Case 11: Could This Be Guillain-Barré Syndrome?

Dana Cummings, MD, PhDPreceptor: Thomas Crawford, MD

Disclosures

February 22, 2002

In This Article

History and Physical Exam

Laboratory Studies

  • Erythrocyte sedimentation rate (ESR): 57

  • White blood cell count (WBC): 8600 (17 S, 79 L, 1 B)

  • Hematocrit (Hct): 30.9

  • Platelets: 137,000

She was a full-term infant, following a normal spontaneous vaginal delivery. She has a history of neonatal jaundice, no other hospitalizations, and no known drug allergies.

Development. The child walked at 14 months, has normal speech, language, and fine motor milestones; was recently toilet trained.

Review of systems. The child is irritable and complains of a "tired feeling" of her left arm; normal appetite; no nausea or vomiting; no history of trauma; no visible rash.

Family history. She has a 1-year-old healthy sister and no family history of gait disorders, seizures, or mental retardation.

Social history. The patient lives with her mother, father, and sister in a suburban setting. She began at a new preschool in the last 3 weeks. Her grandfather, a physician, contacted JHH pediatric neurology about the possibility of GBS.

  • T 36.7°C

  • BP 94/56

  • P 120/minute, regular

  • RR 24/minute

  • Head circumference 47.5 cm (25%)

  • Weight 13 kg (25%-50%)

General.

The patient is tearful, clingy, and quiet, and is sitting in stroller.

HEENT. She is normocephalic/atraumatic. Her neck is supple. She has a normal funduscopic exam, and has no papilledema, no submandibular or supraclavicular adenopathy, and no conjunctival pallor.

Cardiac. She has a regular heart rhythm and rate, no murmur; chest clear to auscultation.

Gastrointestinal. No hepatosplenomegaly; liver at costal margin; spleen not palpable.

Musculoskeletal. No joint pain or tenderness, no joint erythema or warmth, extremity cyanosis, clubbing, or edema; no back tenderness to percussion; no muscle tenderness.

The child initially was shy, clingy, awake, and uncooperative, but later became more cooperative. She follows commands and performed simple naming tasks.

Cranial nerves. Visual fields full to confrontation, pupils equal and reactive to light with no afferent pupillary defect (APD); symmetric facial sensation and strength; extraocular movements intact, no nystagmus; hearing intact to bilateral whispering and finger friction; symmetric sternocleidomastoid and trapezius strength; normal phonation and symmetric palatal elevation.

Motor. Normal tone and bulk; strength at least 4+/5 throughout. The patient can stand and take slow careful steps and can climb into a stroller; deep tendon reflexes 2+ throughout.

No Gower's sign, but when moving from sitting to standing, she places her arms on her thighs as if to protect her quadriceps. Legs are tremulous on activation of quadriceps.

Sensory. Responds to light touch in all extremities and trunk; no extinction to double simultaneous stimulation.

Coordination. No ataxia.

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