Belatedly diagnosed acute motor axonal neuropathy after cardiac surgery

Chong Tae Kim, Todd Beery

Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, USA.
Division of Rehabilitation Medicine, The Children’s Hospital of Philadelphia, Philadelphia, USA;Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, USA.

DOI: 10.4236/crcm.2013.27105                

Abstract

Surgery has been reported a rare cause of Guillain-Barré syndrome (GBS), but a recent retrospective study reported a much higher incidence rate for post-surgical patients. There are several case reports of GBS presenting after cardiac surgical procedures. All these cases were diagnosed as acute inflammatory demyelinating polyradiculoneuropathy (AIDP). We described a case of acute motor axonal neuropathy (AMAN) after cardiac surgery. Clinical features were reviewed along with spinal magnetic resonance imaging (MRI) and cerebral spinal fluid (CSF) analysis. Sequential electrodiagnostic studies (EDx) were performed. This case represented a rare complication of AMAN with urinary retention after cardiac surgery.

Keywords

Guillain-Barré Syndrome; Acute Motor Axonal Neuropathy; Cardiac Surgery; Sequential Electrodiagnosis; Urinary Retention

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Arnason, B.G. and Asbury, A.K. (1968) Idiopathic polyneuritis after surgery. Archives of Neurology, 18, 500-507. http://dx.doi.org/10.1001/archneur.1968.00470350058005
[2]	Gensicke, H., Datta, A.N., Dill, P., Schindler, C. and Fischer, D. (2012) Increased incidence of Guillain-Barre syndrome after surgery. European Journal of Neurology, 19, 1239-1244. http://dx.doi.org/10.1111/j.1468-1331.2012.03730.x
[3]	Renlund, D.G., Hanley, D.F. and Traill, T.A. (1987) Guillain-Barre syndrome following coronary artery bypass surgery. American Heart Journal, 113, 844-845. http://dx.doi.org/10.1016/0002-8703(87)90736-8
[4]	Campbell, A.J., McKinlay, K. and Scott, N.B. (2009) Guillain-Barre syndrome after cardiopulmonary bypass. Journal of Cardiothorac Vascular Anesthesia, 23, 82-83. http://dx.doi.org/10.1053/j.jvca.2008.04.019
[5]	Hogan, J.C., Briggs, T.P. and Oldershaw, P.J. (1992) Guillain-Barre syndrome following cardiopulmonary bypass. International Journal of Cardiology, 35, 427-428. http://dx.doi.org/10.1016/0167-5273(92)90248-2
[6]	Costantino, T. and Weintraub, A. (1972) The GuillainBarre syndrome as a complication of the postperfusion syndrome. American Heart Journal, 84, 678-680. http://dx.doi.org/10.1016/0002-8703(72)90183-4
[7]	Cheng, J., Kahn, D.E. and Wang, M.Y. (2011) The acute motor-sensory axonal neuropathy variant of GuillainBarre syndrome after thoracic spine surgery. Journal of Neurosurgery and Spine, 15, 605-609. http://dx.doi.org/10.3171/2011.8.SPINE1159
[8]	Hiraga, A., Mori, M., Ogawara, K., Hattori, T. and Kuwabara, S. (2003) Differences in patterns of progression in demyelinating and axonal Guillain-Barre syndrome. Neurology, 61, 471-474. http://dx.doi.org/10.1212/01.WNL.0000081231.08914.A1
[9]	Griffin, J.W., Li, C.Y., Macko, C., Ho, T.W., Hsieh, S.T., Xue, P., et al. (1996) Early nodal changes in the acute motor axonal neuropathy pattern of the Guillain-Barre syndrome. Journal of Neuroctyology, 25, 33-51. http://dx.doi.org/10.1007/BF02284784
[10]	Archelos, J.J., Previtali, S.C. and Hartrung, H.-P. (1999) The role of integrins in immune-mediated diseases of the nervous system. Trends in Neuroscience, 22, 30-38. http://dx.doi.org/10.1016/S0166-2236(98)01287-9
[11]	Yuki, N. (2001) Infectious origins of, and molecular mimicry in, Gullain-Barre and Fisher syndromes. Lancet Infectious Disease, 1, 29-37. http://dx.doi.org/10.1016/S1473-3099(01)00019-6
[12]	Hartung, H.P., Willison, H.J. and Kieseier, B.C. (2002) Acute inflammatory neuropathy: Update on GuillainBarre syndrome. Current Opinions in Neurology, 15, 571-577. http://dx.doi.org/10.1097/00019052-200210000-00008
[13]	Asimakopoulos, G. (2001) Systemic inflammation and cardiac surgery. Perfusion, 16, 353-360. http://dx.doi.org/10.1177/026765910101600505
[14]	Staff, N.P., Engelstad, J.N., Klein, C.J., Amrami, K.K., Spinner, R.J., Dyck, P.J., et al. (2010) Post-surgical inflammatory neuropathy. Brain, 133, 2866-2880. http://dx.doi.org/10.1093/brain/awq252
[15]	Hogan, B.V., Peter, M.B., Shenoy, H.G., Horgan, K. and Hughes, T.A. (2011) Surgery induced immunosuppression. Surgeon, 9, 38-43. http://dx.doi.org/10.1016/j.surge.2010.07.011
[16]	Hiraga, A., Mori, M., Ogawara, K., Misawa, S., Kanesaka, T., Koga, M., et al. (2005) Recovery of patterns and long term prognosis for axonal Guillain-Barre syndrome. Journal of Neurology Neurosurgery & Psychiatry, 76, 719-722. http://dx.doi.org/10.1136/jnnp.2004.051136
[17]	Tamura, N., Kuwabara, S., Misawa, S., Kanai, K., Nakata, M., Sawai, S., et al. (2007) Time course of axonal regeneration in acute motor axonal neuropathy. Muscle & Nerve, 35, 793-795. http://dx.doi.org/10.1002/mus.20729
[18]	Hughes, R.A. and Cornblath, D.R. (2005) Guillain-Barre syndrome. Lancet, 366, 1653-1666. http://dx.doi.org/10.1016/S0140-6736(05)67665-9
[19]	Albers, J.W., Donofrio, P.D. and McGonagle, T.K. (1985) Sequential electrodiagnostic abnormalities in acute inflammatory demyelinating polyradiculoneuropathy. Muscle & Nerve, 8, 528-539. http://dx.doi.org/10.1002/mus.880080609
[20]	Hiraga, A., Kuwabara, S., Ogawara, K., Misawa, S., Kanesaka, T., Koga, M., et al. (2005) Patterns and serial changes in electrodiagnostic abnormalities of axonal Guillain-Barre syndrome. Neurology, 64, 856-860. http://dx.doi.org/10.1212/01.WNL.0000153071.71335.E9
[21]	Sakakibara, R., Hattori, T., Kuwabara, S., Yamanishi, T. and Yasuda, K. (1997) Micturitional disturbance in patients with Guillain-Barre syndrome. Journal Neurology Neurosurgery & Psychiatry, 63, 649-653. http://dx.doi.org/10.1136/jnnp.63.5.649
[22]	Sakakibara, R., Uchiyama, T., Tamura, N., Kuwabara, S., Asahina, M. and Hattori, T. (2007) Urinary retention and sympathetic sphincter obstruction in axonal GuillainBarre syndrome. Muscle & Nerve, 35, 111-115. http://dx.doi.org/10.1002/mus.20639
[23]	Sawai, S., Sakakibara, R., Uchiyama, T., Liu, Z., Yamamoto, T., Ito, T., et al. (2007) Acute motor axonal neuropathy presenting with bowel, bladder, and erectile dysfunction. Journal of Neurology, 254, 250-252. http://dx.doi.org/10.1007/s00415-006-0336-3
[24]	Parys, B.T., Woolfenden, K.A. and Parsons, K.F. (1990) Bladder function after simple hysterectomy; urodynamic and neurological evaluation. European Urololgy, 17, 129-133.
[25]	Cheek, W.R., Anchondo, H., Raso, E. and Scott, R. (1973) Neurogenic bladder and the lumbar spine. Urology, 2, 30-33. http://dx.doi.org/10.1016/0090-4295(73)90210-0