Case Report
Seizures and Guillain-Barré Syndrome Leading to the Discovery of Systemic Lupus: Case of an Adolescent in Lomé and Review of the Literature
Issue:
Volume 14, Issue 3, September 2026
Pages:
47-56
Received:
7 May 2026
Accepted:
22 May 2026
Published:
17 July 2026
Abstract: Background: Systemic lupus erythematosus (SLE) is a chronic idiopathic autoimmune disease. Guillain-Barré syndrome (GBS) is an acute monophasic immune-mediated polyradiculoneuropathy. Case presentation: We report the case of a 16-year-old patient, who presented in November 2023 a flu-like syndrome with diarrhea and abdominal pain. Then he had visual hallucinations and psychosis, followed by generalized tonic-clonic seizures. Urine toxicology assay was positive, a syndrome of hepatic cytolysis and cholestasis were noted. Toxic encephalopathy and hepatopathy were mentioned and he was transferred to a psychiatric ward where he persisted with an infectious syndrome, hallucinations, delirium and then flaccid tetraplegia of ascending evolution with dyspnea and respiratory distress. In January 2024, there was tetraplegia, abolished deep tendon reflexes (DTR) in all 4 limbs, hypoesthesia in all 4 limbs. Cerebrospinal fluid examination found albumin -cytological dissociation. Magnetic resonance imaging of the spinal cord was normal. He received 500 mg of intravenous methylprednisolone for 3 days then a per os relay with prednisolone 50 mg in addition to azathioprine (Aza) 50 mg x2/day and functional rehabilitation. The electroencephalogram revealed signs of non-structural generalised epilepsy in March 2024. The electroneuromyogram found a neurophysiological pattern of acute polyradiculoneuropathy in the recovery phase. In the evolution, an antinuclear antibody assay (indirect immunofluorescence) came back positive at a titer of 1/160, with a speckled appearance. On the basis of the American College of Rhumatology (ACR) with a score of 19, the diagnosis of SLE was retained and background treatment with Aza 50 mg/day continued. At the end of May 2025, there persisted a predominantly distal tetraparesis, an abolition of DTR. Conclusion: Although rare, GBS can be the mode of revelation of SLE. This SLE-GBS association is often serious and can be life-threatening.
Abstract: Background: Systemic lupus erythematosus (SLE) is a chronic idiopathic autoimmune disease. Guillain-Barré syndrome (GBS) is an acute monophasic immune-mediated polyradiculoneuropathy. Case presentation: We report the case of a 16-year-old patient, who presented in November 2023 a flu-like syndrome with diarrhea and abdominal pain. Then he had visua...
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Review Article
Multimodal Approach to Diagnosing Mild Traumatic Brain Injury: A Comprehensive Literature Review
Issue:
Volume 14, Issue 3, September 2026
Pages:
57-68
Received:
6 May 2026
Accepted:
7 July 2026
Published:
30 July 2026
DOI:
10.11648/j.ajpn.20261403.12
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Abstract: Mild traumatic brain injury (mTBI) affects 69 million people annually worldwide. A significant subset of those affected will develop long-term sequelae that can seriously impact quality of life and lead to other health problems. Clinical diagnosis of mTBI is complicated by patient malingering, subjective symptomatology, and variable patient reporting. This review aimed to evaluate the potential effectiveness of combining advanced neuroimaging techniques with psychometric testing and blood biomarker analyses for developing a more objective and comprehensive mTBI assessment protocol. A review was conducted using PubMed as the primary database, analyzing studies published between 2015 and 2023. Included studies evaluated mTBI (defined as Glasgow Coma Scale score ≥ 14) and incorporated neuroimaging assessment. Studies had to include patients presenting with characteristic mTBI symptoms, such as headache, balance/motor deficits, cognitive impairments, and fatigue. Studies focused on diagnostic accuracy, clinical utility, and integration of different assessment modalities were included. Advanced neuroimaging techniques, particularly Diffusion Tensor Imaging (DTI), demonstrated superior detection of subtle axonal damage compared to conventional CT and MRI. Specific brain regions, including temporal, fusiform, inferior parietal, and lateral occipital areas, showed promising diagnostic potential. Psychometric assessments, notably the Test of Memory Malingering combined with pupillometry, demonstrated high sensitivity in detecting symptom validity. Blood biomarker analyses revealed S-100B, neurofilament light, and Tau proteins as potential diagnostic indicators, where temporal profiles correlating with symptom progression. Evidence suggests that integration of multiple diagnostic modalities will significantly enhance mTBI diagnosis accuracy. A multimodal approach is the most effective way to overcome the limitations of individual methods. For example, psychometric tests are relatively subjective, while neuroimaging after an injury is unable to distinguish between pre-existing and new injuries. Devising a clinically relevant multimodal approach will require establishment of standardized norms and studies further validating individual approaches and estimating diagnostic accuracy for combinations of modalities relative to patient outcomes. These findings have particular relevance for Nevada's healthcare system, where rapid and accurate mTBI diagnosis could significantly impact patient care in both urban and rural settings. Future research should focus on validating specific combinations of these techniques and establishing standardized protocols for clinical implementation.
Abstract: Mild traumatic brain injury (mTBI) affects 69 million people annually worldwide. A significant subset of those affected will develop long-term sequelae that can seriously impact quality of life and lead to other health problems. Clinical diagnosis of mTBI is complicated by patient malingering, subjective symptomatology, and variable patient reporti...
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,
Kokou Mensah Guinhouya
