Autonomic involvement in Guillain–Barre syndrome: A review

Abstract

Autonomic neuropathy is an important and common complication of Guillain-Barré syndrome (GBS). Manifestations be present in cardiovascular, sudomotor, gastrointestinal and other systems involving both sympathetic and parasympathetic fibers. Some apparently selective acute autonomic neuropathies may be subvarieties of GBS. Experimental work in animal models, pathological studies of GBS patients, and autonomic function studies have provided some help in the understanding of this complication. In managing GBS patients with autonomic dysfunction there are important practical considerations that can improve their care. In this article we review the literature on autonomic neuropathy in GBS and propose a management scheme to accommodate it in the overall treatment of the neuropathy.

Faecal Incontinence in Gullain-Barre Syndrome with Bulbar Palsy-A Case Report with Review of Literature

“…Though mechanism is not clearly understood, pathology of the Gastrointestinal autonomic dysfunction in Guillain-Barre Syndrome usually reveals immune-mediated inflammation in autonomic ganglia with destruction of peripheral ganglionic cells [15] causing imbalance between sympathetic and parasympathetic activity. Demonstration of mononuclear cell infiltration, demyelination, chromatolysis, and nodules of Nageotte within autonomic ganglia in histopathology [11] further strengthen the hypothesis.…”

“…Dysautonomia is common association in Guillain-Barre Syndrome [11], involving both parasympathetic and sympathetic nervous system. Among autonomic involvements it affects most commonly cardiovascular system [12], presents as sinus tachycardia, labile hypertension and postural hypotension.…”

“…However, sinus bradycardia, asystole, supraventricular tachycardia, junctional tachycardia and ventricular tachycardia have also been reported in studies [13], even serious bradyarrhythmias in less severely affected patients [14]. Parasympathetic hyperactivity is usually intermittent, causing fatal bradyarrhythmias ranging from bradycardia to asystole, and a significant number of deaths in Guillain-Barre Syndrome patients [11].…”

“…autonomic nervous system causing gastro-paresis [11] and adynamic ileus (17 out of 114 patients) [15]. Autonomic dysfunction may also be manifested as SIADH (Syndrome of Inappropriate Anti Diuresis) [16,17].…”

Gullian- Barre Syndrome in Pregnancy – A Case Report and Review of the Literature

“…Paresthesia in the hands and feet accompanies weakness in more than 80% of patients followed by dysautonomia (70%) which manifests as tachycardia, urinary retention, blood pressure fluctuation. Pain, located in the back and extremities can be the presenting symptom in the acute phase in up to 66% of patients [8][9][10][11][12]. The wide variation and clinical presentation often results in a delay of diagnosis, especially as some changes mimic the normal physiological changes of pregnancy.…”