Eelco F. M. Wijdicks

Clinical factors associated with Guillain-Barré syndrome following surgery

Background We sought to identify clinical associations and potential triggers of Guillain-Barré syndrome (GBS) within 6 weeks of surgery. Methods We retrospectively reviewed consecutive patients diagnosed with GBS within 6 weeks of a surgery between January 1995 and June 2014 at Mayo Clinic. Postsurgical GBS was defined as symptom onset within 6 weeks of surgery. Patients with postsurgical GBS were compared with patients who did not have a surgery prior to GBS onset to determine differences between groups. Results A total of 208 patients with GBS, median age 55 years (interquartile range [IQR] 41–68), were included. Nineteen patients (9.1%) developed postsurgical GBS. Median duration from the surgery to onset of first GBS symptom was 15 days (IQR 9–37). The main types of surgeries preceding GBS were gastrointestinal, orthopedic, and cardiac. General anesthesia was used in 18 (95%) and conscious sedation in 1 (5%) patient. Among the 19 patients with postsurgical GBS, 11 (57.9%) had a known diagnosis of malignancy. Autoimmune conditions were present in 5 (26.3%) patients. Postoperative infection was found in 4 (21%) patients. On univariate analysis, the factors that showed an association with postsurgical GBS were age (p = 0.02), malignancy (p ⩽ 0.0004), active malignancy (p = 0.03), preexisting autoimmune disorder (p = 0.02), and infection (p = 0.0001). On multivariate analysis, only active malignancy (0.03) remained associated. Conclusions Surgery antedated GBS in 9.1% of patients. Postsurgical GBS was more common in patients with an active malignancy. A prospective study is needed to determine whether active malignancy represents an independent risk factor for the development of postsurgical GBS.

Critical care neurology: Five new things

Critical care neurology has generated interest both because of the urgency to understand acute brain injury and because acute interventions could improve outcomes. Unifying themes include intervention without delay and early recognition of the potential for deterioration of the patient. While monitoring devices offer useful prognostic indicators, conducting a thorough clinical neurologic examination is paramount in determining the most effective course of patient management. Recent progress has been made in acute brain injury monitoring, more effective reversal of anticoagulation after cerebral hemorrhage, use of hypothermia as a therapeutic intervention, and in the management of severe Guillain-Barré syndrome.

Guillain-Barré syndrome after surgical procedures: Predisposing factors and outcome

Abstract Background: We sought to identify clinical associations and potential triggers of Guillain-Barre syndrome (GBS) within 8 weeks of surgical procedures. Methods: We retrospectively reviewed consecutive patients diagnosed with GBS within 8 weeks of a surgical procedure between January 1995 and June 2014 at Mayo Clinic. Postsurgical GBS was defined as symptom onset within 8 weeks of a surgical procedure. Patients with postsurgical GBS were compared with patients who did not have a surgery or procedure prior to GBS onset to determine differences between groups. Results: A total of 208 patients with GBS, median age 55 years (interquartile range [IQR] 41–68), were included. Thirty-one patients (15%) developed postsurgical GBS. Median duration from the surgery or procedure to onset of first GBS symptom was 19 days (IQR 11.1–37.5). The main types of surgeries/procedures preceding GBS were gastrointestinal, cardiac, and orthopedic. General anesthesia was used in 18 (58%) and conscious sedation in 13 (42%) patients. Among the 31 patients with postsurgical GBS, 19 (61%) had a known diagnosis of malignancy. Autoimmune conditions were present in 9 (29%) patients. Additional triggering factors were identified in 11 (35.5%) patients. On univariate analysis, the factors that showed an association with postsurgical GBS were age ( p = 0.003), malignancy ( p p = 0.05), preexisting autoimmune disorder ( p = 0.001), and duration of hospital stay ( p = 0.015). On multivariate analysis, age ( p = 0.045), malignancy ( p p = 0.004) remained associated. Conclusions: Surgical procedures antedated GBS in 15% of patients, which is unexpectedly high. History of malignancy or autoimmune disease may predispose to development of postsurgical GBS.