RRR, S1, S2 wnl, No murmurs, rubs, or gallops heard, Carotid upstroke NL, no bruit. Radial, Posterior tibial, dorsalis pedis pulse intact 2+ b/l, feet warm
– Neuro Exam: Mental Status Exam, Cranial nerves (including fundoscopic exam), Motor exam, DTRs, Gait, sensory exam
Alert and Oriented x 3, CN 2-12 intact grossly (except …); Motor: Strength 5/5 in all muscle groups; Sensation: Intact to pinprick and soft touch; DTRs, symmetric 2+ in upper and lower extremities, (-) babinski bilaterally; Gait: Normal
– burning foot paresthesias, that are worse at night and loss of ankle reflexes
– Neuropathic disorders associated with diabetes mellitus.
– Presumed to be as a result from diabetic microvascular injury involving small blood vessels that supply nerves (vasa nervorum)
– Relatively common conditions which may be associated with diabetic neuropathy include third nerve palsy; mononeuropathy; mononeuropathy multiplex; diabetic amyotrophy; a painful polyneuropathy; autonomic neuropathy; and thoracoabdominal neuropathy.
– Acute, autoimmune, polyradiculoneuropathy affecting the peripheral nervous system, usually triggered by an acute infectious process.
– Several types of GBS, but unless otherwise stated, GBS refers to the most common form, acute inflammatory demyelinating polyneuropathy (AIDP).
– Severe and usually ascending paralysis starting with lower limb (legs) weakness that ascends to upper limbs and face along with complete loss of DTRs.
DDX:
– Guillain-Barré Syndrome (GBS)
– Multiple Sclerosis (MS)
– Polymyositis
– Myasthenia Gravis (MG)
– Peripheral Neuropathy
– Tumor in the vertebral canal
Work-up:
– CBC with diff, Electrolytes, CPK, Serum B12
– LP—CSF analysis
– MRI— spine
– EMG/Nerve Conduction Study
– Tensilon Test
Treatment:
– plasmapheresis followed by immunoglobulins and supportive care
(ventilator b/c death may occur if severe pulmonary complications and dysautonomia are present)