Akute Immunneuropathie und Optikusneuritis – Übersicht und
                    Fallbericht eines seltenen Überlappungssyndroms

Marvin Jüchtern; Frederik Maximilian Nebelo; Michael Mull; Manuel Dafotakis; Robert Brunkhorst; Oliver Matz

doi:10.1055/a-2282-8434

Klinische Neurophysiologie, Table of Contents

Klinische Neurophysiologie 2024; 55(04): 209-217
DOI: 10.1055/a-2282-8434

Übersicht

Akute Immunneuropathie und Optikusneuritis – Übersicht und Fallbericht eines seltenen Überlappungssyndroms

Acute Immune-Mediated Neuropathy and Optic Neuritis – Overview and Case Report of a Rare Syndrome Overlap

Authors

Marvin Jüchtern

¹Department of Neurology, University Hospital Aachen, Aachen, Germany
Frederik Maximilian Nebelo

¹Department of Neurology, University Hospital Aachen, Aachen, Germany
Michael Mull

²Clinic for Diagnostic and Interventional Neuroradiology, University Hospital Aachen, Aachen, Germany
Manuel Dafotakis

¹Department of Neurology, University Hospital Aachen, Aachen, Germany
Robert Brunkhorst

¹Department of Neurology, University Hospital Aachen, Aachen, Germany
Oliver Matz

¹Department of Neurology, University Hospital Aachen, Aachen, Germany

Abstract

Zusammenfassung

Die vorliegende Arbeit gibt einen Überblick über nosologische, pathomechanistische und therapeutische Aspekte von kranialen Überlappungssyndromen akuter Immunneuropathien. Eine 18-jährige Patientin entwickelte eine bilaterale faziale Parese, akrodistale Parästhesien und Sehstörungen nach einem gastrointestinalen Infekt. Kraft, Koordination und Muskeleigenreflexe der Extremitäten waren regelrecht. Bei Kontrastmittelaufnahme mehrerer Hirnnerven sowie von Konus- und Kaudafasern, zytoalbuminärer Dissoziation im Liquor und Demyelinisierungszeichen in der Elektroneurographie diagnostizierten wir eine akut-inflammatorische demyelinisierende Polyradikuloneuritis mit Neuritis nervi optici. Die Beschwerden der Patientin sprachen gut auf eine Plasmapherese an. Auch bei Patienten mit Hirnnervenparesen und Parästhesien ohne Hyporeflexie oder Extremitätenschwäche sollte an eine akute Immunneuropathie gedacht werden. Kombinationen mit zentraler Affektion wie der Optikusneuritis sind dabei möglich.

Abstract

The present work provides an overview of nosological, pathomechanistic and therapeutic aspects of cranial overlap syndromes of acute immune-mediated neuropathies. An 18-year-old woman developed bilateral facial palsy and hypesthesia, acrodistal paresthesia as well as impaired vision after a gastrointestinal infection. Muscle power and coordination were unaffected and deep tendon reflexes were preserved. Based on contrast enhancement of cranial nerves II, IV, V and VII as well as conus and cauda fibers, albuminocytologic dissociation in the cerebrospinal fluid and electroneurographic signs of demyelination, we diagnosed acute-inflammatory demyelinating polyradiculoneuropathy with optic neuritis. The patient’s complaints responded well to plasmapheresis. Even in patients with cranial nerve palsies and paresthesias without diminished deep tendon reflexes or extremity weakness, one should consider the possibility of acute immune-mediated neuropathy. A coincident central affection such as optic neuritis is possible.

Schlüsselwörter

Inflammatorische Neuropathie - Diplegia facialis - Parästhesie - Polyneuritis cranialis - Zytoalbuminäre Dissoziation

Keywords

Inflammatory neuropathy - paresthesia - albuminocytologic dissociation - bifacial weakness - polyneuritis cranialis

Full Text

References

Literatur
1 Shahrizaila N, Lehmann HC, Kuwabara S. Guillain-Barre syndrome. Lancet 2021; 397: 1214-1228
2 Wakerley BR, Yuki N. Mimics and chameleons in Guillain-Barre and Miller Fisher syndromes. Pract Neurol 2015; 15: 90-99
3 Wakerley BR, Uncini A, Yuki N. et al. Guillain-Barre and Miller Fisher syndromes--new diagnostic classification. Nat Rev Neurol 2014; 10: 537-544
4 Wakerley BR, Yuki N. Polyneuritis cranialis--subtype of Guillain-Barre syndrome?. Nat Rev Neurol 2015; 11: 664
5 Wakerley BR, Yuki N. Polyneuritis cranialis: oculopharyngeal subtype of Guillain-Barre syndrome. J Neurol 2015; 262: 2001-2012
6 Susuki K, Koga M, Hirata K. et al. A Guillain-Barre syndrome variant with prominent facial diplegia. J Neurol 2009; 256: 1899-1905
7 Stuby J, Roth R, Strecker N. et al. Post-COVID-19 bifacial weakness and paraesthesia: a case report. Swiss Med Wkly 2021; 151: w30066
8 Hutchins KL, Jansen JH, Comer AD. et al. COVID-19-Associated Bifacial Weakness with Paresthesia Subtype of Guillain-Barre Syndrome. AJNR Am J Neuroradiol 2020; 41: 1707-1711
9 Castiglione JI, Crespo JM, Lecchini L. et al. Bilateral facial palsy with paresthesias, variant of Guillain-Barre syndrome following COVID-19 vaccine: A case series of 9 patients. Neuromuscul Disord 2022; 32: 572-574
10 Yuki N. Infectious origins of, and molecular mimicry in, Guillain-Barre and Fisher syndromes. Lancet Infect Dis 2001; 1: 29-37
11 Baxter R, Lewis E, Fireman B. et al. Case-centered Analysis of Optic Neuritis After Vaccines. Clin Infect Dis 2016; 63: 79-81
12 Petzold A, Fraser CL, Abegg M. et al. Diagnosis and classification of optic neuritis. Lancet Neurol 2022; 21: 1120-1134
13 Li H, Li Z, Huang B. et al. Co-occurrence of polyneuritis crainials and visual impairment: a case report and literature review. Neurol Sci 2022; 1-12
14 Richardson-May J, Purcaru E, Campbell C. et al. Guillain-Barre Syndrome and Unilateral Optic Neuritis Following Vaccination for COVID-19: A Case Report and Literature Review. Neuroophthalmology 2022; 46: 413-419
15 Rubino A, Della Corte M, Bruno G. et al. Atypical Clinical and Neuroradiological Findings in a Child With Bifacial Weakness With Paresthesias. J Clin Neuromuscul Dis 2021; 23: 105-109
16 Doxaki C, Papadopoulou E, Maniadaki I. et al. Case Report: Intracranial Hypertension Secondary to Guillain-Barre Syndrome. Front Pediatr 2020; 8: 608695
17 Chen A, Kim J, Henderson G. et al. Posterior reversible encephalopathy syndrome in Guillain-Barre syndrome. J Clin Neurosci 2015; 22: 914-916
18 Nadkarni N, Lisak RP. Guillain-Barre syndrome (GBS) with bilateral optic neuritis and central white matter disease. Neurology 1993; 43: 842-843
19 Chan JW. Optic neuritis in anti-GQ1b positive recurrent Miller Fisher syndrome. Br J Ophthalmol 2003; 87: 1185-1186
20 Andersen EW, Ryan MM, Leventer RJ. Guillain-Barre syndrome with optic neuritis. J Paediatr Child Health 2022; 58: 887-890
21 Wakerley BR, Kokubun N, Funakoshi K. et al. Clinical classification of 103 Japanese patients with Guillain-Barre syndrome. J Neurol Sci 2016; 369: 43-47
22 Hiew FL, Ramlan R, Viswanathan S. et al. Guillain-Barre Syndrome, variants & forms fruste: Reclassification with new criteria. Clin Neurol Neurosurg 2017; 158: 114-118
23 Kumar P, Charaniya R, Bahl A. et al. Facial Diplegia with Paresthesia: An Uncommon Variant of Guillain-Barre Syndrome. J Clin Diagn Res 2016; 10: OD01-OD02
24 Trikamji B, Adler M. Guillain-Barre Syndrome Variant With Facial Diplegia and Paresthesias Presenting With Bulbar Weakness. J Clin Neuromuscul Dis 2019; 21: 122-123
25 Kim JK, Oh SY, Sohn EH. et al. When is facial diplegia regarded as a variant of Guillain-Barre syndrome?. J Peripher Nerv Syst 2015; 20: 32-36
26 Frahm-Falkenberg S, de la Cour CD, Andersen PB. Simultaneous bilateral peripheral facial paralysis is a rare variant of Guillain-Barre syndrome. Ugeskr Laeger 2014; 176 V01140028
27 Albuainain G. Bilateral Facial Palsy and Hyperreflexia as the Main Clinical Presentation in Guillain-Barre Syndrome. Am J Case Rep 2021; 22: e932757
28 Dal Verme A, Acosta P, Margan M. et al. Facial diplegia with atypical paresthesia. A variant of Guillain-Barre syndrome. Medicina (B Aires) 2015; 75: 178-180
29 Susuki K, Atsumi M, Koga M. et al. Acute facial diplegia and hyperreflexia: A Guillain-Barre syndrome variant. Neurology 2004; 62: 825-827
30 Lehmann HC, Macht S, Jander S. et al. Guillain-Barre syndrome variant with prominent facial diplegia, limb paresthesia, and brisk reflexes. J Neurol 2012; 259: 370-371
31 Yuki N, Kokubun N, Kuwabara S. et al. Guillain-Barre syndrome associated with normal or exaggerated tendon reflexes. J Neurol 2012; 259: 1181-1190
32 Aasfara J, Hajjij A, Bensouda H. et al. A unique association of bifacial weakness, paresthesia and vestibulocochlear neuritis as post-COVID-19 manifestation in pregnant women: a case report. Pan Afr Med J 2021; 38: 30
33 Carroll CG, Campbell WW. Multiple cranial neuropathies. Semin Neurol 2009; 29: 53-65
34 Götz GF, Hartmann H, Giesemann AM. Polyneuritis cranialis: Neuroborreliose mit asymptomatischem Hirnnervenenhancement. Klinische Neurophysiologie 2015; 46: 98-99
35 Achenbach P, Block F, Dafotakis M. Medikamentös-induzierte Polyneuropathien jenseits von Chemotherapeutika und Antiinfektiva. Klinische Neurophysiologie 2022; 53: 174-187
36 Yamashita H, Koga M, Morimatsu M. et al. Polyneuritis cranialis related to anti-GT1 a IgG antibody. J Neurol 2001; 248: 65-66
37 Shahrizaila N, Yuki N. Bickerstaff brainstem encephalitis and Fisher syndrome: anti-GQ1b antibody syndrome. J Neurol Neurosurg Psychiatry 2013; 84: 576-583
38 Koga M, Yoshino H, Morimatsu M. et al. Anti-GT1a IgG in Guillain-Barre syndrome. J Neurol Neurosurg Psychiatry 2002; 72: 767-771
39 O'Leary CP, Veitch J, Durward WF. et al. Acute oropharyngeal palsy is associated with antibodies to GQ1b and GT1a gangliosides. J Neurol Neurosurg Psychiatry 1996; 61: 649-651
40 Yoshino H, Maeda Y, King M. et al. Sulfated glucuronyl glycolipids and gangliosides in the optic nerve of humans. Neurology 1993; 43: 408-411
41 Chiba A, Kusunoki S, Obata H. et al. Ganglioside composition of the human cranial nerves, with special reference to pathophysiology of Miller Fisher syndrome. Brain Res 1997; 745: 32-36
42 Biotti D, Boucher S, Ong E. et al. Optic neuritis as a possible phenotype of anti-GQ1b/GT1a antibody syndrome. J Neurol 2013; 260: 2890-2891
43 Lamotte G, Laballe R, Dupuy B. Bilateral eyelid retraction, loss of vision, ophthalmoplegia: an atypical triad in anti-GQ1b syndrome. Rev Neurol (Paris) 2014; 170: 469-470
44 Incecik F, Herguner OM, Besen S. et al. Guillain-Barre syndrome with hyperreflexia and bilateral papillitis in a child. J Pediatr Neurosci 2016; 11: 71-73
45 Wen HJ. Acute bilateral vision deficit as the initial symptom in Guillain-Barre syndrome: A case report. Exp Ther Med 2018; 16: 2712-2716
46 Matsunaga M, Kodama Y, Maruyama S. et al. Guillain-Barre syndrome and optic neuritis after Mycoplasma pneumoniae infection. Brain Dev 2018; 40: 439-442
47 Cortese A, Franciotta D, Alfonsi E. et al. Combined central and peripheral demyelination: Clinical features, diagnostic findings, and treatment. J Neurol Sci 2016; 363: 182-187
48 Kamm C. New clinical insights into combined central and peripheral demyelination (CCPD). J Neurol Sci 2016; 364: 27-28
49 Kira JI. Anti-Neurofascin 155 Antibody-Positive Chronic Inflammatory Demyelinating Polyneuropathy/Combined Central and Peripheral Demyelination: Strategies for Diagnosis and Treatment Based on the Disease Mechanism. Front Neurol 2021; 12: 665136
50 Hughes RA, Brassington R, Gunn AA. et al. Corticosteroids for Guillain-Barre syndrome. Cochrane Database Syst Rev 2016; 10: CD001446
51 Biotti D, Vignal C, Sharshar T. et al. Blindness, weakness, and tingling. Surv Ophthalmol 2012; 57: 565-572
52 Belkhribchia MR, Chekabab A, Naji Y. et al. Severe Headache, Paraesthesias, Facial Diplegia and Pleocytosis: A Misleading Presentation of Guillain-Barre Syndrome. Eur J Case Rep Intern Med 2021; 8: 002211