Finger drop sign: Rare presentation of a common disorder. 2016

Rachana Dubey, and Jaya Shankar Kaushik, and Anil Israni, and Lokesh Saini, and Harsh Patel, and Biswaroop Chakrabarty, and Sheffali Gulati
Division of Child Neurology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India.

BACKGROUND Guillain Barre syndrome (GBS) commonly presents with limb weakness and occasional cranial nerve, respiratory or autonomic involvement. Isolated or predominant bilateral finger drop as presenting feature has never been reported in the pediatric age group. METHODS A 9-year-old boy presented with deformity of both hands for 7 days and leg pain with difficulty in getting up from floor for 3 days. On examination he had bilateral clawing with subtle hip flexor weakness and hyporeflexia. His nerve conduction study revealed motor axonal neuropathy. His serum lead levels and autoimmune markers were within normal limits. His cerebrospinal fluid examination revealed albuminocytological dissociation. He was diagnosed as GBS and was given intravenous immunoglobulin. He improved completely over next 8 weeks. CONCLUSIONS GBS is one of the commonest causes of acquired neuropathy in the tropics. In resource limited setting, where electrophysiological facilities may not be available, identification of finger drop sign may help in correct management.

UI MeSH Term Description Entries
D008297 Male Males
D009431 Neural Conduction The propagation of the NERVE IMPULSE along the nerve away from the site of an excitation stimulus. Nerve Conduction,Conduction, Nerve,Conduction, Neural,Conductions, Nerve,Conductions, Neural,Nerve Conductions,Neural Conductions
D009460 Neurologic Examination Assessment of sensory and motor responses and reflexes that is used to determine impairment of the nervous system. Examination, Neurologic,Neurological Examination,Examination, Neurological,Examinations, Neurologic,Examinations, Neurological,Neurologic Examinations,Neurological Examinations
D002648 Child A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL. Children
D005385 Fingers Four or five slender jointed digits in humans and primates, attached to each HAND. Finger
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D018908 Muscle Weakness A vague complaint of debility, fatigue, or exhaustion attributable to weakness of various muscles. The weakness can be characterized as subacute or chronic, often progressive, and is a manifestation of many muscle and neuromuscular diseases. (From Wyngaarden et al., Cecil Textbook of Medicine, 19th ed, p2251) Muscular Weakness,Muscle Weaknesses,Muscular Weaknesses,Weakness, Muscle,Weakness, Muscular,Weaknesses, Muscle,Weaknesses, Muscular
D020275 Guillain-Barre Syndrome An acute inflammatory autoimmune neuritis caused by T cell- mediated cellular immune response directed towards peripheral myelin. Demyelination occurs in peripheral nerves and nerve roots. The process is often preceded by a viral or bacterial infection, surgery, immunization, lymphoma, or exposure to toxins. Common clinical manifestations include progressive weakness, loss of sensation, and loss of deep tendon reflexes. Weakness of respiratory muscles and autonomic dysfunction may occur. (From Adams et al., Principles of Neurology, 6th ed, pp1312-1314) Acute Autoimmune Neuropathy,Acute Inflammatory Demyelinating Polyradiculoneuropathy,Acute Inflammatory Polyneuropathy,Landry-Guillain-Barre Syndrome,Polyradiculoneuropathy, Acute Inflammatory,Acute Infectious Polyneuritis,Acute Inflammatory Demyelinating Polyneuropathy,Acute Inflammatory Polyradiculoneuropathy,Demyelinating Polyradiculoneuropathy, Acute Inflammatory,Guillain-Barre Syndrome, Familial,Guillain-Barré Syndrome,Guillaine-Barre Syndrome,Inflammatory Demyelinating Polyradiculoneuropathy, Acute,Inflammatory Polyneuropathy Acute,Polyneuropathy, Acute Inflammatory,Polyneuropathy, Inflammatory Demyelinating, Acute,Polyradiculoneuropathy, Acute Inflammatory Demyelinating,Acute Autoimmune Neuropathies,Acute Inflammatory Polyneuropathies,Acute Inflammatory Polyradiculoneuropathies,Autoimmune Neuropathies, Acute,Autoimmune Neuropathy, Acute,Familial Guillain-Barre Syndrome,Familial Guillain-Barre Syndromes,Guillain Barre Syndrome,Guillain Barre Syndrome, Familial,Guillain Barré Syndrome,Guillain-Barre Syndromes, Familial,Guillain-Barré Syndromes,Guillaine Barre Syndrome,Infectious Polyneuritis, Acute,Inflammatory Polyneuropathies, Acute,Inflammatory Polyneuropathy, Acute,Inflammatory Polyradiculoneuropathies, Acute,Landry Guillain Barre Syndrome,Neuropathy, Acute Autoimmune,Polyneuritis, Acute Infectious,Polyneuropathy Acute, Inflammatory,Polyradiculoneuropathies, Acute Inflammatory,Syndrome, Familial Guillain-Barre,Syndrome, Guillain-Barre,Syndrome, Guillain-Barré,Syndrome, Guillaine-Barre,Syndrome, Landry-Guillain-Barre

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