Epidemiologic, clinical and outcome features of acute inflammatory demyelinating polyneuropathy at the Hospital Center of Nouakchott Specialities (About 21 Cases).

Abstract

Backgroun : Guillain Barré syndrome (GBS) is a rapid-onset muscle weakness caused by the immune system damaging the peripheral nervous system. The initial symptoms are typically changes in sensation or pain along with muscle weakness, beginning in the feet and hands. This often spreads to the arms and upper body with both sides being involved. The symptoms develop over hours to a few weeks. During the acute phase, the disorder can be lifethreatening with about 15% developing weakness of the breathing muscles requiring mechanical ventilation. The higher risk is respiratory failure. The aim of our study was to describe the epidemiological, clinical and prognosis features of GBS in hospital settings in Mauritania. Methods : We conducted a retrospective study in the Neurology Department of the Nouakchott's Specialities Hospital, the only neurology department in the country. Participants included all patients admitted and treated for GBS or Acute inflammatory demyelinating polyneuropathy from May 2014 to October 2016. Results : A total of 21 patients were recruited including 19 women (90.5%) and 2 men (9.5%). The mean age was 36 years and the disease was pregnancy-related in 6 patients (1 abortion, 2 post-partum cases and 3 pregnancies). We found sensory symptoms in 33.3% of patients, but no sensory deficit on examination. Flaccid weakness of the 4 limbs with ascending evolution was found in all patients. Cranial nerves palsy (IX, X and XI) was found in 19% of patients. Autonomic nervous system was affected in 9.5% and this concerned the urinary sphincter for all patients. Lumbar puncture was done in 15 patients and albuminocytological dissociation found in 7 patients (46.6%). On electrophysiological testing, we found 4 cases of both axonal and demyelination damage out of 6 patients who were tested. No acute respiratory failure was noticed. Conclusion : Although its outcome is favorable in most of cases, acute PRN must be managed in a neurological department with an intensive care unit (ICU) since some of these patients have high risk of developing acute respiratory failure and other will remain with residual motor or sensory deficits. The high death rate reported here is mainly due to poor management and care.