Orginal Publication Date
MCV/Q, Medical College of Virginia Quarterly
Progressive flaccid paralysis occurring over a period of hours or days is usually associated with the Landry-Guillain-Barré-Strohl syndrome. This symptom complex is often accompanied by a history of previous flu-like illness, antecedent myalgias, and subjective sensory complaints of tingling or simply a “tight” sensation in hands and feet. The paralysis that ensues either ascends from the feet and legs or descends from the facial muscles to involve all or most of the voluntary skeletal musculature. Along with paralysis of the intercostal and diaphragmatic musculature, severe cases may also involve other cranial nerves as well as the autonomic nervous system. In all cases the deep tendon reflexes are markedly diminished or absent early in the course of the disease. Sensory abnormalities are usually mild or absent. Confirmatory diagnostic studies include examination of the cerebral spinal fluid (CSF) which shows no or few mononuclear cells and an elevated protein. Nerve conduction studies may show prolonged distal latencies, slowing of nerve conduction velocities, and prolonged F responses which measure the radicular segments of the nerve. Overall prognosis is difficult to predict, with recovery taking weeks to months. Fatalities can occur despite optimal care in an intensive care unit.
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