Perioperative management of term pregnant patient with Guillian Barre syndrome

Jyothi, B; Verma, Himanshu; Vaidyanathan,; Shaikh, Safiya I

doi:10.4103/0019-5049.100848

Cited by 2 publications

(2 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, in pregnancy it may be associated with increased maternal morbidity and mortality. 1 Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological entity described by Hinchey et al in 1996. PRES can have varied clinical presentations ranging from headache, nausea/vomiting, seizures, altered sensorium, visual abnormalities, and focal neurological deficits.…”

Section: Introductionmentioning

confidence: 99%

“Double” Trouble in Postpartum State

Chandrashekaraiah¹,

Sundaramurthy²,

Colaco³

2021

Journal of South Asian Federation of Obstetrics and Gynaecology

View full text Add to dashboard Cite

Background: Guillain-Barre syndrome (GBS) is a perplexing neurological disease of autoimmune etiology with an incidence of 1.2 to 1.9 cases/100,000 population. The overall incidence remains almost the same in pregnancy. Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological entity most commonly encountered in peripartum preeclampsia; however, it can also be seen in other clinical scenarios such as immunosuppressant treatment, infection/sepsis, autoimmune diseases, and during cancer chemotherapy. GBS can be considered as an independent risk factor of PRES, due to acute dysautonomia and pain. Here we report the unique case of a patient who presented to the neurology department with flaccid quadriparesis in the immediate postpartum period, was diagnosed as having GBS and initiated on treatment for the same, and subsequently developed seizures secondary to PRES. Case description: A 22-year-old patient, with no previously known comorbidities, was admitted to the obstetrics department in her 37th week of gestation in labor. The patient underwent an emergency lower segment cesarean section (LSCS) (previous LSCS in labor) with no periprocedural complications. On the next day, she developed progressive ascending quadriparesis sparing sensory and sphincters. Nerve conduction studies done showed features of GBS, and cerebrospinal fluid studies done showed albuminocytological dissociation. The patient was then initiated on plasmapheresis in the intensive care unit setting and closely monitored for any deterioration in overall neurological picture and bulbar symptoms. The patient remained stable and showed positive response to the plasmapheresis. On the morning of postpartum day 6, the patient complained of sudden painless bilateral complete loss of vision followed by an episode of generalized tonic-clonic seizures. She had labile blood pressure with reactive pupils, normal fundus, and no other long-tract signs. Magnetic resonance imaging (MRI) brain and magnetic resonance venogram were done. MRI brain done showed features suggestive of PRES. She was managed with antiepileptic drugs, blood pressure optimization, and supportive care with rapid recovery in vision in 2 days. She showed steady improvement in motor power following plasmapheresis and subsequently was managed with physiotherapy to full functional recovery. Conclusion and clinical significance: GBS in pregnancy, PRES in the postpartum female, and PRES in GBS are all unique entities with no defined incidence and only documented case reports. GBS rarely complicates pregnancies; there are few case reports of the same, the exact incidence of which is not defined. Proposed mechanisms leading to PRES in patients with GBS are dysautonomia leading to acute rise in the blood pressure, activation of sympathetic nervous system secondary to pain, and intravenous immunoglobulin usage. Review of the literature shows that previous cases of PRES in combination with GBS is a very unique finding with only a few case reports making this case distinctive. In our pa...

show abstract

Section: Introductionmentioning

confidence: 99%

“Double” Trouble in Postpartum State

Chandrashekaraiah¹,

Sundaramurthy²,

Colaco³

2021

Journal of South Asian Federation of Obstetrics and Gynaecology

View full text Add to dashboard Cite

show abstract

“…However, in pregnancy it may be associated with increased maternal morbidity and mortality. [ 1 ] There are reports of safe use of regional anaesthesia in pregnancy with GBS,[ 2 ] and also where GBS worsened in the postoperative period after regional anaesthesia. [ 3 ] We describe a patient with the hyperacute onset and rapidly progressive neuropathy leading to quadriplegia and respiratory failure following spinal anaesthesia for caesarean section.…”

mentioning

confidence: 99%