Fulminant Guillain–Barré Syndrome and Spontaneous Intraventricular Hemorrhage: A Case Report and Literature Review

Abstract

Guillain–Barré syndrome (GBS) is an acute, immune-mediated inflammatory peripheral polyneuropathy that is characterized by flaccid paralysis. A few cases have reported that GBS can be caused by head trauma or neurosurgery, but it has never been associated with intraventricular hemorrhage. Here, we report an uncommon case of fulminant GBS that occurred after spontaneous intraventricular hemorrhage. A 73-year-old woman was admitted to the hospital after sudden unconsciousness and vomiting. A head computed tomography (CT) scan following the incident showed a newly developed intraventricular hemorrhage, which led to an immediate ventriculostomy. After 5 days, the endotracheal tube was removed. Two days later, the external ventricular drainage tube was also removed. At this time, the patient was alert and the neurological examination was normal. However, the patient suddenly presented with acute respiratory failure and bilateral limb weakness 3 days later. An analysis of the patient’s cerebrospinal fluid (CSF) revealed that albuminocytologic dissociation was present. The patient was treated with intravenous immunoglobulin (0.4 g/kg/day) for 5 days. Despite timely medical intervention in the hospital, the patient passed away 2 months later. After a cerebral hemorrhagic injury, limb and respiratory muscle weakness can occur on occasion in the ICU. In this context, the potential involvement of GBS should not be ignored. Importantly, the pathogenic mechanism of GBS has been discussed for over a century, and it still remains a mystery. We speculate that the TLR4/NF-κB signaling pathway may be involved in the pathogenesis of GBS following intraventricular hemorrhage. The prognosis of most patients with GBS is usually good, but cerebral hemorrhage and mechanical ventilation may serve as risk factors that exacerbate the condition. This case is reported to remind clinicians to consider the possibility of GBS when patients present limb and respiratory muscle weakness after intraventricular hemorrhage, and to provide a starting point to discuss potential mechanisms of GBS after intraventricular hemorrhage.

Trauma-Related Guillain–Barré Syndrome: Systematic Review of an Emerging Concept

“…Besides C. jejuni, GBS has been associated with other antecedent pathogens, including cytomegalovirus, Epstein-Barr virus, influenza virus, herpes simplex virus, adenovirus, varicella-zoster virus, Mycoplasma pneumoniae, Haemophilus influenzae, and most recently, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (11)(12)(13). Prodromal immunizations have also been proposed as a possible risk factor for GBS, although there is debate about this association owing to conflicting results among studies, and the relative risk differs among vaccination types (14,15).…”

Intracranial Hemorrhage in a Patient With Guillain-Barré Syndrome: A Potential Complication, a Coincidental Finding or a Treatment-Related Complication

“…When GBS is complicated by cerebral bleeding, the prognosis worsens even more. Taking into consideration the existing data, most of the reported patients showed only limited recovery [ 11 ].…”

Identifying ferroptosis-related genes associated with coronary heart disease based on bioinformatics analysis

“…Those with autoimmune conditions, such as systemic lupus erythematosus, rheumatoid arthritis, or psoriasis, are at a greater risk of developing CHD [36] . Immune cell infiltration is a significant factor in the progression of the disease in CHD patients [37] . Our results showed that notable distinctions in B cells, T cells, and dendritic cells between individuals with CHD and those without.…”