Mintalevél

London Polyclinics

Department of Neurology

4 Swan Lane

SE London

UK

 

25/11/2014

 

Dr Bob Hill

Family Health Care Centre

5 Lime Lane

NW London

UK

 

 

Dear Dr Hill,

 

Thank you for referring this patient to me, who is a 45-year-old man. He was admitted with a suspected brain stem infarction, after referral by his GP to the emergency department.

The patient noticed right-sided facial weakness involving progressive weakness in the upper and lower limbs. He also complained of numbness and paraesthesia in the limbs.

I agree with your suspected diagnosis that he has brain stem infarction.

Routine blood tests showed no significant abnormality and lumbar puncture revealed a protein of 6.0 g/L; no red blood cells, white blood cells or microbes were seen.

I would call your attention to the fact that the exact diagnosis of the patient is Guillain-Barré syndrome (GBS), which is a type of autoimmune polyradiculomyelitis.

I would also highlight that GBS is a possible response of the nervous system to an immunological challenge. It may occur in association with malignancy, after surgical procedures or the administration of an inoculation.

In the process of establishing the differential diagnosis diphtheria, botulism, porphyria, toxic neuropathy or poliomyelitis should always be excluded.

I should stress the fact that oxygen therapy (ventilation) may be life-saving for the patient when the oxygen saturation in the blood decreases to a critical level. Therefore, blood gas levels should continuously be monitored. The patient should receive immunoglobulin and undergo plasmapheresis as well.

 

Yours sincerely,

 

Lea/Tim Bell, MD

Clinical neurologist