Guillain-Barré syndrome physical examination: Difference between revisions
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===Appearance of the Patient=== | ===Appearance of the Patient=== | ||
*Patients with Guillain Barre syndrome might have abnormal gait.<ref name="pmid11320188">{{cite journal |vauthors=Mori M, Kuwabara S, Fukutake T, Yuki N, Hattori T |title=Clinical features and prognosis of Miller Fisher syndrome |journal=Neurology |volume=56 |issue=8 |pages=1104–6 |date=April 2001 |pmid=11320188 |doi= |url=}}</ref> | *Patients with Guillain Barre syndrome might have abnormal [[gait]].<ref name="pmid11320188">{{cite journal |vauthors=Mori M, Kuwabara S, Fukutake T, Yuki N, Hattori T |title=Clinical features and prognosis of Miller Fisher syndrome |journal=Neurology |volume=56 |issue=8 |pages=1104–6 |date=April 2001 |pmid=11320188 |doi= |url=}}</ref> | ||
===Vital Signs=== | ===Vital Signs=== | ||
*[[Tachycardia]] or bradycardia | *[[Tachycardia]] or bradycardia | ||
*Blood pressure disturbance<ref name=":1">{{Victor, M., 2001. Diseases of spinal cord peripheral nerve and muscle. Principles of Neurology}}</ref> | *[[Blood pressure]] disturbance<ref name=":1">{{Victor, M., 2001. Diseases of spinal cord peripheral nerve and muscle. Principles of Neurology}}</ref> | ||
===Skin=== | ===Skin=== | ||
* Skin examination of patients with Guillain Barre syndrome is usually normal. | * Skin examination of patients with Guillain Barre syndrome is usually normal. | ||
* We might see evidence of recent chicken pox disease.<ref name="pmid3404161">{{cite journal |vauthors=Winer JB, Hughes RA, Anderson MJ, Jones DM, Kangro H, Watkins RP |title=A prospective study of acute idiopathic neuropathy. II. Antecedent events |journal=J. Neurol. Neurosurg. Psychiatry |volume=51 |issue=5 |pages=613–8 |date=May 1988 |pmid=3404161 |pmc=1033063 |doi= |url=}}</ref> | * We might see evidence of recent [[chicken pox]] disease.<ref name="pmid3404161">{{cite journal |vauthors=Winer JB, Hughes RA, Anderson MJ, Jones DM, Kangro H, Watkins RP |title=A prospective study of acute idiopathic neuropathy. II. Antecedent events |journal=J. Neurol. Neurosurg. Psychiatry |volume=51 |issue=5 |pages=613–8 |date=May 1988 |pmid=3404161 |pmc=1033063 |doi= |url=}}</ref> | ||
===HEENT=== | ===HEENT=== | ||
* Extra-ocular movements may be abnormal | * Extra-ocular movements may be abnormal.<ref name="pmid11320188" /> | ||
*Ophthalmoscopic exam may be abnormal with findings of papilledema.<ref name="pmid13493684">{{cite journal |vauthors=JOYNT RJ |title=Mechanism of production of papilledema in the Guillain-Barre syndrome |journal=Neurology |volume=8 |issue=1 |pages=8–12 |date=January 1958 |pmid=13493684 |doi= |url=}}</ref> | *Ophthalmoscopic exam may be abnormal with findings of [[papilledema]].<ref name="pmid13493684">{{cite journal |vauthors=JOYNT RJ |title=Mechanism of production of papilledema in the Guillain-Barre syndrome |journal=Neurology |volume=8 |issue=1 |pages=8–12 |date=January 1958 |pmid=13493684 |doi= |url=}}</ref> | ||
* Hearing acuity may be reduced.<ref name="pmid3399076">{{cite journal |vauthors=Nelson KR, Gilmore RL, Massey A |title=Acoustic nerve conduction abnormalities in Guillain-Barré syndrome |journal=Neurology |volume=38 |issue=8 |pages=1263–6 |date=August 1988 |pmid=3399076 |doi= |url=}}</ref> | * Hearing acuity may be reduced.<ref name="pmid3399076">{{cite journal |vauthors=Nelson KR, Gilmore RL, Massey A |title=Acoustic nerve conduction abnormalities in Guillain-Barré syndrome |journal=Neurology |volume=38 |issue=8 |pages=1263–6 |date=August 1988 |pmid=3399076 |doi= |url=}}</ref> | ||
* | * [[Myokymia|Facial myokymia]] (Involuntary facial movement)<ref name="pmid6681885">{{cite journal |vauthors=Mateer JE, Gutmann L, McComas CF |title=Myokymia in Guillain-Barré syndrome |journal=Neurology |volume=33 |issue=3 |pages=374–6 |date=March 1983 |pmid=6681885 |doi= |url=}}</ref> | ||
* | * [[Vocal cord]] [[paralysis]] (Difficulty speaking)<ref name="pmid8441543">{{cite journal |vauthors=Panosian MS, Quatela VC |title=Guillain-Barré syndrome presenting as acute bilateral vocal cord paralysis |journal=Otolaryngol Head Neck Surg |volume=108 |issue=2 |pages=171–3 |date=February 1993 |pmid=8441543 |doi=10.1177/019459989310800211 |url=}}</ref> | ||
===Neck=== | ===Neck=== | ||
* We might see some [[Lymphadenopathy]] because of prior infection with EBV or CMV.<ref name="pmid8784256">{{cite journal |vauthors=Irie S, Saito T, Nakamura K, Kanazawa N, Ogino M, Nukazawa T, Ito H, Tamai Y, Kowa H |title=Association of anti-GM2 antibodies in Guillain-Barré syndrome with acute cytomegalovirus infection |journal=J. Neuroimmunol. |volume=68 |issue=1-2 |pages=19–26 |date=August 1996 |pmid=8784256 |doi= |url=}}</ref><ref name="pmid3404161" /> | * We might see some [[Lymphadenopathy]] because of prior infection with [[EBV]] or [[CMV]].<ref name="pmid8784256">{{cite journal |vauthors=Irie S, Saito T, Nakamura K, Kanazawa N, Ogino M, Nukazawa T, Ito H, Tamai Y, Kowa H |title=Association of anti-GM2 antibodies in Guillain-Barré syndrome with acute cytomegalovirus infection |journal=J. Neuroimmunol. |volume=68 |issue=1-2 |pages=19–26 |date=August 1996 |pmid=8784256 |doi= |url=}}</ref><ref name="pmid3404161" /> | ||
* Using accessory muscle for breathing in severe cases. | * Using accessory muscle for breathing in severe cases. | ||
===Lungs=== | ===Lungs=== | ||
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* Back examination of patients with Guillain Barre syndrome is usually normal. | * Back examination of patients with Guillain Barre syndrome is usually normal. | ||
===Genitourinary=== | ===Genitourinary=== | ||
* Evidences of urinary retention may be present.<ref name=":1" /> | * Evidences of [[urinary retention]] may be present.<ref name=":1" /> | ||
===Neuromuscular=== | ===Neuromuscular=== | ||
*Patient is usually oriented to persons, place, and time. | *Patient is usually oriented to persons, place, and time. | ||
* Altered mental status may be present. | * Altered mental status may be present. | ||
* Glasgow coma scale is 15/ 15 | * [[Glasgow coma scale]] is 15/ 15 | ||
* Based on the type of GBS, hyperreflexia or areflexia may be present. | * Based on the type of GBS, [[hyperreflexia]] or [[areflexia]] may be present. | ||
* Bilateral distal and proximal muscle weakness is present. | * Bilateral distal and proximal muscle weakness is present. | ||
* Reduced muscle force especially in lower extremities. | * Reduced muscle force especially in lower extremities. | ||
*Unilateral or bilateral sensory abnormality especially in deep sensation in the upper/lower extremities. | *Unilateral or bilateral sensory abnormality especially in deep sensation in the upper/lower extremities. | ||
*Abnormal gait is present in Miller | *Abnormal gait is present in [[Miller Fisher Syndrome|Miller Fisher type]] of GBS.<ref name="pmid160003352">{{cite journal |vauthors=Cochen V, Arnulf I, Demeret S, Neulat ML, Gourlet V, Drouot X, Moutereau S, Derenne JP, Similowski T, Willer JC, Pierrot-Deseiligny C, Bolgert F |title=Vivid dreams, hallucinations, psychosis and REM sleep in Guillain-Barré syndrome |journal=Brain |volume=128 |issue=Pt 11 |pages=2535–45 |date=November 2005 |pmid=16000335 |doi=10.1093/brain/awh585 |url=}}</ref><ref name=":0">{{cite book | last = Mattle | first = Heinrich | title = Fundamentals of neurology : an illustrated guide | publisher = Thieme | location = Stuttgart New York | year = 2017 | isbn = 9783131364524 }}</ref><ref name="pmid12084449">{{cite journal |vauthors=Kuwabara S, Nakata M, Sung JY, Mori M, Kato N, Hattori T, Koga M, Yuki N |title=Hyperreflexia in axonal Guillain-Barré syndrome subsequent to Campylobacter jejuni enteritis |journal=J. Neurol. Sci. |volume=199 |issue=1-2 |pages=89–92 |date=July 2002 |pmid=12084449 |doi= |url=}}</ref><ref name="pmid">{{cite journal |vauthors=Kuwabara S, Ogawara K, Koga M, Mori M, Hattori T, Yuki N |title=Hyperreflexia in Guillain-Barré syndrome: relation with acute motor axonal neuropathy and anti-GM1 antibody |journal=J. Neurol. Neurosurg. Psychiatry |volume=67 |issue=2 |pages=180–4 |date=August 1999 |pmid= |pmc=1736477 |doi= |url=}}</ref><ref name=":1" /> | ||
===Extremities=== | ===Extremities=== |
Revision as of 15:17, 27 December 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D.
Overview
Physical Examination
Physical examination of patients with Guillain Barre syndrome is usually remarkable for:
Appearance of the Patient
Vital Signs
- Tachycardia or bradycardia
- Blood pressure disturbance[2]
Skin
- Skin examination of patients with Guillain Barre syndrome is usually normal.
- We might see evidence of recent chicken pox disease.[3]
HEENT
- Extra-ocular movements may be abnormal.[1]
- Ophthalmoscopic exam may be abnormal with findings of papilledema.[4]
- Hearing acuity may be reduced.[5]
- Facial myokymia (Involuntary facial movement)[6]
- Vocal cord paralysis (Difficulty speaking)[7]
Neck
- We might see some Lymphadenopathy because of prior infection with EBV or CMV.[8][3]
- Using accessory muscle for breathing in severe cases.
Lungs
- Pulmonary examination of patients with Guillain barre syndrome is usually normal.
Heart
- Cardiovascular examination of patients with Guillain Barre syndrome is usually normal.
Abdomen
- Abdominal examination of patients with Guillain Barre syndrome is usually normal.
Back
- Back examination of patients with Guillain Barre syndrome is usually normal.
Genitourinary
- Evidences of urinary retention may be present.[2]
Neuromuscular
- Patient is usually oriented to persons, place, and time.
- Altered mental status may be present.
- Glasgow coma scale is 15/ 15
- Based on the type of GBS, hyperreflexia or areflexia may be present.
- Bilateral distal and proximal muscle weakness is present.
- Reduced muscle force especially in lower extremities.
- Unilateral or bilateral sensory abnormality especially in deep sensation in the upper/lower extremities.
- Abnormal gait is present in Miller Fisher type of GBS.[9][10][11][12][2]
Extremities
- Extremities examination of patients with Guillain Barre syndrome is usually normal.
References
- ↑ 1.0 1.1 Mori M, Kuwabara S, Fukutake T, Yuki N, Hattori T (April 2001). "Clinical features and prognosis of Miller Fisher syndrome". Neurology. 56 (8): 1104–6. PMID 11320188.
- ↑ 2.0 2.1 2.2 Template:Victor, M., 2001. Diseases of spinal cord peripheral nerve and muscle. Principles of Neurology
- ↑ 3.0 3.1 Winer JB, Hughes RA, Anderson MJ, Jones DM, Kangro H, Watkins RP (May 1988). "A prospective study of acute idiopathic neuropathy. II. Antecedent events". J. Neurol. Neurosurg. Psychiatry. 51 (5): 613–8. PMC 1033063. PMID 3404161.
- ↑ JOYNT RJ (January 1958). "Mechanism of production of papilledema in the Guillain-Barre syndrome". Neurology. 8 (1): 8–12. PMID 13493684.
- ↑ Nelson KR, Gilmore RL, Massey A (August 1988). "Acoustic nerve conduction abnormalities in Guillain-Barré syndrome". Neurology. 38 (8): 1263–6. PMID 3399076.
- ↑ Mateer JE, Gutmann L, McComas CF (March 1983). "Myokymia in Guillain-Barré syndrome". Neurology. 33 (3): 374–6. PMID 6681885.
- ↑ Panosian MS, Quatela VC (February 1993). "Guillain-Barré syndrome presenting as acute bilateral vocal cord paralysis". Otolaryngol Head Neck Surg. 108 (2): 171–3. doi:10.1177/019459989310800211. PMID 8441543.
- ↑ Irie S, Saito T, Nakamura K, Kanazawa N, Ogino M, Nukazawa T, Ito H, Tamai Y, Kowa H (August 1996). "Association of anti-GM2 antibodies in Guillain-Barré syndrome with acute cytomegalovirus infection". J. Neuroimmunol. 68 (1–2): 19–26. PMID 8784256.
- ↑ Cochen V, Arnulf I, Demeret S, Neulat ML, Gourlet V, Drouot X, Moutereau S, Derenne JP, Similowski T, Willer JC, Pierrot-Deseiligny C, Bolgert F (November 2005). "Vivid dreams, hallucinations, psychosis and REM sleep in Guillain-Barré syndrome". Brain. 128 (Pt 11): 2535–45. doi:10.1093/brain/awh585. PMID 16000335.
- ↑ Mattle, Heinrich (2017). Fundamentals of neurology : an illustrated guide. Stuttgart New York: Thieme. ISBN 9783131364524.
- ↑ Kuwabara S, Nakata M, Sung JY, Mori M, Kato N, Hattori T, Koga M, Yuki N (July 2002). "Hyperreflexia in axonal Guillain-Barré syndrome subsequent to Campylobacter jejuni enteritis". J. Neurol. Sci. 199 (1–2): 89–92. PMID 12084449.
- ↑ Kuwabara S, Ogawara K, Koga M, Mori M, Hattori T, Yuki N (August 1999). "Hyperreflexia in Guillain-Barré syndrome: relation with acute motor axonal neuropathy and anti-GM1 antibody". J. Neurol. Neurosurg. Psychiatry. 67 (2): 180–4. PMC 1736477.