DEAR DR. DONOHUE: My brother recently had Guillain-Barre syndrome. What causes it, and what is its treatment? Will he be able to walk again? – J.M.

ANSWER: Guillain-Barre (gee-YAWN buh-RAY) syndrome is an illness unfamiliar to most people until a friend or relative comes down with it. My nephew had it this past summer. It’s not a rare bird. Usually, a minor infection like a simple respiratory or digestive-tract infection precedes it by a week. The preceding illness is often forgotten once GB sets in.

It comes about from a disruption of nerve transmission because nerves lose their insulation covering – myelin. The immune system, primed by the preceding illness, bombards the myelin. The first symptoms can be a vague tingling in the feet. Then muscle weakness sets in.

The weakness begins in the legs and progresses up the body, and it can be so profound that the person is paralyzed. When breathing muscles are affected, a ventilator has to assist in breathing. The heart can speed up or slow down. Blood pressure might rise. People have a hard time emptying their bladder.

In two to four weeks, the illness reaches its peak and then plateaus.

From that time on, most make a steady improvement that can take from weeks to months. About 20 percent of people are left with some residual muscle weakness, and a very few succumb.

Intravenous immunoglobulin (gamma globulin) is one treatment. Plasma exchange is another. Plasma is the fluid part of blood, and it is the part that contains the myelin-attacking antibodies produced by the immune system. They’re removed.

If your brother is like most GB patients, he will be walking again.

DEAR DR. DONOHUE: My 39-year-old daughter had been told she had migraine headaches. She had a headache and took a nap. When she woke, she felt like someone had punched her in the eye. She saw a doctor, who patched the eye. In a week, she had lost sight in that eye.

She was finally diagnosed with pseudotumor cerebri. She had to have a shunt put in her brain. Most doctors, other than ophthalmologists and neurologists, have to look up this disease. I wonder how many patients diagnosed with migraine headaches have it. – P.W.

ANSWER: Your point is one that should be taken to heart by doctors and patients. Uncommon causes can lie at the bottom of common complaints, like headaches. “Pseudotumor cerebri” means “false brain tumor.” A person has symptoms of a brain tumor – headache, dizziness, double vision, vision loss – but no brain tumor is present.

What has happened is that fluid pressure within the brain has risen. Most often, the reason for that is inexplicable.

Although this can happen to anyone, it often happens to obese young women – another inexplicable fact. Too much vitamin A or adrenal-gland malfunction also cause it, but for most no cause is found.

A shunt is a thin, plastic tube, which is inserted into the fluid compartments of the brain and which drains cerebrospinal fluid into the abdominal cavity or into a vein, thereby lowering brain pressure.

It’s tragic that your daughter lost sight in one eye.

Pseudotumor cerebri is rare and is a condition best managed by a team of doctors – a neurosurgeon, neurologist and eye doctor.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com

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