title: Orthopaedic manifestations and diagnostic clues in children with Guillain-Barré syndrome.
abstract: BACKGROUND
  Guillain-Barré syndrome (GBS) is an acute inflammatory demyelinating polyneuropathy characterized by symmetric limb weakness. Children with GBS sometimes consult the orthopaedists because of limb pain and gait disturbance. The orthopaedists, however, are unfamiliar with GBS, since it has rarely been delineated in detail in the orthopaedic literature. In the present study, we specifically describe orthopaedic manifestations and diagnostic clues in pediatric GBS.
  
  
  METHODS
  We reviewed seven patients with pediatric GBS in regard to age, gender, clinical symptoms, department at the first medical consultation, initial diagnosis, physical and laboratory findings, medical interventions, and the latest clinical outcome.
  
  
  RESULTS
  There were five boys and two girls, with a mean age at presentation of 7.2 years. Gait disturbance associated with lower limb pain and weakness was the most frequent early clinical symptom. Among the five patients who presented initially at the orthopaedic department, three were misdiagnosed. Loss of deep tendon reflexes was seen in all patients. Anti-ganglioside antibodies were positive in three and protein levels of cerebrospinal fluid were elevated in five patients. Six patients recovered completely after intravenous immunoglobulin (IVIG) treatment, while one patient who had not undergone IVIG treatment showed minor residual disability.
  
  
  CONCLUSIONS
  Acute symmetrical limb pain and gait disturbance associated with loss of tendon reflexes were important clinical manifestations of pediatric GBS. Early diagnosis is essential to prevent delayed recovery, long-term weakness, and permanent functional disabilities.
authors.affiliation: Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8550 Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Matsushita
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kitoh
authors.forename: Kazuya
authors.initials: K
authors.lastname: Itomi
authors.forename: Takahiko
authors.initials: T
authors.lastname: Kitakoji
authors.forename: Koji
authors.initials: K
authors.lastname: Iwata
authors.forename: Kenichi
authors.initials: K
authors.lastname: Mishima
authors.forename: Naoki
authors.initials: N
authors.lastname: Ishiguro
authors.forename: Tadashi
authors.initials: T
authors.lastname: Hattori
keywords: Children; Diagnostic clue; Gait disturbance; Guillain–Barré syndrome; Limb pain; Loss of tendon reflex