A Report Of Guillain-barre Syndrom With Paralysis Of Respiratory Muscle

A 60-year-old male patient was admitted to the hospital beacause of progressive weakness of extremities for 3 days and accompany with numbness for 1 day.About 2 days prior to his admission the patient felt dizziness snivel sneeze and experience weakness of bilateral upper extremities.Movement is not agility.He considered that was conduced by tied,so he had not pay attention to it.From this morning the patient feel the weakness of bilateral upper extremities exacerbation, and felt weakness of bilateral lower extremities.He was difficult to walk,and felt numbness of his fingers and toes.Without headache, vomiting, fever, felt oppressed dysphagia or shortness of breath.Past history: He had not similar attacks, had not hypertension and diabetea.Examination on admissim: T:36.6℃, P80 per min, R20 per min, P:15.0/9.3kpa. Common conditions were well, superfacial lymph nodes were impalpable. Posterior pharyngeal wall was congested.Thyroid was normal and trachea was in the center position.Examinations of lung,heart and abdomen were regular.Neurological examination: He was conscious mind and specking was clear Palpebral fissures symmetrical without blepharoptosis.Pupils were round,symmetrical, dia 3.0 mm and reactive to light is normal and no nystagmus. The jundi showed no papilledema. The nasolabial groove was similarity . The fasciculatious of the tongue is in the midline. There was no atrophy of the tongue. The movement of soft palate were well.The gag reflex was intect .He shrugged his shoulders and turned his neck. The pulsation of the carotid arteries were symmetry. Muscles of all extremities had not atrophy. The upper extremities muscle force were III grade.and the lower extremities muscle force were II grade.The muscular tension were diminished. Abdominal refle(+),the bilaterally reflexes of biceps reflex, patellar reflex and ankle jerk extinction. His sensation were normal and no ataxia.There was no pathologic reflexes meningeal irriation and antagonistic system was normal. Assisted examination1.Laboratory examination:Routine examination of the blood urine and stool were normal. Liver and kindney serum founctions were regular. Fasting blood sugar:6.02 mmol L,K⁺ 3.90mmol/L. serum myokinase, hyroid function and blood sedimentation rate were normal.2. Image analysis: Lung x-ray slide; brain CT scan was normal.3. Electrocardiogram examination was normal.4.Electromyogram: F-wave latent period alongation and frequency of occurrence reduce, motor nerver condution velocity reduce,sensory nerver condution velocity was normal.5. Examination of cerebrospinal fluid: The CSF was clear, pressure 100 mm H2O ,cell count 4 X 109/ L ,protein0.4 g/ L ,glucose 4.2 mmol/ L , CL+ 121mmol/L.Lumbar examition was operation after 12 days, the CSF was clear, pressure:110 mmH2O,cell count2 X 109/ L ,protein0.83 g/ L ,glucose 3.8 mmol/ L , CL+125mmol/L6. Prostigmine Test result was Negative.7.Sural nerve Biopsy: Nerve fiber slightiy swelling, segment myelin losed a small inflammatory infiltrateAfter related examination were taken, the patient received treatment with corticosteroid antibiotics VitB₁ and VitBj2. After patient was admitted 2 days,his extremities muscle force were descend to 0,and feel dyspnea palpitation obtundation , operate tracheostomy and intraacheal tube with ventilator was used.