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Syndrome to Giyena-Barra (acute polyradiculitis)
The syndrome to Giyena-Barra (other name acute polyradiculitis) is an acute inflammatory poliradikulonevropatiya which is shown by disorders of vegetative character, sluggish paresis, sensitivity disturbance.
Thereof diseases of people stays in a condition of a full or partial obezdvizhennost. Gradually, in development of an illness of people loses ability to take things hands, to swallow, raise eyelids, etc. This disease is rather rare. SGB is diagnosed worldwide, shown both at adults, and at children. Develops at men more often, however a considerable difference of quantity of cases of an illness at different floors it is not fixed.
The first this illness was described in 1916 by neuropathologists from France G. Giyen and J. Barret on whose names the disease also was called afterwards. But still there is no exact information on the reasons of its emergence. Generally the illness develops as an effect of the acute infection which is earlier shown at the patient. There is an assumption that the disease provokes the filtered virus. But nevertheless most of specialists are inclined to consider that the syndrome to Giyena-Barra has the allergic nature.
The illness is considered as autoimmune process at which destruction of nervous tissue develops. Therefore, the immune system of the person begins "fight" against own organism and develops antibodies to some molecules of a cover of nerves. There is a damage of nerves and nervous roots which are on a joint of peripheral and central nervous systems. At the same time there is no damage of a head and spinal cord. The disease begins to develop under the influence of viruses. In this case most often the illness begins with defeat of an organism a cytomegalovirus, a virus Epshtayn-Barra, and also bacteria. Reaction of immunity to penetration of the alien agent develops at an organism normality. But failures in reaction to own and others cells are in certain cases shown. As a result, immunity fights against an organism.
Syndrome symptoms to Giyena-Barra are initially shown by the general weakness, and also fervescence to subfebrile and hand and legs pain. Pain can also have the surrounding character. But nevertheless a distinguishing character of SGB is the accurate feeling of weakness of muscles in extremities. In distal departments, both hands, and legs, paresthesias are shown, in certain cases they arise also around a mouth and in language. Weakness of face muscles and other nerves of the person, and also vegetative disturbances is sometimes noted. Disturbances of motive character are initially shown in legs, and later – move also to hands. Sometimes the general symptom complex at this syndrome reminds myopathy signs.
If at development of a syndrome to Giyena-Barra damages of nerves of bulbar group are noted, then without timely respiratory reanimation of people can die.
Also disturbances of vegetative character which are shown by a chill and a cold snap of distal departments of extremities, the hyperhidrosis phenomenon are brightly expressed. At a heavy course of a disease disturbance of pelvic functions is sometimes observed that is shown by an urination delay. Such symptom, as a rule, proceeds from 3 to 5 days.
Acute polyradiculitis, as a rule, develops on an extent from two to four weeks then the condition of the person is stabilized, and there comes improvement of a state. Not only acute forms of a disease, but also subacute, and also chronic are diagnosed. In most cases it is about the favorable forecast, but sometimes the disease develops as the ascending Landry's paralysis when paralysis extends to muscles of hands, trunks and bulbar muscles.
That the outcome was favorable, it is important to distinguish an illness at early stages and to timely begin its therapy. Initially the specialist carries surely out detailed inquiry during which he defines how there was an increase of symptoms of an illness what signs were shown. The syndrome to Giyena-Barra is considered important criterion for establishment of the diagnosis muscular weakness in hands and/or in legs, having progressing character, and also a tendinous areflexia.
The doctor surely notes existence of symmetry of defeat, disturbances of sensitivity, damage of cranial nerves, vegetative disturbances. An important point also is absence of fever in the first days of an illness. In the course of diagnosis it is important to define existence of typical proteinaceous and cellular dissociation in cerebrospinal liquid. When carrying out a puncture high concentration of protein is noted.
Giyen's polyradiculoneuritis (Giyena-Barra) has some signs similar to symptoms of other diseases. It is important to distinguish its manifestations from botulism, a myasthenia, paralysis which arises as an effect of reception of antibiotics. It is also important to differentiate an illness with damages of a spinal cord and a trunk of a brain, a cross myelitis, a porfiriyny polyneuropathy, etc. Laboratory researches are for this purpose conducted, additional methods of inspection of the patient are appointed. In particular, at suspicion on SGB research of composition of cerebrospinal fluid, an electromyography is conducted. If in cerebrospinal fluid the high level of protein after the first week of an illness takes place, or its contents increases later, then it is possible to speak about suspicion on a syndrome to Giyena-Barra. Also features of cellular structure are investigated.
Treatment of an illness to Giyena-Barra is carried out right after establishment of the diagnosis. As an effective method of therapy it is considered to be a plasma exchange with administration intravenously of immunoglobulin. Sick SGB the blood plasma partially is removed, uniform elements at the same time return. Also in the course of treatment reception of glucocorticoids practices (in particular, to patients Prednisolonum on 1–2 mk/kg in days), antihistaminic drugs (Suprastinum, a Dimedrol), reception of vitamins (mainly groups B is appointed). Also complex treatment includes reception of antikholinesterazny drugs (Prozerina, Galantaminum).
In the course of therapy it is important to provide high-quality care of the patient, and also to constantly control functions of his cardiovascular and respiratory systems. At a severe disease respiratory insufficiency very quickly can be shown, and in the absence of fast treatment the lethal outcome is possible. At reduction of capacity of lungs or at manifestation of bulbar syndromes urgent carrying out an intubation or tracheotomy is necessary to provide artificial ventilation of the lungs. In the course of a nosotrophy, at least, once very carefully follows at two o'clock to overturn the patient in a bed.
If the patient has symptoms of arterial hypertension, and also tachycardias, then attacks need to be removed by means of antagonists of calcium ions and beta adrenoblockers. To avoid rise in arterial pressure, administration of liquid intravenously practices to increase intravascular volume.
If it observes an acute delay of urination, then owing to a metastasis ad nervos pulse and arterial pressure can fluctuate. At such development of a disease it is necessary to apply a constant catheter.
It is not less important to provide high-quality recovery therapy when the condition of the person improves. At this time physiotherapy exercises, ozokerite, massage, paraffin, etc. are shown to the patient.
If to speak about forecasts, then recovery of a normality of health without serious effects is observed approximately at 80% of people for whom polyneuropathy to Giyena-Barra was diagnosed. However it is necessary to consider that at a severe disease recovery will also be longer and difficult. Patients completely recover and lead full life. But nevertheless throughout life the people who had SGB can feel small weakness in hands and legs.
Also existence or lack of the residual phenomena depends on weight of an illness. Sometimes recovery happens about 1,5-2. But it happens and so that recovery does not happen, and the person then completely depends on the help of other people. Such picture is observed approximately in 5-8% of cases of SGB. According to different data, mortality owing to a disease can make from 1 to 18%. Most often people perish owing to bronchial pneumonia and respiratory a distress syndrome.