atypical findings of guillain-barré syndrome in children

how to cite this article: karimzadeh p, bakhshandeh bali mk, nasehi mm, taheri otaghsara sm, ghofrani m. atypical findings of guillain-barré syndrome in children. iran j child neurol autumn 2012;6(4):17-22.   abstract objective guillain-barre syndrome (gbs) is an immune-mediated polyneuropathy that occurs mostly after  prior infection. the diagnosis of this syndrome is dependent heavily on the history and examination, although cerebrospinal fluid analysis and electrodiagnostic testing usually confirm the diagnosis. this is a retrospective study which was performed to investigate the atypical features of gbs. materials & methods thirty three patients (21/63.6% males and 12/36.4% females) with gbs were retrospectively studied and prospectively evaluated at the child neurology institute of mofid children hospital of shahid beheshti university of medical sciences between may 2011 and september 2012. results the mean age was 5.4 years (range, 1.5-10.5).twenty one patients (87.9 %) had previous history of infections. eight patients (24.2%) admitted with atypical symptoms like upper limb weakness (3%), ptosis (3%), neck stiffness (3%), inability to stand (proximal weakness) (9.1%), headache (3%) and dysphagia (3%).according to disease process, weakness was ascending in 26 (78.8%), descending in 5 (15.2%) and static in 2 (6.1%) patients. cranial nerve involvement was found in 8(24.3%) children, most commonly as facial palsy in 3 (9.1%). conclusion in this study, 24.3% of our patients presented with atypical symptoms of gbs as upper limb weakness, ptosis, neck stiffness, inability to stand (proximal weakness), headache and dysphagia   references: hughes ra, cornblath dr. guillain-barré syndrome. lancet. 2005 nov 5;366(9497):1653-66. mcgillicuddy dc, walker o, shapiro ni, edlow ja. guillain-barré syndrome in the emergency department. ann emerg med. 2006 apr;47(4):390-3. cosi v, versino m. guillain-barré syndrome. neurol sci. 2006;27(suppl 1):s47-51. hughes ra, cornblath dr. guillain-barré syndrome. lancet. 2005 nov;366(9497):1653-66. barzegar m, dastgiri s, karegarmaher mh, varshochiani a. epidemiology of childhood guillan barre syndrome in the north west of iran. bmc neurol. 2007 aug 5;7:22. vriesendorp fj, mishu b, blaser mj, koski cl. serum antibodies to gm1, gd1b, peripheral nerve myelin, and campylobacter jejuni in patients with guillain-barre syndrome and controls: correlation and prognosis. ann neurol. 1993 aug;34(2):130-5. asbury ak, cornblath dr. assessment of current diagnostic criteria for guillain-barre syndrome. ann neurol. 1990;27 suppl:s21-4. hughes ra, cornblath dr. guillain-barre syndrome. lancet. 2005 nov;366(9497):1653-66. govoni v, granieri e. epidemiology of the guillain-barre syndrome. curr opin neurol. 2001 oct;14(5):605-13. gordon ph, wilbourn aj. early electrodiagnostic findings in guillain-barré syndrome. arch neurol. 2001 jun;58(6):913-7. darabi k, abdel-wahab o, dzik wh. current usage of intravenous immune globulin and the rationale behind it: the massachusetts general hospital data and a review of the literature. transfusion. 2006 may;46(5):741-53. hughes ra, raphaël jc, swan av, van doorn pa. intravenous immunoglobulin for guillain-barré syndrome. cochrane database syst rev. 2006 jan 25;(1):cd002063. hughes ra, swan av, van koningsveld r, van doorn pa. corticosteroids for guillain-barré syndrome. cochrane database syst rev. 2006 apr 19;(2):cd001446. asbury ak, cornblath dr. assessment of current diagnostic criteria for guillain-barre syndrome. ann neurol. 1990; 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