La Revue de médecine interne
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Guillain-Barré syndrome (GBS) is the most common cause of acute neuropathy. It usually onset with a rapidly progressive ascending bilateral weakness with sensory disturbances, and patients may require intensive treatment and close monitoring as about 30% have a respiratory muscle weakness and about 10% have autonomic dysfunction. The diagnosis of GBS is based on clinical history and examination. ⋯ Some anti-ganglioside antibodies are associated with particular variants of GBS: the Miller-Fisher syndrome, facial diplegia and paresthesias, the pharyngo-cervico-brachial variant, the paraparetic variant, and the Bickerstaff brainstem encephalitis. Their semiological differences might be explained by a distinct expression of gangliosides among nerves. The aim of this review is to present pathophysiological aspects and the diagnostic approach of GBS and its variants.
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Recreational use of nitrous oxide (N2O) is increasing in Western countries, including France. During the COVID-19 pandemic, some authors warned that recreational N2O use could increase further as the supply of illicit drugs was impacted by various containment measures. ⋯ Despite a marked increase in recreational N2O exposures during the COVID-19 pandemic, the exact impact of COVID-19 on this increase remains to be determined as it was observed from 2019.
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Sleepiness concerns one in five French people and involves a severe accidental risk. The recent notion of hypersomnolence includes excessive daytime sleepiness and the excessive need for sleep. The diagnostic approach to hypersomnolence begins with a clinical exploration by interview and sleep diary in order to specify the symptoms, to compare them with the typology and the patient's individual sleep need to rule out chronic sleep deprivation and a circadian rhythm disorder. ⋯ The diagnosis of central hypersomnia can be suspected on the characteristics of hypersomnolence or at the end of the diagnostic process. It will require ruling out the most frequent causes of hypersomnolence and the confounding factors for polysomnography interpretation. The causes and consequences associated with hypersomnolence require early detection, precise diagnosis and comprehensive management.