Abstract
Background: Guillain-Barré Syndrome (GBS) frequently affects autonomic nerves with subsequent fluctuations in blood pressure. Posterior reversible encephalopathy syndrome (PRES) is a descriptive radiological term for hypertensive encephalopathy. This article describes a unique case in which autonomic neuropathy led to marked elevations in blood pressure with subsequent PRES prior to the sigificant motor weakness and diagnosis of GBS.
Methods: To describe a patient who presented with PRES and GBS.
Results: A 58-year-old female presented to the local emergency room with complaints of acute sharp thoracolumbar back pain. Within the following 2 days, her blood pressure showed marked elevation with sudden episodic falls. She subsequently became encephalopathic and had a tonic-clonic seizure. Brain MR1 was consistent with PRES. By day 5 of her initial presentation, she had developed weakness and areflexia with the electrophysiological findings of GBS. Her sensorium recovered, and MRI changes reversed with control of blood pressure. She was treated with intravenous immunoglobulin with full recovery back to baseline over the next 4 to 5 months.
Conclusion: The autonomic effects of GBS may cause hypertensive encephalopathy or PRES prior to the motor manifestations.
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References
Covarrubias DJ, Luetmer, PH, Campeau NG. Posterior reversible encephalopathy syndrome: prognostic utility of quantitative diffusion-weighted MR images. Am J Neuroradiol 2002;23:1038–1048.
Hinchey J, Charles C, Appignani B, et al. A reversible posterior leukoencephalopathy syndrome. N Eng J Med 1996;334:494–500.
Garg, RK. Posterior leukoencephalopathy syndrome. Postgrad Med J 2001;77:24–28.
Schwarz, R Hyperperfusion encephalopathies: hypertensive encephalopathy and related conditions. Neurologist 2002;8:22–24.
Okada T, Hiyoshi K, Noto N, et al. A case of Guillain-Barré syndrome accompanied by sympathetic overactivity and hypertensive encephalopathy. Acta Paediatr 1996;85:1006–1008.
Dixon, SF, Appleton RE, Davidson JE, Hughes DA, Tedman BM. Acute, Severe Self-Limiting Dysautonomia and Hypertensive Encephalopathy. Pediatr Neurol 2001;25(4):319–324.
Zochodne DW. Autonomic involvement in Guillain-Barré syndrome: a review. Muscle Nerve 1994;17:1145–1155.
Litchenfield P. Autonomic dysfunction in the Guillain-Barré syndrome. Am J Med 1972;50:772–780.
Flacheneker P, Wermuth P, Hartung HP, et al. Quantitative assessment of cardiovascular autonomic function in Guillain-Barré syndrome. Ann Neurol 1997;42:171–179.
Richards AM, Nicholls MG, Beard MEJ, Parkin PJ, Espiner EA. Severe hypertension and raised haematocrit: unusual presentation of Guillain-Barré syndrome. Postgard Med J 1985;61:53–55.
Schwartz, R B. A reversible posterior leukoencephalopathy syndrome [letter]. N Eng J Med 1996;334:1743.
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Elahi, A., Kelkar, P. & Louis, E.K.S. Posterior reversible encephalopathy Syndrome as the initial manifestation of Guillain-Barré Syndrome. Neurocrit Care 1, 465–468 (2004). https://doi.org/10.1385/NCC:1:4:465
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DOI: https://doi.org/10.1385/NCC:1:4:465