Depression of spinal motoneurons may underlie weakness associated with severe anemia.
A 37-year-old woman had a 2-week history of progressive weakness, muscle hypotonia, and absent or hypoactive deep tendon reflexes. Nerve conduction studies showed diminished H-reflexes and absent or decreased persistence of F-waves in all limbs. The patient was admitted to the hospital with a diagnosis of Guillain-Barré syndrome. Laboratory studies revealed severe anemia with a hemoglobin level of 4.1 g/dl and hematocrit of 15.1%. Immediate blood transfusion resulted in a hemoglobin of 13.2 g/dl and hematocrit of 40.2%, associated with rapid neurological recovery (normal stretch reflexes and muscle strength) and normalization of F-waves and H-reflexes. This case demonstrates that severe anemia may be associated with signs and symptoms that mimic Guillain-Barré syndrome, both clinically and electrophysiologically. It also suggests that a relative depression of spinal motoneuron excitability may be a possible mechanism for the weakness that is commonly observed in severe anemia.
Leis
A Arturo
AA
Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, 1350 East Woodrow Wilson, Suite 2, Jackson, Mississippi 39216, USA. artleis@aol.com
Stokic
Dobrivoje S
DS
Shepherd
Jinna M
JM
D000328:Adult; D000740:Anemia / Q000150:complications* / Q000503:physiopathology; D005260:Female; D006181:H-Reflex; D006801:Humans; D009046:Motor Neurons / Q000502:physiology*; D018908:Muscle Weakness / Q000209:etiology* / Q000503:physiopathology; D009431:Neural Conduction