PMID- 32525426
OWN - NLM
STAT- MEDLINE
DCOM- 20210614
LR  - 20210614
IS  - 2324-7096 (Electronic)
IS  - 2324-7096 (Linking)
VI  - 8
DP  - 2020 Jan-Dec
TI  - Ascending Paralysis in a 36-Year-Old Woman With Bipolar Disorder and Recent 
      Aspiration Pneumonia.
PG  - 2324709620931649
LID - 10.1177/2324709620931649 [doi]
LID - 2324709620931649
AB  - Guillain-Barre syndrome (GBS) is an acute inflammatory demyelinating 
      polyneuropathy affecting both motor and sensory peripheral nerves. Typically 
      presenting after a gastrointestinal or a respiratory tract infection, it 
      manifests as ascending paralysis with concomitant areflexia in patients. 
      Cytoalbuminologic dissociation is a supportive finding on cerebrospinal fluid 
      (CSF) analysis. Due to variability in presentation, misdiagnosis and delay in 
      treatment can occur, and consequently, GBS can become life threatening due to 
      respiratory failure. We report ascending paralysis in a 36-year-old woman with 
      known history of bipolar disorder who recently recovered from aspiration 
      pneumonia following a drug overdose event. Given her psychiatric history, she was 
      initially misdiagnosed as conversion disorder. Intravenous immunoglobulin (IVIG) 
      therapy was initiated at our hospital due to strong suspicion of GBS, based on 
      history and physical examination findings consistent with flaccid quadriparesis 
      and impending respiratory failure. CSF analysis and radiological findings 
      subsequently supported our clinical suspicion and clinical findings. Concurrent 
      IVIG therapy, pain management, aggressive physical and respiratory therapy, and 
      monitoring resulted in symptom improvement. One must have a high index of 
      suspicion for GBS when presented with acute inflammatory demyelinating 
      neuropathies in patients who present with ascending paralysis. Early initiation 
      of therapy is key and can prevent life-threatening complications.
FAU - Varma-Doyle, Aditi Vian
AU  - Varma-Doyle AV
AUID- ORCID: 0000-0002-9699-5668
AD  - Louisiana State University Health Sciences Center, New Orleans, LA, USA.
AD  - Louisiana State University, New Orleans, LA, USA.
FAU - Garvie, Kristen
AU  - Garvie K
AD  - Louisiana State University, New Orleans, LA, USA.
FAU - Walvekar, Seema
AU  - Walvekar S
AD  - Louisiana State University Health Sciences Center, New Orleans, LA, USA.
AD  - Louisiana State University, New Orleans, LA, USA.
FAU - Igi, Mae
AU  - Igi M
AD  - Louisiana State University, New Orleans, LA, USA.
FAU - Garikepati, Radha Mayuri
AU  - Garikepati RM
AD  - Louisiana State University Health Sciences Center, New Orleans, LA, USA.
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - J Investig Med High Impact Case Rep
JT  - Journal of investigative medicine high impact case reports
JID - 101624758
RN  - 0 (Immunoglobulins, Intravenous)
SB  - IM
MH  - Adult
MH  - Bipolar Disorder/*complications
MH  - Female
MH  - Guillain-Barre Syndrome/cerebrospinal fluid/*diagnosis/therapy
MH  - Humans
MH  - Immunoglobulins, Intravenous/therapeutic use
MH  - Pneumonia, Aspiration/*complications
MH  - Quadriplegia/*etiology
MH  - Respiratory Insufficiency/etiology
PMC - PMC7290259
OTO - NOTNLM
OT  - Guillain-Barre syndrome
OT  - aspiration pneumonia
OT  - bipolar disorder
OT  - early CSF analysis
OT  - immunoglobulin therapy
COIS- Declaration of Conflicting Interests: The author(s) declared no potential 
      conflicts of interest with respect to the research, authorship, and/or 
      publication of this article.
EDAT- 2020/06/12 06:00
MHDA- 2021/06/16 06:00
PMCR- 2020/06/11
CRDT- 2020/06/12 06:00
PHST- 2020/06/12 06:00 [entrez]
PHST- 2020/06/12 06:00 [pubmed]
PHST- 2021/06/16 06:00 [medline]
PHST- 2020/06/11 00:00 [pmc-release]
AID - 10.1177_2324709620931649 [pii]
AID - 10.1177/2324709620931649 [doi]
PST - ppublish
SO  - J Investig Med High Impact Case Rep. 2020 Jan-Dec;8:2324709620931649. doi: 
      10.1177/2324709620931649.