When the patient was initially admitted to the medicine floor many ideas
were discussed regarding her diagnosis. Multiple sclerosis, ALS, severe
flu-like illness or Guillain-Barre associated with her recent GI illness
could all be possible causes for her paralysis.
Diagnosis
It was determined through symptom analysis and a spinal tap that showed
increased protein, that the patient was suffering from Guillain-Barre, an
autoimmune disorder that attacks the peripheral nervous system following an
acute illness. If treatment was begun immediately the patient should have a
positive outcome.
Treatment
The patient began a 5 day course of intravenous immune globulin which should
block the antibodies that were damaging the patient’s nervous system. There
was no significant improvement following this course and the patient had a
tracheostomy (trach) performed for long term ventilator support. The
patient was able to be weaned from continuous drips to as needed pain
medications and was weaned from the ventilator to a trach collar (no
ventilator support, just supplemental oxygen). Also, daily visits from
physical and occupational therapy were scheduled to continue to work on
regaining strength and muscle mass.
Outcome
The patient was able to be transferred to a regular floor on trach collar
and was then transferred to an acute rehabilitation center to work on
strength building and work towards decannulation (trach removal). Most
people can completely recover from this illness, but the faster it is
recognized and treated, the faster the patient can recover completely.
Case created by Erica Kunkel, 2011.