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Use of pacemaker in GBS dysautonomia
  1. Zaira Abbas1 and
  2. Zomer Sardar2
  1. 1Stroke Medicine, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
  2. 2Neurology Department, Mayo Hospital, Lahore, Pakistan
  1. Correspondence to Dr Zaira Abbas; zaira.abbas{at}live.com

Abstract

Autonomic dysfunction in Guillain-Barrè syndrome (GBS) involves labile hypotension, hypertension, resting tachycardia and sweating. While autonomic involvement affects 66% of patients with GBS, the changes are usually transient and reversible. We hereby delineate a case of a female who presented to our medical centre with flaccid, painless progressive quadriparesis with features of dysautonomia. She had resting tachycardia, was tachypneic with reduced chest expansion and required immediate invasive mechanical ventilation. After pertinent laboratory evaluation, nerve conduction studies were promptly performed at the bedside and findings were concordant with acquired acute inflammatory demyelinating polyneuropathy. The diagnosis of GBS was made on the standard set of investigations and plasmapheresis was initiated on the same day. Her intensive care unit stay was complicated by the multiple episodes of asystole. Even though a temporary transvenous pacemaker was inserted, she, unfortunately, succumbed to a sudden episode of asystole. This paper illustrates that GBS-associated autonomic dysfunction can be severe and close cardiac monitoring is imperative in these patients.

  • peripheral nerve disease
  • neuro ITU
  • neuroanaesthesia
  • clinical neurophysiology

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Footnotes

  • Contributors ZA has written this case report in association with her coauthor ZS.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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