input plsssssssssss

[princessloulou]

hi,
i am an RN and i have a pt. w/out a definitive dx. he presents w/ h/o polio as a child, cervical bulging discs x2,  random muscle twitching, lower ext., weakness R>L , and R upper ext weakness as well.
he has r foot drop, and muscle atrophey. his r ring finger also is dropped. denies any vision changes no facial drooping. he feels like his muscles are "vibrating" or on fire, primarily hs or upon waking.,   he has had some testing done and has been to the als specialist., undiagnosed. i'm seeing him for IVIG. any thoughts? thankyou for you time

[LarryMicker]

Has anyone checked the patients cholesterol levels? Are they taking a statin or on a low cholesterol diet? B vitamins or d3 deficiency?  Could also be an endocrine dysfunction in the way of adrenal insufficiency or a pituitary tumor.

[Abhijeet Deshmukh, MD]

Hi.

It is only by chance that I happened to check this forum today, and I noticed this post by doglady2007_pugs.

I tried to put the information in simple terms. May be, I used too simple a terminology for an educated visitor. And I accept this in good faith.

Keeping in consideration the limitations and scope of the forum, it is not possible really to put information in details. And I think it is always better to discuss it with your treating physician or surgeon. That way, a lot of misinterpretation of the data can be avoided.

I do not see any more benefit in pouring all the information that is available on the internet. Besides, there is no check on the authenticity of the data available on the web.

To say that blood has "nothing to do with" it, would be to deny the very basis of the immune system. I would rather encourage the reader to read about the origin of the immune system. And increased protein is not specific for GBS. It is the acellular rise of proteins that strongly hints towards GBS.

Nevertheless, I thank doglady2007_pugs for making me realise that it really matters a lot how you word your responses. One can really interprete the information the wrong way.

Regards

[doglady2007_pugs]

The posting on march 9th from Abhijeet Deshmukh contained some misinformation which i'm sure you have discovered since you were going to do some research on guillain barre syndrome. It is not always a post infection process. in 60% of the cases, there is no cause that can be found.The blood has nothing to do with guillain barre syndrome The immune system antibodies attack the covering on the nerves(myelin sheath) and in more severe cases, can attack the under lying nerves, I was diagnosed with guillain barre syndrome in April of 2008, so I have gained some knowledge of this syndrome. It is diagnosed by increased protein in the CSF.  Regards and hope dx has been found.

[Abhijeet Deshmukh, MD]

Hi.

Guillain Barre Syndrome is an acute inflammatory polyneuropathy with a demyelination process. It is a post infection process. The blood has antibodies against the myelin sheath. The polyneuropathy is predominantly motor in nature. This means the patient will have more motor weakness than sensory symptoms. The weakness typically starts in the small muscles of the feet (distal) and ascends upwards.

The diagnosis is based on a history of infection, clinical examination revealing an ascending paralysis and CSF examination showing increased proteins without increased cell count (acellular rise of proteins).

Regards

[princessloulou]

the weakness first started in his lower extremeites. an mri of the spine was done. lymes was ruled out by blood as well as LP.

he has had extensive testing emg/ncs, ua, LP, all which were normal other than the EMG showing chronic changes and his fasciculations and weakness are all believed to be a result of post-polio syndrome. the dx on his face sheet that i received is mononeuritis.

i saw him today for 3 of 5 ivig. i notices that his mild tremors in his hands has gotten better. still presents w/ lower ext. weaknes R>L; R upper weakness arm especially when he tries to lift it away from his body and up. he had lower back pain today "burning" and only feels the "vibrating" of lower ext. when he "overdoes it".

i'm not very familiar w/ gullain barre. i'm going to check it out. how is the diagnosis confirmed for gullaine barre?

yes, this is the first time he is recieving IVIG. his brother in law has als. they were tennis partners for many years and is some connection w/ fertilizer or pesticides. he stated the docs don't think its als. no family hx w/ similar problems.

thankyou so much for your time,,,

[Abhijeet Deshmukh, MD]

Hello.

As rightly mentioned by patsy10, you should also be looking at ruling out Lyme disease.

Does the patient have any relatives who have similar problems? There are some types of muscular dystrophy which have similar presentation.

Is this the first time the patient is receiving IV Immunoglobulins?

Regards

[patsy10]

Has lyme disease been ruled out?

[Abhijeet Deshmukh, MD]

Hello.

It will be interesting to know where the weakness started first. Was it in the upper limbs or the lower limbs? Since there is muscle atrophy with the foot drop, it seems the nerve supply is dysfunctional. His symptoms could be due to the cervical bulging. An MRI will tell if the bulging is pressing on the cord. Additionally, an MRI of the lumbar spine is also needed to look for any disc problems there.

Why is he receiving IVIG? Did he have any fever or infections? If you know about Guillain Barre Syndrome, you must have seen a few patients. The weakness starts in the feet, slowly progressing to the whole of lower limbs and the upper limbs may also get involved.

How old is the patient?

Regards