Neuropsychiatric debut as a presentation of Guillain-Barré Syndrome: An atypical clinical case and literature review

Sangroula, Dinesh; Durrance, Richard Jesse; Bhattarai, Shirshak; Nandakumar, Thambirajah

doi:10.1016/j.jocn.2017.06.041

Cited by 7 publications

(8 citation statements)

References 18 publications

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“…patients with BBBd at the time of first CAPD diagnosis are more likely to develop cognitive impairment when tested with a broad neuropsychological battery and that the extent of BBBd correlates with the degree of cognitive deficits. Indeed, case reports and studies of Guillain Barré Syndrome (GBS), an acute demyelinating polyneuropathy, have revealed evidence for CNS involvement reflected by neuropsychiatric manifestations [34,35]. In one of these studies the CSF protein concentration correlated with the severity of psychosis observed in GBS [34].…”

Section: Discussionmentioning

confidence: 99%

Patients with chronic autoimmune demyelinating polyneuropathies exhibit cognitive deficits which might be associated with CSF evidence of blood-brain barrier disturbance

et al. 2020

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Background Chronic autoimmune demyelinating polyneuropathies (CADP) result in impaired sensorimotor function. However, anecdotal clinical observations suggest the development of cognitive deficits during the course of disease. Methods We tested 16 patients with CADP (11 patients with chronic inflammatory demyelinating polyneuropathy, 4 patients with multifocal motor neuropathy and 1 patient with multifocal acquired demyelinating sensory and motor neuropathy) and 40 healthy controls (HC) with a neuropsychological test battery. Blood-brain-barrier dysfunction (BBBd) in patients was assessed retrospectively by analysing the cerebral spinal fluid (CSF) status at the time the diagnosis of CAPD was established. Results CADP patients failed on average in 1.7 out of 9 neuropsychological tests (SD ± 1.25, min. 0, max. 5). 50% of the CADP patients failed in at least two neuropsychological tests and 44.3% of the patients failed in at least two different cognitive domains. CADP patients exhibiting BBBd at the time of first diagnosis failed in more neuropsychological tests than patients with intact integrity of the BBB (p < 0.05). When compared directly with the HC group, CADP patients performed worse than HC in tests measuring information processing ability and speed as well as phonemic verbal fluency after adjusting for confounding covariates.

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Section: Discussionmentioning

confidence: 99%

Patients with chronic autoimmune demyelinating polyneuropathies exhibit cognitive deficits which might be associated with CSF evidence of blood-brain barrier disturbance

et al. 2020

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“…These were documented in our patient with known mood disorder but can be seen in patients without any psychiatric history. 9…”

Section: Discussionmentioning

confidence: 99%

Ascending Paralysis in a 36-Year-Old Woman With Bipolar Disorder and Recent Aspiration Pneumonia

Varma-Doyle

Garvie

Walvekar

et al. 2020

Journal of Investigative Medicine High Impact Case Reports

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Guillain-Barré syndrome (GBS) is an acute inflammatory demyelinating polyneuropathy affecting both motor and sensory peripheral nerves. Typically presenting after a gastrointestinal or a respiratory tract infection, it manifests as ascending paralysis with concomitant areflexia in patients. Cytoalbuminologic dissociation is a supportive finding on cerebrospinal fluid (CSF) analysis. Due to variability in presentation, misdiagnosis and delay in treatment can occur, and consequently, GBS can become life threatening due to respiratory failure. We report ascending paralysis in a 36-year-old woman with known history of bipolar disorder who recently recovered from aspiration pneumonia following a drug overdose event. Given her psychiatric history, she was initially misdiagnosed as conversion disorder. Intravenous immunoglobulin (IVIG) therapy was initiated at our hospital due to strong suspicion of GBS, based on history and physical examination findings consistent with flaccid quadriparesis and impending respiratory failure. CSF analysis and radiological findings subsequently supported our clinical suspicion and clinical findings. Concurrent IVIG therapy, pain management, aggressive physical and respiratory therapy, and monitoring resulted in symptom improvement. One must have a high index of suspicion for GBS when presented with acute inflammatory demyelinating neuropathies in patients who present with ascending paralysis. Early initiation of therapy is key and can prevent life-threatening complications.

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“…Table 1 includes six case studies reporting anxiety, lethargy and sleep disturbance at the onset of physical disability, as well as residual psychiatric symptoms at one to four weeks after GBS onset [12][13][14][15]. Two case studies reported that psychiatric symptoms preceded onset of physical disability, including stress, depression, anxiety and amnesia [16,17]. Table 2 includes 24 studies, including a total of 6,984 patients, that collectively reported that GBS causes psychiatric symptoms, including stress, anxiety, depression, fatigue, sleep abnormalities, visual hallucinations, paranoid delusions, disorientation, terror, and psychosis [11,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36].…”

Section: Reviewmentioning

confidence: 99%

Psychiatric Sequelae of Guillain-Barré Syndrome: Towards a Multidisciplinary Team Approach

Hillyar¹,

Nibber

2020

Cureus

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Neuropsychiatric debut as a presentation of Guillain-Barré Syndrome: An atypical clinical case and literature review

Cited by 7 publications

References 18 publications

Patients with chronic autoimmune demyelinating polyneuropathies exhibit cognitive deficits which might be associated with CSF evidence of blood-brain barrier disturbance

Patients with chronic autoimmune demyelinating polyneuropathies exhibit cognitive deficits which might be associated with CSF evidence of blood-brain barrier disturbance

Ascending Paralysis in a 36-Year-Old Woman With Bipolar Disorder and Recent Aspiration Pneumonia

Psychiatric Sequelae of Guillain-Barré Syndrome: Towards a Multidisciplinary Team Approach

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