Peripheral neuropathy Guillain Barré Syndrome
May 24, 2025Central neurological toxicity- Encephalitis
May 24, 2025Neurologic - Central neurological toxicity - Transversal myelitis
Signs & Symptoms
- Acute or subacute neurological signs/symptoms of motor/sensory/autonomic origin
- Most have sensory symptoms
- Often bilateral symptoms
Evaluation
- Always MRI to exclude compression
- Lumbar puncture after brain imaging: analysis of CSF for white blood cell analysis (ideally including flowcytometry analysis), proteinorraghy, glucose level, presence for neoplastic cells
- infectious workup (incl. viral and bacterial analysis in CSF and blood according to local practice (incl. viral and bacterial analysis in CSF and blood: eg varicella, hepatitis E, HSV1, HSV2, VZV, EBV, syphilis, HIV, CMV …):
- Blood analysis for: lactate, copper levels in the blood, TSH, B12
- Autoimmune serology: anti-MOG, anti-aquaporin-4 IgG, ANF
Management
- IV 500mg-1gr methylprednisolone during 3-5 days followed by oral steroid tapering
- Plasmapheresis might be indicated if no response to corticoid therapy upon 1 week of treatment
- ICU admission should be considered if autonomic instability
- Neurological consult