Guillain-Barre syndrome in pregnancy- a rare entity

Abstract

Guillain-Barre syndrome (GBS) is a rare, autoimmune disorder. Estimated incidence is 0.62 to 2.66 cases per 100000 people annually. We report a case of GBS in 29 years old primigravida with pre-gestational diabetes mellitus controlled on insulin, who presented at 7 weeks of the period of gestation with complaints of numbness in both hands and fingers. After 3 days of hospital admission, she had progressive weakness in both limbs and difficulty in walking. MRI of the brain and spinal cord done to exclude other possible causes and was normal. All the other blood investigations including electrolytes were normal. Nerve conduction velocity test was suggestive of acute inflammatory demyelinating axonal motor polyneuropathy and diagnosis of GBS was made. She was managed by multidisciplinary approach in intensive care unit. The patient improved after plasmapheresis and supportive measures as thromboembolism prophylaxis and physiotherapy. Patient was discharged after 2 weeks of hospital stay and had no residual symptoms after 1 month. She was readmitted at 32 weeks of gestation with severe preeclampsia and underwent emergency cesarean section delivering 1.9 kg male baby. She was discharged on day 4 of cesarean section and followed in postpartum period for complications. To summarize, GBS can appear at any stage of pregnancy & postpartum. Diagnosis can be delayed, so needs high index of clinical suspicion. Early diagnosis along with prompt intensive multidisciplinary supportive care improves outcomes for the mother and foetus.

Pregnancy-related Guillain-Barré syndrome: A Case Series

“…However, with full recovery occurring in 70-80% of patients, PE has been shown to improve clinical outcomes (3) and is more affordable compared to IVIG (19). Some of the serious possible side effects of PE during pregnancy are hemodynamic changes, hepatitis, maternal sepsis, and abnormal coagulation (10), but the patients in this study experienced no complications. The patient had complete remission and showed no relapse on 1 month of follow up and there was no side effect of PE observed on born neonates.…”

“…It is often triggered by several antecedent events, such as bacterial or viral infection (9). GBS is also associated with several underlying diseases (10) and its pathophysiology is characterized by repulsive immune cell behavior, which resulting the damage on peripheral nerves and specific gangliosides. The diagnosis of GBS is usually made upon clinical examination, laboratory studies (i.e., CSF and serological test), and neurophysiological studies (11).…”