Treacherous tingling

I was just a few years out of my residency training when a 28-year-old came to see me because of tingling in his toes and weakness in his legs. These symptoms weren’t alarming; I probably saw two patients a day with tingling in their hands or feet. That’s commonly caused by overuse injury, compression of the sciatic nerve, or even anxiety. But I had just seen this young man three weeks before for an upper respiratory infection, and he didn’t have any neurologic issues then. He said he felt like something was really wrong—he couldn’t really tell me more than that. I did a simple test for deep tendon reflexes, tapping just beneath the knee, and got no response—in either leg. That’s when I knew that he was going to need help. I thought of Guillain-Barré syndrome, a rare condition in which the immune system attacks peripheral nerves, causing progressive paralysis. Most cases start after a viral infection. Though he felt unsteady, he could walk. The hospital was only a couple of blocks away, and he was my last patient of the day, so I decided to drive him there. As the admitting physician, I started the workup in the ER. He needed to lie in the fetal position, with his knees against his chest, for a lumbar puncture to extract and test spinal fluid, but he had begun having muscle spasms. A nurse had to hold him in place. Two hours later, the results came back indicating Guillain-Barré, and we transferred him to the intensive care unit. By the next morning, he could barely move his fingers and needed a ventilator because he could no longer breathe on his own. He remained in the hospital for a month, receiving treatment to reduce the antibodies that were attacking his nerve cells. Fortunately, he had been young and healthy, and with the help of rehab, he regained most of his muscle capacity. I haven’t seen another case of Guillain-Barré since, but it still is a reminder that it is so important to optimize your health because you never know when something might happen.