Guillain-Barré Syndrome Presenting with Severe Pain: Report of One Case

以嚴重疼痛表現之Guillain-Barré症候群：一病例報告

黎璧賢(Pi-Hsien Li) ； 張海山(Hai-San Chang) ； 黃小燕(Hsiao-Yen Huang) ； 林哲雄(Jer-Shung Lin)

《Acta Paediatrica Taiwanica》 41卷1期 (2000/02) Pp. 33-35

https://doi.org/10.7097/APT.200002.0033

摘要

神經科醫師多已熟悉Buillain-Barré症候群會合併肢體及背部疼痛，但一般小兒科醫師仍可能忽略疼痛在本症候群的復雜性及重要性。我們報告一位十歲女孩，因頭痛三天及下肢麻木一天而住院體檢發現深層肌健反射降低、肌力輕微減頭部明顯僵硬合併右側顏面神經麻庳，一度曾懷疑為腦膜炎。住院期間，頭部、頸部、下背及小腿持績嚴重疼痛至無法入睡，對止痛藥反應差。發病後第八天因呼吸衰竭需要使用呼吸器。入院首次脊隨液檢查為正常，發病後第十一天之脊隨液檢查發現白血球0/mm^3，蛋白質254mg/dl。之後，自主神經失調症狀，如高血壓和心搏過速，陸續出現並持續一周。經給予高劑量的免疫球蛋白治療後，逐漸穩定進步，但四肢關節疼痛仍持續三周。第二十九天脫離呼吸器，約四十天可獨自行走，七十天可以跑步，六個月後完全康復。依病史、體檢發現、病程進展及脊隨液呈白蛋白細胞解離現象而診斷為Guillain-Barré症候群。作者希望藉此病例報告，使小兒科醫師進一步瞭解疼痛在Guillain-Barré症候群的角色，以俾早期正確診斷和治療。

關鍵字

急性神經根炎 ； 疼痛

並列摘要

Most neurologists are familiar with pain in Guillain-Barré syndrome but some pediatricians may still miss or underestimate it. We report a 10-year-old girl who presented with headache and numbness in lower extremities. On examination, she could walk and showed hyporeflexia, mild muscle weakness, prominent neck rigidity and right facial nerve palsy. Headache and pain in neck, low back and calves were so severe that she could not fall asleep and the response to analgesic was very poor. On 8th day of illness, she needed mechanical ventilation and suffered tetraplegia. Symptoms of autonomic dysfunction including hypertension and sinus tachycardia appeared thereafter and lasted for a week. After receiving a high dose of intravenous immunoglobulin (2 g/kg in 2 days), her condition improved gradually although joint pain persisted for about three weeks. She could walk unaided by day 40 and run by day 70, and recovered completely 6 months later. We emphasize that pain in GBS needs proper evaluation and management in children as well as in adults.

並列關鍵字

polyneuropathy ； Guillain-Barré syndrome ； pain