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Guillain–Barré syndrome can lead to death as a result of a number of complications: severe infections, blood clots, and cardiac arrest likely due to autonomic neuropathy. Despite optimum care this occurs in about 5% of cases.
There is a variation in the rate and extent of recovery. The prognosis of Guillain–Barré syndrome is determined mainly by age (those over 40 may have a poorer outcome), and by the severity of symptoms after two weeks. Furthermore, those who experienced diarrhea before the onset of disease have a worse prognosis. On the nerve conduction study, the presence of conduction block predicts poorer outcome at 6 months. In those who have received intravenous immunoglobulins, a smaller increase in IgG in the blood two weeks after administration is associated with poorer mobility outcomes at six months than those whose IgG level increased substantially. If the disease continues to progress beyond four weeks, or there are multiple fluctuations in the severity (more than two in eight weeks), the diagnosis may be chronic inflammatory demyelinating polyneuropathy, which is treated differently.
In research studies, the outcome from an episode of Guillain–Barré syndrome is recorded on a scale from 0 to 6, where 0 denotes completely healthy, 1 very minor symptoms but able to run, 2 able to walk but not to run, 3 requiring a stick or other support, 4 confined to bed or chair, 5 requiring long-term respiratory support, 6 death.
The health-related quality of life (HRQL) after an attack of Guillain–Barré syndrome can be significantly impaired. About a fifth are unable to walk unaided after six months, and many experience chronic pain, fatigue and difficulty with work, education, hobbies and social activities. HRQL improves significantly in the first year.
Two thirds of people with Guillain–Barré syndrome have experienced an infection before the onset of the condition. Most commonly these are episodes of gastroenteritis or a respiratory tract infection. In many cases, the exact nature of the infection can be confirmed. Approximately 30% of cases are provoked by "Campylobacter jejuni" bacteria, which cause diarrhea. A further 10% are attributable to cytomegalovirus (CMV, HHV-5). Despite this, only very few people with "Campylobacter" or CMV infections develop Guillain–Barré syndrome (0.25–0.65 per 1000 and 0.6–2.2 per 1000 episodes, respectively). The strain of "Campylobacter" involved may determine the risk of GBS; different forms of the bacteria have different lipopolysaccharides on their surface, and some may induce illness (see below) while others will not.
Links between other infections and GBS are less certain. Two other herpesviruses (Epstein–Barr virus/HHV-4 and varicella zoster virus/HHV-3) and the bacterium "Mycoplasma pneumoniae" have been associated with GBS. The tropical viral infection dengue fever and Zika virus have also been associated with episodes of GBS. Previous hepatitis E virus infection has been found to be more common in people with Guillain–Barré syndrome.
Some cases may be triggered by the influenza virus and potentially influenza vaccine. An increased incidence of Guillain–Barré syndrome followed influenza immunization that followed the 1976 swine flu outbreak (H1N1 A/NJ/76); 8.8 cases per million recipients developed the complication. Since then, close monitoring of cases attributable to vaccination has demonstrated that influenza itself can induce GBS. Small increases in incidence have been observed in subsequent vaccination campaigns, but not to the same extent. The 2009 flu pandemic vaccine (against pandemic swine flu virus H1N1/PDM09) did not cause a significant increase in cases. It is considered that the benefits of vaccination in preventing influenza outweigh the small risks of GBS after vaccination. Even those who have previously experienced Guillain–Barré syndrome are considered safe to receive the vaccine in the future. Other vaccines, such as those against poliomyelitis, tetanus or measles, have not been associated with a risk of GBS.
The clinical features and course of the condition, the associated auto-antibodies against relevant antigens, and the response to treatment, all suggest that Bickerstaff brainstem encephalitis is an autoimmune disease. However, each of these criteria fails to fit a substantial proportion of patients, and there is no single test or feature which is diagnostic of Bickerstaff brainstem encephalitis. It is therefore possible that a proportion of cases are due to other causes, such as infection or lymphoma, but remain undiagnosed. It is also possible that there is more than one autoimmune disease that can cause an illness which would currently be diagnosed as Bickerstaff's. There is certainly overlap between Guillain–Barré syndrome, Miller Fisher syndrome and Bickerstaff brainstem encephalitis, as well as other conditions associated with anti-ganglioside antibodies such as chronic ophthalmoplegia with anti-GQ1b antibody.
and the pharyngo-cervico-brachial variant of GBS.
Most patients reported in the literature have been given treatments suitable for autoimmune neurological diseases, such as corticosteroids, plasmapheresis and/or intravenous immunoglobulin, and most have made a good recovery. The condition is too rare for controlled trials to have been undertaken.
Acute cerebellar ataxia is the most common cause of unsteady gait in children. The condition is rare in children older than ten years of age. Most commonly acute cerebellar ataxia affects children between age 2 and 7 years.
Chronic paresthesia (Berger's paresthesia, Sinagesia or Bernhardt paresthesia) indicates a problem with the functioning of neurons or poor circulation.
In older individuals, paresthesia is often the result of poor circulation in the limbs (such as in peripheral vascular disease), most often caused by atherosclerosis, the buildup of plaque within artery walls, over decades, with eventual plaque ruptures, internal clots over the ruptures and subsequent clot healing but leaving behind narrowing of the artery openings or closure, both locally and in downstream smaller branches. Without a proper supply of blood and nutrients, nerve cells can no longer adequately send signals to the brain. Because of this, paresthesia can also be a symptom of vitamin deficiency and malnutrition, as well as metabolic disorders like diabetes, hypothyroidism, and hypoparathyroidism. It can also be a symptom of mercury poisoning.
Irritation to the nerve can also come from inflammation to the tissue. Joint conditions such as rheumatoid arthritis, psoriatic arthritis, and carpal tunnel syndrome are common sources of paresthesia. Nerves below the head may be compressed where chronic neck and spine problems exist and can be caused by, among other things, muscle cramps that may be a result of clinical anxiety or excessive mental stress, bone disease, poor posture, unsafe heavy lifting practices or physical trauma such as whiplash. Paresthesia can also be caused simply by putting pressure on a nerve by applying weight (or pressure) to the limb for extended periods of time.
Another cause of paresthesia may be direct damage to the nerves themselves, i.e., neuropathy, which itself can stem from injury or infection such as frostbite or Lyme disease, or may be indicative of a current neurological disorder. Neuropathy is also a side effect of some chemotherapies (see Chemotherapy-induced peripheral neuropathy). Benzodiazepine withdrawal may also cause paresthesia as the drug removal leaves the GABA receptors stripped bare and possibly malformed. Chronic paresthesia can sometimes be symptomatic of serious conditions, such as a transient ischemic attack, or autoimmune diseases such as multiple sclerosis or lupus erythematosus. Exposure to environmental toxins, chemicals used in water treatment and fluoroquinolones can also cause paresthesia. Stroke survivors and those with Traumatic Brain Injury (TBI) may experience paresthesia from damage to the central nervous system.
The Varicella zoster virus disease (shingles) can attack nerves causing numbness instead of pain commonly associated with shingles. A diagnostic evaluation by a medical doctor is necessary to rule these out.
Other causes may include:
- Anticonvulsant pharmaceutical drugs, such as topiramate, sultiame, and acetazolamide
- Anxiety and/or panic disorder
- Benzodiazepine withdrawal syndrome
- Beta alanine
- Carpal tunnel syndrome
- Cerebral amyloid angiopathy
- Chiari malformation
- Coeliac disease (celiac disease)
- Complex regional pain syndrome
- Decompression sickness
- Dehydration
- Dextromethorphan (recreational use)
- Fabry disease
- Erythromelalgia
- Fibromyalgia
- Fluoroquinolone toxicity
- Guillain–Barré syndrome (GBS)
- Heavy metals
- Herpes zoster
- Hydroxy alpha sanshool, a component of Sichuan peppers
- Hyperglycemia (high blood sugar)
- Hyperkalemia
- Hyperventilation
- Hypoglycemia (low blood sugar)
- Hypocalcemia, and in turn:
- Hypermagnesemia, a condition in which hypocalcemia itself is typically observed as a secondary symptom
- Hypomagnesemia, often as a result of long term proton-pump inhibitor use
- Hypothyroidism
- Immunodeficiency, such as chronic inflammatory demyelinating polyneuropathy (CIDP)
- Intravenous administering of strong pharmaceutical drugs acting on the central nervous system (CNS), mainly opioids, opiates, narcotics; especially in non-medical use (drug abuse)
- Ketorolac
- Lidocaine poisoning
- Lomotil
- Lupus erythematosus
- Lyme disease
- Menopause
- Mercury poisoning
- Migraines
- Multiple sclerosis
- Nitrous oxide, long-term exposure
- Obdormition
- Pyrethrum and pyrethroid (pesticide)
- Rabies
- Radiation poisoning
- Sarcoidosis
- Scorpion stings
- Spinal disc herniation or injury
- Spinal stenosis
- Stinging nettles
- Syringomyelia
- Transverse myelitis
- Vitamin B deficiency
- Vitamin B deficiency
- Withdrawal from certain selective serotonin reuptake inhibitors (or serotonin-specific reuptake inhibitors) (SSRIs), such as paroxetine or serotonin-norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine
Supportive treatment is the only intervention for acute cerebellar ataxia of childhood. Symptoms may last as long as 2 or 3 months.
Over 40 laboratory tests were initially conducted to rule out various pathogens and environmental toxins. These tests were used to try to identify potential viruses carried by humans, pigs, or both, including rotoviruses, adenoviruses, hepatitis A, and hepatitis E. They also tried to identify bacteria such as salmonella and escherichia coli (e. coli), and parasites such as Giardia and cryptosporidium that could be causing the symptoms. All were ruled out.
Neurodegenerative diseases were considered specifically because of the similarity of symptoms and animal involvement thus included investigation of prion associated diseases such as bovine spongiform encephalopathy (BSE), chronic wasting disease (CWD), and variant Creutzfeldt–Jakob disease (vCJD). These all have highly transmissible pathogenic agents that induce brain damage. Since no pathogenic agent had been found, these diseases were ruled out as being related.
Next two very similar neuropathies were ruled out. Guillain–Barré syndrome (GBS) induces an acute autoimmune response which affects the Schwann cells in the peripheral nervous system. GBS is usually triggered by an infection that causes weakness and tingling that may lead to muscle loss. This condition may be life-threatening if muscle atrophy ascends to affect the pulmonary or cardiac systems. So far, no infectious agents have been found that relate to the current disease, progressive infammatory neuropathy. They looked at chronic inflammatory demyelinating polyneuropathy (CIDP) which is characterized by progressive weakness and sensory impairment in the arms and legs. Damage occurs to the myelin sheath in the peripheral nervous system. As doctors at the Mayo Clinic were beginning to note, the problem they were seeing in progressive inflammatory neuropathy was occurring in the spinal nerve roots.
An initial comprehensive study of 24 known cases was conducted by multiple doctors from various disciplines at the Mayo Clinic. They identified the cause of this neurological disease to be occupational exposure to aerosolized pig neural tissue. Investigators from the Minnesota Department of Health (MDH) simultaneously determined that the 70 ppsi pressure used to liquefy and extract the pig brains caused the aerosolization of the pig neural tissue, sending it into the air in a fine mist. The workers closest in proximity to the "head" table, the area in the plant where high pressured air was used to evacuate the brain tissue from the pig's skull, were the most likely to be affected. The aerosolized mist was inhaled and readily absorbed into the workers' mucus membranes. The pig neural tissue was recognized by their systems as foreign and an immune response was initiated. The pig antigen was found most prominently in the nerve roots of the spine which were also swollen. Researchers determined that the irritation was due to the voltage-gated potassium channels being blocked. They identified 125 1-α-dendrotoxin as the antagonist that binds to and blocks the channels, causing an intracellular build-up of potassium ions which causes inflammation and irritation, and consequently, hyper-excitability in the peripheral nervous system. It is this hyper-excitability that leads to the tingling, numbness, pain, and weakness.
Researchers from the Mayo Clinic developed a mouse model that received twice daily liquefied pig neural tissue intranasally to replicate the symptoms that the workers were experiencing. Physiological testing indicated signature antibodies in the mouse model at 100% in potassium channel antibodies and myelin basic antibodies, and 91% in calcium channel antibodies. This model allowed the researchers to decipher what was causing these neurological symptoms. It was found that the potassium channels were being blocked so that inflammation was occurring at the nerve root and causing hyper-excitability down the peripheral nerves.
Currently the mechanism of spread and infection is unknown despite the tedious epidemiological, clinical, and neurological studies that have been conducted. Recent Studies show Horizontal Disease Transmission, or the transmission of a disease from one individual to another of the same generation. It appears that VE is an infectious disease; however, the incubation period would have to be very extensive (in excess of 5 years). Many infected individuals attribute the initial symptoms as a result of a plunge in frigid waters. So far, no causative agent has been found in blood, spinal fluid, or brain tissue.
It may result in death, and it is one of the most common causes of death for people with sickle cell anemia.
In medicine, describing a disease as acute denotes that it is of short and, as a corollary of that, of recent . The quantitation of how much time constitutes "short" and "recent" varies by disease and by context, but the core denotation of "acute" is always qualitatively in contrast with "chronic", which denotes long-lasting disease (for example, in acute leukemia and chronic leukemia). In addition, "acute" also often connotes two other meanings: onset and , such as in acute myocardial infarction (EMI), where suddenness and severity are both established aspects of the meaning. It thus often connotes that the condition is fulminant (as in the EMI example), but not always (as in acute rhinitis, which is usually synonymous with the common cold). The one thing that acute MI and acute rhinitis have in common is that they are not chronic. They can happen again (as in recurrent pneumonia, that is, multiple acute pneumonia episodes), but they are not the same ongoing for months or years (unlike chronic obstructive pulmonary disease, which is).
A noncount sense of "acute disease" refers to the acute phase, that is, a short course, of any disease entity. For example, in an article on ulcerative enteritis in poultry, the author says, "in acute disease there may be increased mortality without any obvious signs", referring to the acute form or phase of ulcerative enteritis.
Acute care is the early and specialist management of adult patients suffering from a wide range of medical conditions requiring urgent or emergency care usually within 48 hoursof admission or referral from other specialties.
Acute hospitals are those intended for short-term medical and/or surgical treatment and care. The related medical speciality is acute medicine.
Hydroxyurea is a medication that can help to prevent acute chest syndrome. It may cause a low white blood cell count, which can predispose the person to some types of infection.
Having cancer (current or previous) is currently one of the most prevalent out of all conditions among patients. High blood pressure, Chronic lung conditions, Alcohol abuse, Kidney failure, Malnutrition are another major risk factors.
ERU occurs in horses worldwide, but is more common in North America than in Europe, Australia or South Africa. Males and females are equally affected.
The Appaloosa has a higher risk of developing ERU than other breeds; this predisposition has a genetic basis. Appaloosas which develop ERU are more likely than other breeds to have ERU in both eyes, and more likely to become blind in one or both eyes.
Acute esophageal necrosis made an appearance on an American medical drama show, . Jan Garavaglia, the show's host, receives a female body, that at time of the autopsy had a severe case of acute esophageal necrosis due to chronic alcoholism.
As of 2007, fewer than 500 Yakut individuals have been infected with VE. Viliuisk Encephalomyelitis is classified as a progressive neurological disorder that ultimately ends in the death of the infected individual. The disease has three distinguishable phases: The acute form, the progressive form, and the chronic form.
The acute form is the most rapid and most violent of all the stages. It begins with the characteristic rigidity of the muscles, accompanied by slurred speech, severe headaches, and exaggeration of cold-like symptoms. Patients usually die within weeks of the initial symptoms. Routine post-mortem examinations yield: severe inflammation of the brain lining, clusters of dead cells and tissue, and largely increased amounts of macrophages and lymphocytes.
The progressive form is the most common case. Patients initially experience acute-like symptoms which are not as severe, and subside within a few weeks. Following the sub-acute phase, the patients experience a few mild symptoms including some behavioral changes, incoordination, and difficulty in speech. Eventually the disease developed fully and those infected were stricken with the characteristic symptoms of rigidity, slurred speech, and deterioration of cognitive functions. Ultimately, brain function depreciates rapidly resulting in death.
Many patients who undergo the chronic form claim never to have had an acute attack. These patients endure varying measures of impairment and suffer mental deterioration for the remainder of their lives. Usually they live to be very old and succumb to other diseases.
In almost all cases there are changes characteristic of VE. Early onset shows an increased number of lymphocytes and increased protein concentration — which reduces over many years. These factors help neurologists determine the form of VE based on progression. The trademark changes in the brain include: thickened inflamed meninges, necrotic cortical lesions, increased number of lymphocytes, and neuronal death.
Sixty percent of people with acute interstitial pneumonitis will die in the first six months of illness. The median survival is 1½ months.
However, most people who have one episode do not have a second. People who survive often recover lung function completely.
Late-onset meningitis is most likely infection from the community. Late onset meningitis may be caused by other Gram-negative bacteria and "staphylococcal" species. In developing countries "Streptococcus pneumoniae" accounts for most cases of late onset.
A study performed at Strong Memorial Hospital in Rochester, New York, showed that infants ≤ 60 days old meeting the following criteria were at low-risk for having a serious bacterial illness:
- generally well-appearing
- previously healthy
- full term (at ≥37 weeks gestation)
- no antibiotics perinatally
- no unexplained hyperbilirubinemia that required treatment
- no antibiotics since discharge
- no hospitalizations
- no chronic illness
- discharged at the same time or before the mother
- no evidence of skin, soft tissue, bone, joint, or ear infection
- White blood cells (WBCs) count 5,000-15,000/mm
- absolute band count ≤ 1,500/mm
- urine WBC count ≤ 10 per high power field (hpf)
- stool WBC count ≤ 5 per high power field (hpf) "only in infants with diarrhea"
Those meeting these criteria likely do not require a lumbar puncture, and are felt to be safe for discharge home without antibiotic treatment, or with a single dose of intramuscular antibiotics, but will still require close outpatient follow-up.
One risk for Group B streptococcal infection (GBS) is Preterm rupture of membranes. Screening women for GBS (via vaginal and rectal swabbing) and treating culture positive women with intrapartum chemoprophylaxis is reducing the number of neonatal sepsis caused by GBS.
In early-onset neonatal meningitis, acquisition of the bacteria is from the mother before the baby is born or during birth. The most common bacteria found in early-onset are group B "Streptococcus" (GBS), "Escherichia coli", and "Listeria monocytogenes". In developing countries, Gram-negative enteric (gut) bacteria are responsible for the majority of early onset meningitis.
Acute GPP typically requires inpatient management including both topical and systemic therapy, and supportive measures. Systemic glucocorticoid withdrawal is a common causative agent. Withdrawal or administration of certain drugs in the patient's previous medication regimen may be required. Oral retinoids are the most effective treatment, and are considered first line. Cyclosporine or infliximab may be required for particularly acute cases.