*3.1.1 Hospital clinical evolution*

Day 1. Laboratories. Hematic biometry: leukocytes 6,800 leu/μl, neutrophils 27%, lymphocytes 62%, monocytes 8%, hemoglobin 13.6%, hematocrit 40.3%, platelets 482 thousand, CRP 0 mg/dl, CPK 737 U/l. Seric electrolytes: sodium 138 meq/l, potassium 4.9 meq/l, chlorine 105 meq/l, calcium 11.1 mg/dl, phosphorus 6.2 mg/dl, magnesium 2.3 mg/dl. Blood chemistry and kidney function tests: glucose 70 mg/dL, BUN 22 mg/dL, Urea 47 mg/dL, creatinine 0.3 mg/dl. Lumbar puncture: clear, colorless, transparent liquid, 1 cells, 100% monocytes, negative erythrocytes, glucose 43 mg/dl, chloride 118.3 meq/L, proteins 57 mg/dl, pandy positive (+), pH 7.6, lactate 1.6, no bacteria, negative coagglutination. Medical treatment was started with intravenous immunoglobulin (IVIG) at a dose of 1 gr/kg for 3 days.

Day 2. Neuroconduction study: acute inflammatory demyelinating variant GBS (see **Figure 1**).

Day 3. Negative cerebrospinal fluid culture. Negative peripheral blood culture.

Day 6. During his hospital stay, he presented adequate evolution, with gradual improvement in the mobility of the lower extremities; strength 4/5, bilateral areflexia, preserved sensitivity, no secondary complications, tolerating the oral route, no respiratory distress, without requiring ventilatory support, deciding his discharge with wheelchair support and sent to pediatric rehabilitation for 6 months with clinical improvement.

#### **3.2 2nd hospitalization**

7 year old female. Condition: 3 day history of upper airway infection with torpid evolution despite established medical treatment, adding paresthesias of the lower limbs with ascending, progressive and symmetrical spread, extending to the upper limbs and poor management of bronchial secretions, therefore which, goes to the emergency service for assessment. Upon admission to the emergency service, she had stable vital signs; HR 95/minute, FR 14/minute, oxygen saturation 93%, temperature 36.5 °C. Physical examination: female of apparent age similar to the chronological one, adequate hydric status, full oral cavity without alterations, neck without megaly, cardiopulmonary without compromise, abdomen without megaly, no data of peritoneal irritation, upper extremities; eutrophic, strength decreased 1/5 on the Daniels scale in the left upper limb and 2/5 in the left upper limb, bone tendon reflexes abolished and sensitivity preserved, lower limbs; eutrophic, decrease in strength 0/5 on the Daniels scale, bilateral areflexia, non-withdrawal of pain and preserved sensitivity. Neurological: awake, reactive to external stimuli, no palpebral ptosis, normoreflectic isochoric pupils, normal bilateral fundus, preserved cranial nerves, preserved superior mental functions, non-assessable gait, non-assessable romberg signs, preserved sensitivity, absent meningeal signs, no dysautonomias.

Guillain Barré Syndrome was diagnosed, for which it was decided to prescribe hydroelectrolytic treatment with solutions to basal requirements by the Hollidey-Sigar formula.

*Recurrence of Guillain Barré Syndrome in Patient Pediatric with Presentation of Two Different… DOI: http://dx.doi.org/10.5772/intechopen.96358*

reflexes, pain withdrawal and conserved sensitivity, lower extremities; eutrophic, strength reduction 3/5 on the Daniels scale, bilateral areflexia, withdrawal to pain and preserved sensitivity. Neurological: awake, reactive to external stimuli, nonmeasurable gait, preserved sensitivity, preserved cranial nerves, absent meningeal

Day 1. Laboratories. Hematic biometry: leukocytes 6,800 leu/μl, neutrophils 27%, lymphocytes 62%, monocytes 8%, hemoglobin 13.6%, hematocrit 40.3%, platelets 482 thousand, CRP 0 mg/dl, CPK 737 U/l. Seric electrolytes: sodium 138 meq/l, potassium 4.9 meq/l, chlorine 105 meq/l, calcium 11.1 mg/dl, phosphorus 6.2 mg/dl, magnesium 2.3 mg/dl. Blood chemistry and kidney function tests: glucose 70 mg/dL, BUN 22 mg/dL, Urea 47 mg/dL, creatinine 0.3 mg/dl. Lumbar puncture: clear, colorless, transparent liquid, 1 cells, 100% monocytes, negative erythrocytes, glucose 43 mg/dl, chloride 118.3 meq/L, proteins 57 mg/dl, pandy positive (+), pH 7.6, lactate 1.6, no bacteria, negative coagglutination. Medical treatment was started with intravenous immunoglobulin (IVIG) at a dose of 1 gr/kg for 3 days. Day 2. Neuroconduction study: acute inflammatory demyelinating variant GBS

Day 3. Negative cerebrospinal fluid culture. Negative peripheral blood culture. Day 6. During his hospital stay, he presented adequate evolution, with gradual

7 year old female. Condition: 3 day history of upper airway infection with torpid evolution despite established medical treatment, adding paresthesias of the lower limbs with ascending, progressive and symmetrical spread, extending to the upper limbs and poor management of bronchial secretions, therefore which, goes to the emergency service for assessment. Upon admission to the emergency service, she had stable vital signs; HR 95/minute, FR 14/minute, oxygen saturation 93%, temperature 36.5 °C. Physical examination: female of apparent age similar to the chronological one, adequate hydric status, full oral cavity without alterations, neck without megaly, cardiopulmonary without compromise, abdomen without megaly, no data of peritoneal irritation, upper extremities; eutrophic, strength decreased 1/5 on the Daniels scale in the left upper limb and 2/5 in the left upper limb, bone tendon reflexes abolished and sensitivity preserved, lower limbs; eutrophic, decrease in strength 0/5 on the Daniels scale, bilateral areflexia, non-withdrawal of pain and preserved sensitivity. Neurological: awake, reactive to external stimuli, no palpebral ptosis, normoreflectic isochoric pupils, normal bilateral fundus, preserved cranial nerves, preserved superior mental functions, non-assessable gait, non-assessable romberg signs, preserved sensitivity, absent meningeal signs, no dysautonomias. Guillain Barré Syndrome was diagnosed, for which it was decided to prescribe hydroelectrolytic treatment with solutions to basal requirements by the Hollidey-

improvement in the mobility of the lower extremities; strength 4/5, bilateral areflexia, preserved sensitivity, no secondary complications, tolerating the oral route, no respiratory distress, without requiring ventilatory support, deciding his discharge with wheelchair support and sent to pediatric rehabilitation for 6 months

signs, no neurological deterioration or dysautonomias.

*3.1.1 Hospital clinical evolution*

(see **Figure 1**).

with clinical improvement.

**3.2 2nd hospitalization**

Sigar formula.





#### *Demyelination Disorders*






#### **Figure 1.**

*Neuroconduction study (female 2 years).*

*Recurrence of Guillain Barré Syndrome in Patient Pediatric with Presentation of Two Different… DOI: http://dx.doi.org/10.5772/intechopen.96358*
