Bilateral lower motor neuron type facial palsy is an unusual neurological disorder. There are few reports that associate it with the human immunodeficiency virus (HIV) infection on initial presentation. A 51-year-old married woman, who was previously healthy and had no risk of HIV infection, presented solely with bilateral simultaneous facial palsy. A positive HIV serology test was confirmed by an enzyme-linked immunosorbent assay test. Following a short course of oral prednisolone, the patient recovered completely from facial palsy in three months, even though an antiretroviral treatment was suspended. Exclusion of HIV infection in patients with bilateral facial palsy is essential for early diagnosis and management of HIV.
Administration, Oral ; Cerebrospinal Fluid Pressure ; Enzyme-Linked Immunosorbent Assay ; Facial Paralysis ; complications ; drug therapy ; Female ; HIV Infections ; complications ; diagnosis ; Humans ; Middle Aged ; Prednisolone ; therapeutic use ; Prednisone ; administration & dosage

This is the report of a 63-year-old woman presenting with Brown-Sequard syndrome due to spontaneous extradural C5-6 cervical disc herniation. Anterior discectomy was performed with favorable outcome. Review of literature show that the reported cases mainly involve paracentral disc at C5-6 level, with good surgical outcome.

INTRODUCTIONSevere Guillain-Barré syndrome (GBS) causes ventilatory insufficiency and the need for prolonged artificial ventilation. Under circumstances where medical care for patients with severe GBS is required in a resource-limited institution, identifying initial clinical presentations in GBS patients that can predict respiratory insufficiency and the need for prolonged mechanical ventilation (> 15 days) may be helpful for advanced care planning.

METHODSThe medical records of patients diagnosed with GBS in a tertiary care and medical teaching hospital from January 2001 to December 2010 were retrospectively reviewed. The demographic data and clinical presentations of the patients were summarised using descriptive statistics. Clinical predictors of respiratory insufficiency and the need for prolonged mechanical ventilation (> 15 days) were identified using univariate logistic regression analysis.

RESULTSA total of 55 patients with GBS were included in this study. Mechanical ventilation was needed in 28 (50.9%) patients. Significant clinical predictors for respiratory insufficiency were bulbar muscle weakness (odds ratio [OR] 5.08, 95% confidence interval [CI] 1.31-21.60, p = 0.007) and time to peak limb weakness ≤ 5 days (OR 0.75, 95% CI 0.62-0.91, p < 0.001). Bulbar muscle weakness (p = 0.006) and time to peak limb weakness ≤ 5 days (p < 0.001) were also found to be significantly associated with the need for prolonged mechanical ventilation (> 15 days).

CONCLUSIONBulbar weakness and time to peak limb weakness ≤ 5 days were able to predict respiratory insufficiency and the need for prolonged mechanical ventilation in patients with GBS.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Guillain-Barre Syndrome ; diagnosis ; therapy ; Humans ; Male ; Middle Aged ; Muscle Weakness ; complications ; Odds Ratio ; Regression Analysis ; Respiration, Artificial ; Respiratory Insufficiency ; therapy ; Retrospective Studies ; Tertiary Care Centers ; Young Adult