Session Time: 12:30pm-2:00pm
Location: Research Hub - Kiosk 1
Disclosures: Lauren A. White, DO, MPH: Nothing to disclose
Case Description: Patient presented with bilateral hand numbness, impaired fine motor function, and diplopia approximately 2 weeks after an upper respiratory tract infection. Physical exam revealed binocular diplopia but otherwise intact cranial nerves; asymmetric diminished sensation and weakness in upper extremities; symmetric diminished sensation and intact strength in lower extremities. Areflexic without upper motor neuron signs. Cerebrospinal fluid (CSF) studies showed normal protein, no infection. Magnetic resonance imaging of brain and cervical spine were unrevealing. She was treated with intravenous immunoglobulin for presumed pharyngeal-brachial-cervical variant of Guillain-Barre syndrome. Further testing positive only for anti-GD1b antibody. Electromyography confirmed acute motor and sensory axonal neuropathy with active denervation. She had some initial improvement in strength after treatment, but had further dysphagia and dysarthria requiring nasogastric tube (NGT) placement due to aspiration risk. At time of admission to inpatient rehabilitation, she was dependent with most activities of daily living (ADL) and required moderate assist of two people for mobility. She was discharged home on regular diet, ambulating with a walker, and minimal assistance for dressing.
Setting: Tertiary care hospital
Patient: A 56-year-old female with history of Hashimoto’s thyroiditis and recent upper respiratory infection.
Assessment/Results: On follow-up 6 weeks later, she was bathing and dressing independently, ambulating without device at home. Hand weakness remained but improving with hand occupational therapy. She still had mild hoarseness due to laryngeal weakness.
Discussion: AMSAN is an uncommon variant of GBS. Prior studies describe elevated protein in CSF in most GBS variants, including AMSAN. Anti-GD1b antibodies are most reported in relation to neuropathy causing ataxia, which our patient did not exhibit.
Conclusion: Anti-GD1b antibody can be associated with AMSAN following upper respiratory infection in absence of elevated CSF protein.
Level of Evidence: Level V
To cite this abstract in AMA style:White LA, Papp B, Spickler M. Anti-GD1b Antibody-associated Acute Motor and Sensory Axonal Neuropathy (AMSAN) as a Guillain Barre Variant Following Upper Respiratory Infection: A Case Report [abstract]. PM R. 2019; 11(S2)(suppl 2). https://pmrjabstracts.org/abstract/anti-gd1b-antibody-associated-acute-motor-and-sensory-axonal-neuropathy-amsan-as-a-guillain-barre-variant-following-upper-respiratory-infection-a-case-report/. Accessed July 30, 2021.
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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/anti-gd1b-antibody-associated-acute-motor-and-sensory-axonal-neuropathy-amsan-as-a-guillain-barre-variant-following-upper-respiratory-infection-a-case-report/