Landry-Guillain-Barre-Strohl syndrome in India

Abstract

Sixty-three patients from a series of 710 patients suffering from various types of neuropathy were considered to be suffering from the Landry-Guillain-Barre-Strohl syndrome. Prodromal symptoms were noted in 49.2% of cases. There was virtually complete paralysis of the limbs in 57 cases, moderate weakness in 4 and mild weakness in only 2. In 26 out of 33 cases in whom differential weakness could be recognized, distal groups were predominantly involved and in only 7, the proximal muscles. Higher cerebral functions were disturbed in 10 cases. Cranial nerves were involved at some stage in 58.7% of cases. Loss of tendon reflexes was generally the first abnormal sign and these were the last to return. In 1 case there was evidence of involvement of the pyramidal tract. Sphincters were involved in 23.8% of cases. Hypertension persisting from a few days to 4 months was seen in 23 patients. The CSF protein content in these cases was analysed in detail. The protein level did not vary significantly with the day of determination. Major electrocardiographic abnormalities were seen in 18 patients out of 47 in whom an ECG was done. Nerve biopsies done in 29 patients showed degenerative changes in the majority. In 4 out of 5 cases in whom nerve biopsy was repeated, the abnormalities disappeared along with clinical recovery. Pyruvic acid levels in blood (recorded in 15 patients) were significantly high in the fasting state as well as after glucose in these cases when compared to normal values. The mortality rate in this series was 28.5%. Relapse was noted in 4 cases. 59% showed complete or almost complete recovery usually within the first 3 months. Compared to the course of arsenical neuropathy, recovery was significantly speedier in this condition (P < 0.05).