Reader Response: Clinical factors associated with Guillain-Barré syndrome following surgery
Nathaniel M.Robbins, Assistant Professor of Neurology, Dartmouth Geisel School of Medicine
Submitted July 20, 2018
I read with interest the article by Hocker et al. [1] I took care of a 45-year-old man several years ago with neurotropic squamous cell carcinoma of the oropharynx (T2N0M0). His brother and paternal uncle had testicular cancer, and his mother had breast cancer. Three months after his initial resection, he developed neuropathic pain of the tongue, and MRI showed tumor recurrence. Two weeks later he developed classic Miller-Fisher syndrome with mild ophthalmoparesis, ataxia, areflexia, elevated CSF protein, and an elevated anti-Gq1b. He was treated with IVIG and did well. Two weeks later he underwent repeat surgery. In the days following this, he developed neuropathic pain in the right shoulder that persisted for a month and was followed by atrophy and weakness in several right arm muscles. Clinical and electrodiagnostic testing confirmed a diagnosis of brachial neuritis.
As the authors pointed out, surgeries are common, and even tumor surgeries are not infrequent. In contrast, post-surgical immune-mediated neuropathies are rare, and even more rarely paraneoplastic. I would hypothesize that both characteristics of the tumor and genetic factors matter: was there any preponderance for neurotropism in the tumors in this series? Did cancer run in these patients’ families?
1. Hocker S, Nagarajan E, Rubin M, Wijdicks EFM. Clinical factors associated with Guillain-Barré syndrome following surgery. Neurol Clin Pract 2018;8:201-206.
I read with interest the article by Hocker et al. [1] I took care of a 45-year-old man several years ago with neurotropic squamous cell carcinoma of the oropharynx (T2N0M0). His brother and paternal uncle had testicular cancer, and his mother had breast cancer. Three months after his initial resection, he developed neuropathic pain of the tongue, and MRI showed tumor recurrence. Two weeks later he developed classic Miller-Fisher syndrome with mild ophthalmoparesis, ataxia, areflexia, elevated CSF protein, and an elevated anti-Gq1b. He was treated with IVIG and did well. Two weeks later he underwent repeat surgery. In the days following this, he developed neuropathic pain in the right shoulder that persisted for a month and was followed by atrophy and weakness in several right arm muscles. Clinical and electrodiagnostic testing confirmed a diagnosis of brachial neuritis.
As the authors pointed out, surgeries are common, and even tumor surgeries are not infrequent. In contrast, post-surgical immune-mediated neuropathies are rare, and even more rarely paraneoplastic. I would hypothesize that both characteristics of the tumor and genetic factors matter: was there any preponderance for neurotropism in the tumors in this series? Did cancer run in these patients’ families?
1. Hocker S, Nagarajan E, Rubin M, Wijdicks EFM. Clinical factors associated with Guillain-Barré syndrome following surgery. Neurol Clin Pract 2018;8:201-206.
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