We have recently encountered an unexpected rapid improvement of weakness in a patient with the Guillain-Barré syndrome (GBS) who was treated with high-dose methylprednisolone. The observation was striking and of potential clinical interest. The patient, a 25-year-old white man, presented with progressive bilateral arm weakness and paresthesias that began 3 weeks after reconstructive knee surgery and 1 week after an upper respiratory infection. After a cerebrospinal fluid (normal) sample was obtained by C1-C2 puncture, cervical computed tomography revealed a 3- to 5-mm lesion consistent with a small hemorrhage in the course of the needle track. Because of the presumed acute cord trauma, methylprednisolone therapy was instituted with an intravenous bolus dose of 30 mg/kg of body weight, followed by an infusion at 5.4 mg/kg per hour for 23 hours. Twelve hours later, strength had markedly improved, particularly in the arms, and tendon reflexes could be obtained. Weakness, which was more
Bethea JW, Hogan EL. Transient Improvement in Guillain-Barré Syndrome After Megadose Intravenous Methylprednisolone. Arch Neurol. 1994;51(7):644–645. doi:10.1001/archneur.1994.00540190018008
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