Yoğun Bakımda Guillain-Barré Sendromu Yönetimi
Özet
48 yaş erkek yaklaşık 2 gündür ellerde ayaklarda uyuşma yaygın güzsüzlük şikayetiyle başvurdu. Derin tendon reflekslerinde azalma, beyin omurilik (BOS) incelemesinde albüminositolojik disosiasyon olan hasta takibinde gelişen hızlı progresyon ve solunum sıkıntısı nedeniyle yoğun bakım ünitesine yatırıldı. Guillain-barré sendromu (GBS) öntanısıyla ıntravenöz immunglobulin (IVIG) başlanan hasta immun tedavi ve destekleyici tedaviden belirgin fayda gördü. Elbette süreçte fizik tedavi desteği ile takip edilen hastanın servis taburculuğunda; kas gücünde düzelme ve klinik iyileşme gözlendi. Hasta GBS için tipik bir vaka örneğiydi. Guillain-Barré sendromu akut başlangıçlı, jeneralize kas güçsüzlüğü ve duysal semptomlarla seyreden bir nörolojik acildir. Klinik progresyon sonrası bilinç ön planda etkilenmezken solunum sıkıntısı mekanik ventilatör ihtiyacı ve disotonomik bulgular hayatı tehtid edebilir. Tedavide destek tedavi yanında IVIG plazmaferez gibi immun tedavilerin yeri vardır. Genellikle monofazik olan bu hastalığın tanı,takip ve tedavi süreçleri tartışılacaktır.
A 48-year-old male presented with complaints of numbness in the hands and feet and generalized weakness that had persisted for approximately two days. Neurological examination revealed decreased deep tendon reflexes. Cerebrospinal fluid (CSF) analysis demonstrated albuminocytologic dissociation. During follow-up, the patient developed rapidly progressive weakness and respiratory distress, necessitating admission to the intensive care unit. With a presumptive diagnosis of Guillain-Barré syndrome (GBS), intravenous immunoglobulin (IVIG) therapy was initiated. The patient benefited significantly from both immunotherapy and supportive management. Physical therapy was also provided during the clinical course. At the time of discharge from the ward, improvement in muscle strength and overall clinical recovery were noted. This case represents a typical presentation of GBS.
Guillain-Barré syndrome is an acute-onset neurological emergency characterized by generalized muscle weakness and sensory symptoms. While consciousness is usually preserved during the clinical progression, respiratory failure requiring mechanical ventilation and autonomic dysfunction may be life-threatening. Treatment involves supportive measures as well as immunomodulatory therapies, such as IVIG and plasma exchange. The disease is generally monophasic in nature. The diagnostic, follow-up, and therapeutic processes will be discussed in detail in this section.
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