Acute idiopathic neuritis (Syndrome to Giyena-Barra)
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Description:
Giyn's syndrome — Barre (SGB, acute polyradiculitis) — the acute autoimmune inflammatory poliradikulonevropatiya which is shown sluggish paresis, sensitivity disturbances, vegetative frustration.
Symptoms of Acute idiopathic neuritis (Syndrome to Giyena-Barra):
The disease is characterized by rather symmetric muscular weakness (sluggish paresis) which typically begins in proximal departments of muscles of legs and in several hours or days extends to hands. Often weakness is followed by paresthesias of fingers of feet and brushes. Sometimes weakness first of all arises in hands or at the same time in hands and legs. Cerebrospinal fluid protein content increases (since 2nd week of a disease). In hard cases there are paralyzes of respiratory and cranial muscles, mainly mimic and bulbar. Tension symptoms are frequent a dorsodynia, a shoulder and pelvic girdle, sometimes irradiating on the course of roots. The expressed vegetative disturbances are often noted: increase or falling of arterial pressure, orthostatic hypotension, sinus tachycardia, bradyarrhythmia, passing ischuria. The intubation or suction of slime can provoke sharp bradycardia, a collapse and even a cardiac standstill. Having reached peak, the symptomatology is stabilized (the phase of the plateau lasts 2 — 4 weeks), and then recovery which can continue from several weeks to 1 — 2 years begins. Death is possible from the respiratory insufficiency connected with paralysis of the respiratory and/or bulbar centers, pneumonia, thromboembolisms of pulmonary arteries, cardiac standstills, sepsis, but thanks to modern methods of an intensive care, first of all IVL, the lethality decreased to 5% in the last decade.
Reasons of Acute idiopathic neuritis (Syndrome to Giyena-Barra):
In 1 — 3 weeks prior to display of a disease at most of patients note symptoms of an infection of digestive tract or respiratory tracts. Most often — after the enteritis caused by Campylobacter jejuni (the risk of development of SGB increases approximately by 100 times). Also it can be the infection caused herpes viruses (a cytomegalovirus, Epstein's virus — Barre, etc.), mycoplasmas, a hemophilic stick, etc. Possibly, the postponed infection starts autoimmune reaction (immunity of an organism strikes own cells). Vaccination, surgeries, injuries of peripheral nerves can play the same role. Autoimmune reaction against antigens of schwannian cells and a myelin leads to hypostasis, lymphocytic infiltration and segmented demyelination of roots of spinal and cranial nerves. Less often antigens of axons of peripheral nerves (are exposed to the attack at axonal option of a syndrome).
Treatment of Acute idiopathic neuritis (Syndrome to Giyena-Barra):
Even in mild cases to Giyen's syndrome — Barret in an acute phase should treat as medical emergency in view of danger of bystry development of heavy respiratory insufficiency or disturbance of a cordial rhythm. Urgent hospitalization of patients in intensive care units is obligatory. In a progressing phase — hourly observation of a condition of the patient with assessment of respiratory function, a cordial rhythm, arterial pressure, a condition of bulbar muscles, pelvic functions. Precursory symptoms of respiratory insufficiency: weakening of a voice, need to do pauses for a breath during the conversation, a sweat vystupaniye on a forehead and tachycardia at forced ventilation, easing of cough. At bulbar paralysis the intubation and introduction of the nazogastralny probe are necessary. The plasma exchange and immunoglobulin intravenously, capable to accelerate recovery and to reduce residual defect, are especially reasonable in a progressing phase (usually in the first 2 — 3 weeks from the beginning of a disease). Corticosteroids do not improve a disease outcome. For prevention of a deep vein thrombosis of a shin (at a plegiya in legs) appoint small doses of heparin or low-molecular heparin (фраксипарин). At paresis of mimic muscles measures for protection of a cornea are necessary (an instillation of eye drops, a bandage for the night). The early rehabilitation actions including massage, remedial gymnastics, other physiotherapeutic procedures are important (paraffin applications, magnetotherapy, radonic and hydrosulphuric bathtubs, electrostimulation, etc.).
