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JXUwMDA4JXUwMDNmJXUwMDAzJXUwMDE1JXUwMDFhJXUwMDBmJXUwMDA1JXUwMDA3JXUwMDA3JXUw
MDBhJXUwMDEw
JXUwMDFjJXUwMDIxJXUwMDE1JXUwMDExJXUwMDEzJXUwMDA2JXUwMDE5JXUwMDA4JXUwMDBiJXUw
MDFh
JXUwMDM3JXUwMDA5
JXUwMDE2JXUwMDJiJXUwMDEwJXUwMDA3JXUwMDFkJXUwMDAzJXUwMDAzJXUwMDA4JXUwMDFl
JXUwMDZj
JXUwMDBiJXUwMDI0JXUwMDE2JXUwMDBm
JXUwMDE0JXUwMDJkJXUwMDBmJXUwMDBi
JXUwMDBiJXUwMDE2
JXUwMDE0JXUwMDIzJXUwMDAxJXUwMDBhJXUwMDBiJXUwMDAx
JXUwMDBkJXUwMDFl
JXUwMDZhJXUwMDA3JXUwMDFhJXUwMDFlJXUwMDAwJXUwMDFlJXUwMDFkJXUwMDAyJXUwMDAxJXUw
MDA1
JXUwMDFjJXUwMDM2
JXUwMDFhJXUwMDJkJXUwMDBk
JXUwMDEwJXUwMDIxJXUwMDA1JXUwMDAw
JXUwMDFlJXUwMDI3JXUwMDBjJXUwMDA0JXUwMDA1JXUwMDE1
JXUwMDEwJXUwMDJkJXUwMDA0JXUwMDBkJXUwMDE4JXUwMDFj
JXUwMDFiJXUwMDIyJXUwMDEzJXUwMDE3
JXUwMDFiJXUwMDI2JXUwMDBiJXUwMDFhJXUwMDA2JXUwMDE3
JXUwMDZk
JXUwMDE0JXUwMDI1JXUwMDA0JXUwMDA4
JXUwMDE0JXUwMDJkJXUwMDBmJXUwMDBi
JXUwMDE2JXUwMDE5
JXUwMDE0JXUwMDIzJXUwMDAxJXUwMDBhJXUwMDBiJXUwMDAx
JXUwMDBkJXUwMDFl
JXUwMDFjJXUwMDIxJXUwMDA0JXUwMDEz
Dr Hill,
Thank you for
JXUwMDJhJXUwMDE3JXUwMDAzJXUwMDAzJXUwMDE3JXUwMDAwJXUwMDFiJXUwMDA3JXUwMDA5
this patient
JXUwMDJjJXUwMDFi
me, who is a
JXUwMDZjJXUwMDAxJXUwMDE4JXUwMDU0JXUwMDFjJXUwMDA0JXUwMDEzJXUwMDVmJXUwMDQyJXUw
MDAzJXUwMDA4
man. He was
JXUwMDM5JXUwMDA1JXUwMDA5JXUwMDA0JXUwMDFkJXUwMDAwJXUwMDExJXUwMDAx
with a
JXUwMDJiJXUwMDA2JXUwMDA2JXUwMDAzJXUwMDE1JXUwMDA2JXUwMDE3JXUwMDExJXUwMDAx
brain stem infarction, after
JXUwMDJhJXUwMDE3JXUwMDAzJXUwMDAzJXUwMDE3JXUwMDAwJXUwMDEzJXUwMDBk
by his GP to the emergency department.
The patient noticed
JXUwMDJhJXUwMDFiJXUwMDBlJXUwMDBmJXUwMDFjJXUwMDU5JXUwMDVlJXUwMDFhJXUwMDBkJXUw
MDAxJXUwMDAx
facial weakness
JXUwMDMxJXUwMDA3JXUwMDE4JXUwMDE5JXUwMDAzJXUwMDFhJXUwMDFmJXUwMDA3JXUwMDA5
progressive weakness in the upper and lower
JXUwMDM0JXUwMDA1JXUwMDA0JXUwMDBmJXUwMDEx
. He also
JXUwMDNiJXUwMDBjJXUwMDAyJXUwMDFkJXUwMDFjJXUwMDBkJXUwMDA4JXUwMDA3JXUwMDBiJXUw
MDAx
of
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and
JXUwMDI4JXUwMDExJXUwMDEzJXUwMDEzJXUwMDA0JXUwMDE2JXUwMDA3JXUwMDFjJXUwMDBkJXUw
MDE2JXUwMDFhJXUwMDA4
in the limbs.
I agree with your
JXUwMDJiJXUwMDA2JXUwMDA2JXUwMDAzJXUwMDE1JXUwMDA2JXUwMDE3JXUwMDExJXUwMDAx
diagnosis that he has
JXUwMDNhJXUwMDEwJXUwMDEzJXUwMDA4JXUwMDA3
JXUwMDJiJXUwMDA3JXUwMDExJXUwMDA4
infarction.
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blood tests showed no
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MDBmJXUwMDFh
abnormality and
JXUwMDM0JXUwMDE5JXUwMDE4JXUwMDBmJXUwMDAzJXUwMDEz
puncture revealed a protein of 6.0 g/L; no red blood cells, white blood cells or microbes were
JXUwMDJiJXUwMDE2JXUwMDAwJXUwMDBi
.
I would call your
JXUwMDM5JXUwMDE1JXUwMDAwJXUwMDExJXUwMDBiJXUwMDFhJXUwMDFkJXUwMDA2JXUwMDAx
to the fact that the
JXUwMDNkJXUwMDFkJXUwMDE5JXUwMDAyJXUwMDE3
diagnosis of the patient is Guillain-Barré syndrome (GBS), which is a
JXUwMDJjJXUwMDBkJXUwMDA5JXUwMDE1
JXUwMDM3JXUwMDA5
autoimmune polyradiculomyelitis.
I would also
JXUwMDMwJXUwMDAxJXUwMDBlJXUwMDBmJXUwMDA0JXUwMDA1JXUwMDBlJXUwMDBmJXUwMDFj
that GBS is a possible response
JXUwMDM3JXUwMDA5
the nervous system to an immunological
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. It may occur
JXUwMDMxJXUwMDA3
JXUwMDM5JXUwMDEyJXUwMDAwJXUwMDFjJXUwMDBjJXUwMDBhJXUwMDA4JXUwMDE1JXUwMDFkJXUw
MDA2JXUwMDAx
with malignancy, after surgical procedures or the administration of
JXUwMDM5JXUwMDBm
JXUwMDMxJXUwMDA3JXUwMDAxJXUwMDBjJXUwMDE2JXUwMDE5JXUwMDBkJXUwMDE1JXUwMDFkJXUw
MDA2JXUwMDAx
.
In the process of
JXUwMDNkJXUwMDE2JXUwMDA3JXUwMDE1JXUwMDAzJXUwMDBlJXUwMDA1JXUwMDFhJXUwMDFiJXUw
MDAxJXUwMDA3JXUwMDA5
the differential diagnosis
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MDA4
, botulism, porphyria, toxic neuropathy or poliomyelitis should always
JXUwMDNhJXUwMDA3
JXUwMDNkJXUwMDFkJXUwMDFiJXUwMDBmJXUwMDE5JXUwMDExJXUwMDAxJXUwMDAx
.
I should
JXUwMDJiJXUwMDA3JXUwMDA2JXUwMDE3JXUwMDE2JXUwMDAw
the fact that oxygen therapy (ventilation) may be
JXUwMDM0JXUwMDA1JXUwMDBmJXUwMDAzJXUwMDQ4JXUwMDVlJXUwMDEyJXUwMDE3JXUwMDFmJXUw
MDA3JXUwMDA5
for the patient when the oxygen
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MDAx
in the blood decreases to a critical level.
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, blood gas levels should continuously
JXUwMDNhJXUwMDA3
JXUwMDM1JXUwMDAyJXUwMDAxJXUwMDA3JXUwMDFkJXUwMDFiJXUwMDFkJXUwMDE3JXUwMDAx
. The patient should receive immunoglobulin and
JXUwMDJkJXUwMDFiJXUwMDBhJXUwMDAxJXUwMDE3JXUwMDE1JXUwMDA4
plasmapheresis as well.
Yours
JXUwMDJiJXUwMDFhJXUwMDA3JXUwMDBkJXUwMDA2JXUwMDE3JXUwMDE3JXUwMDA5JXUwMDE1
,
Lea/Tim Bell, MD
Clinical neurologist