Acute Neuropathy Mimicking Guillain-Barré Syndrome after Diabetic Ketoacidosis: A Case Report

基蘭巴瑞症候群是週邊神經疾病中常見需要重症加護治療的診斷之一，甚至常常需要使用呼吸器治療。然而，在各類重症加護的疾病病患中，基蘭巴瑞症候群卻是極少見的週邊神經併發症，雖然其他神經肌肉疾病，譬如神經肌肉交接處病變(neuromuscular junction disorders)或各種肌肉病變(myopathy)，常常出現在重症加護疾患的身上。本文描述一位四十二歲女性因呈現重度昏迷轉入本院加護病房，入院前四週患者開始出現多喝、多尿及體重快速減少的症狀。實驗室檢查顯示患者的血糖值高達956 mg/dl，同時出現代謝性酸中毒以及尿中酮體陽性反應，因此診斷為糖尿病酮酸中毒。經過大量體液補充以及胰島素靜脈注射治療後患者意識逐漸恢復，而且實驗室檢查數據也趨於正常值。然而患者在入院後第四天下肢逐漸出現上行性肌肉無力與感覺異常(ascending weakness and paresthesia)，根據患者臨床症狀表現、脊椎磁振攝影以及肌電生理檢查的結果，診斷為軸突性(axonal)基蘭巴瑞症候群，同時表現為截癱變異型(paraparesis variant)，此為糖尿病酮酸中毒極少見之相關合併症。患者出院後經過八週的門診復健治療，已可持助行器行走，同時日常生活活動可以完全獨立執行。本文將進一步討論加護重症病患發生急性肌肉無力的鑑別診斷，同時會針對基蘭巴瑞症候群與糖尿病的病生理機轉之相關性進行探討。對於基蘭巴瑞症候群的診斷和處理原則，以及相關的復健治療也將一併描述。

關鍵字

糖尿病酮酸中毒；基蘭巴瑞症候群

並列摘要

A 42 year-old woman was admitted in a comatose state after exhibiting polydipsia and progressive body weight loss of 4-week duration. Diabetic ketoacidosis was diagnosed due to an increased blood glucose level (956 mg/dl), metabolic acidosis, and positive urinary ketone bodies. On the fourth hospital day, despite recovery from the critical state of ketoacidosis, the patient suffered from progressively ascending paresthesia and weakness in the lower limbs. On the basis of clinical and electrophysiological findings, axonal Guillain-Barré syndrome presenting as a paraparesis variant, a very unusual neuropathy related to diabetic ketoacidosis, was diagnosed. The patient reached satisfactory functional outcome after eight weeks of outpatient rehabilitation program. This article discusses the differential diagnoses of acute onset of weakness in critically ill patients. Correlation of pathogenesis between Guillain-Barré syndrome and diabetes mellitus is briefly described. Management policies of Guillain-Barré syndrome, including rehabilitative treatment, are also delineated.

並列關鍵字

diabetic ketoacidosis ； Guillain-Barré syndrome

國際替代計量

Acute Neuropathy Mimicking Guillain-Barré Syndrome after Diabetic Ketoacidosis: A Case Report

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