Neurology: A special case of AMAN

53 years old, female

53 years old, female

Past medical history included hypothyroidism and dyslipidemia, and was treated with levothyroxine and rosuvastatin accordingly

Hypothyroidism and dyslipidemia, and treat accordingly with levothyroxine and rosuvastatin

Physical examination revealed normal muscle strength, sensation, deep tendon reflexes, and coordination in the upper and left leg

Emergency head CT and CTA did not reveal early ischemic changes or arterial occlusion

normal sinus rhythm normal sinus rhythm

Over the next 24 hours, the patient rapidly developed quadriplegia and dysphagia

Tracheal intubation and transfer to the intensive care unit Cardiology team was unable to determine a specific cause or trigger for ventricular fibrillation, including no apparent electrolyte imbalance, toxic exposure, or structural cardiac abnormalities

After stopping the anesthesia, he still couldn't get off the ventilator, and there was no cough and gag reflex

Lumbar puncture revealed elevated protein (0.

surface

Treatment with intravenous immunoglobulin (IVIG) 2 g/kg for 5 days was unresponsive

discuss:

discuss:

GBS is a demyelinating immune-mediated polyneuropathy that is an important cause of acquired neuromuscular weakness

Pathophysiology is mediated by molecular mimicry, with various anti-ganglioside antibodies found in patient serum, the most common being anti-GM1, anti-GD1a, and anti-GD1b

Electrophysiological testing plays a key role in the diagnosis of AMAN, as it does in AIDP

Autonomic dysfunction in GBS patients has various manifestations, the most common being sinus arrhythmia, blood pressure instability, urinary retention, pupillary abnormalities, and sudomotor dysfunction

Sinus arrhythmia, blood pressure instability, urinary retention, pupillary abnormalities, and sweating dysfunction Autonomic dysfunction , arrhythmias with ventricular tachycardia, atrial fibrillation with rapid ventricular response, neurogenic myocardial stunning, cardiomyopathy, syndrome of inappropriate antidiuretic hormone secretion, and posterior reversible encephalopathy syndrome are less common

This case of AMAN has certain educational significance for clinicians

Another learning point is the manifestation of autonomic involvement

In terms of treatment, numerous clinical trials have demonstrated that IVIG and plasma exchange are effective for AIDP

Original source:

Original source:

Pearls & Oy-sters: Delayed Diagnosis of Acute Motor Axonal Neuropathy With Cardiac Arrest .
Neurology.
2022 Feb 22;98(8):336-339.
doi: 10.
1212/WNL.
0000000000013220.
Epub 2021 Dec 14.

Delayed Diagnosis of Acute Motor Axonal Neuropathy With Cardiac Arrest

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