Guillain-Barre syndrome with posterior reversible encephalopathy syndrome

Abstract

Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiologic entity commonly associated with eclampsia, septicemia, chemotherapeutic drugs etc. Concurrent occurrence of Guillain-Barre syndrome (GBS) with PRES is a rare entity. Dysautonomia is a proposed mechanism for such occurrence. Here we present a non-diabetic, non-hypertensive 63-year-old male patient, who came with acute onset flaccid quadriparesis, developing generalized seizures, altered sensorium and raised blood pressure on fifth day of illness. Magnetic resonance imaging (MRI) of brain showed altered signal intensities involving the parieto-occipital areas suggestive of posterior reversible encephalopathy. Cerebrospinal fluid analysis showed albuminocytological dissociation, nerve conduction studies revealed demyelinating type of polyneuropathy. The patient was treated with antihypertensives and antiepileptics. After resolution of the encephalopathy, intravenous immunoglobulin (IVIg) was given. The patient recovered gradually over few months. Our case concludes GBS as independent risk factor, for PRES may be secondary to dysautonomia and physicians should be aware of such rare coexistence so that early treatment can be done to reduce the mortality and morbidity.

Posterior reversible encephalopathy as the first manifestation of Bickerstaff’s brainstem encephalitis

“…Although previous reports have suggested that PRES could be the presenting manifestation of GBS [10, 11] and could occur in patients with GBS variants, such as Miller-Fisher syndrome (MFS) or BBE (Table 2), our case, in contrast to most of the cases, presented with PRES as the first manifestation of BBE with overlapping GBS prior to any intervention. Three previous cases have shown the co-occurrence of MFS or MFS/ BBE-overlap syndrome and non-hypertensive PRES; however, in these cases, IVIG treatment was considered to be the culprit of PRES [4, 5, 12].…”

Posterior reversible encephalopathy syndrome (PRES) as a complication of Guillain-Barre’ syndrome (GBS)

“…This polyradiculoneuroapthy has several known complications including cranial nerve palsies, autonomic dysfunction and respiratory failure 4. Central complications such as altered sensorium and seizures are not seen in GBS.…”

Brainstem posterior reversible encephalopathy syndrome in a case with Guillain–Barré syndrome

“…Autonomic dysfunction leading to hypertension and BP fluctuation, as well as hypercytokinemia, is thought to induce endothelial damage and the breakdown of circulatory autoregulation, which results in BBB leakage . In 47% of the reported comorbid GBS and PRES patients, PRES developed after introduction of IVIg.…”

“…Guillain–Barré syndrome (GBS), an inflammatory demyelinating disease of the peripheral nerves, is frequently complicated by BP fluctuation . However, PRES is rarely reported in GBS . Here, we report a case of GBS in a patient who developed PRES mainly affecting the brainstem after intravenous immunoglobulin (IVIg) administration.…”