Guillain-Barré syndrome and posterior reversible leukoencephalopathy syndrome: a rare association

2020 ◽  
Vol 13 (4) ◽  
pp. e234184 ◽  
Author(s):  
Stuti Joshi ◽  
David Prentice ◽  
Jolandi van Heerden ◽  
Thomas Chemmanam
Keyword(s):  
Visual Disturbance ◽  
Guillain Barre Syndrome ◽  
Sensory Loss ◽  
Antihypertensive Medications ◽  
Guillain Barré Syndrome ◽  
Posterior Reversible Leukoencephalopathy Syndrome ◽  
Electrophysiological Findings ◽  
Posterior Reversible Leukoencephalopathy ◽  
Guillain Barré ◽  
Reversible Encephalopathy

A 69-year-old woman presented with headaches and visual disturbance in the context of marked hypertension secondary to non-compliance with antihypertensive medications. She developed seizures and hyperreflexia, and MRI brain showed changes consistent with posterior reversible encephalopathy syndrome (PRES). She was treated with antihypertensives with the resolution of symptoms. Over the following week, she developed progressive distal sensory loss, weakness and areflexia. The cerebrospinal fluid examination demonstrated albuminocytologic dissociation, and electrophysiological findings were in keeping with a diagnosis of Guillain-Barré syndrome (GBS). She was treated with intravenous immunoglobulin with gradual recovery. The co-occurrence of PRES and GBS has only been described in a handful of cases. In the majority of these, the dysautonomia of GBS leads to profound hypertension and subsequently PRES. This is a rare case of PRES preceding and possibly even triggering the onset of GBS. In this report, we review the literature and discuss the potential pathogenic mechanisms for this unusual association.

scholarly journals An Acute, Severe Axonal Sensorimotor Polyneuropathy in the Setting of Nitrous Oxide Abuse

2020 ◽  
Vol 10 (4) ◽  
pp. 293-296
Author(s):  
Jules C. Beal ◽  
Yishan Cheng ◽  
Sabiha Merchant ◽  
Reza Zarnegar
Keyword(s):  
Nitrous Oxide ◽  
Vitamin B12 ◽  
Clinical Picture ◽  
Guillain Barre Syndrome ◽  
Sensory Loss ◽  
Laboratory Evaluation ◽  
Sensorimotor Polyneuropathy ◽  
Guillain Barré Syndrome ◽  
B12 Deficiency ◽  
Guillain Barré

Nitrous oxide, often used as an anesthetic agent, is also increasingly a drug of abuse due to its euphoric and anxiolytic effects. Frequent exposure to nitrous oxide can lead to neurologic complications, including B12 deficiency and resultant subacute myeloneuropathy, as well as direct neurotoxicity. A clinical presentation of acute sensorimotor polyneuropathy mimicking Guillain-Barré syndrome after chronic nitrous oxide abuse has been reported only rarely. Here we present a 17-year-old previously healthy girl presented with 10 days of progressive ascending sensory loss and weakness in the legs. She admitted to heavy nitrous oxide abuse over a period of a year or more. Laboratory evaluation was significant for normal vitamin B12 level with elevated homocysteine. A magnetic resonance imaging (MRI) of her spine showed abnormal signal involving the bilateral dorsal columns. Nerve conduction studies were suggestive of severe axonal sensorimotor polyneuropathy. This patient demonstrates concurrent multifactorial neurologic injury as a result of nitrous oxide abuse. She had a functional vitamin B12 deficiency as indicated by the elevated homocysteine, leading to a subacute combined degeneration that was evident on the MRI. In addition, she had evidence of direct neurotoxicity leading to axonal injury and sensorimotor polyneuropathy reminiscent of Guillain-Barré syndrome. This clinical picture is a serious but seldom reported possible complication if nitrous oxide abuse and should be considered in patients presenting with a clinical picture suspicious for Guillain-Barré syndrome or its variants.

scholarly journals Two Cases of Guillain-Barré Syndrome Variants Presenting With Dysautonomia

2019 ◽  
Vol 6 ◽  
pp. 2329048X1985677 ◽  
Author(s):  
Omar Abdel-Mannan ◽  
Luigi D’Argenzio ◽  
Matthew Pitt ◽  
Felice D’Arco ◽  
Sanjay Bhate ◽  
...  
Keyword(s):  
Intravenous Immunoglobulin ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Lower Limb ◽  
Guillain Barre Syndrome ◽  
Limb Weakness ◽  
Posterior Reversible Encephalopathy ◽  
Lower Limb Weakness ◽  
Guillain Barré Syndrome ◽  
Guillain Barré ◽  
Reversible Encephalopathy

We describe 2 pediatric cases presenting with posterior reversible encephalopathy syndrome secondary to autonomic dysfunction preceding the onset of motor symptoms in Guillain-Barré syndrome variants. Patient 1 presented acutely with encephalopathy, cerebellar signs, hypertension, lower limb weakness, and respiratory decompensation. Magnetic resonance imaging (MRI) brain showed occipital lesions consistent with posterior reversible encephalopathy syndrome. Nerve conduction studies were consistent with Miller-Fisher syndrome. After intravenous immunoglobulin and plasmapheresis, he improved clinically with radiological resolution. Patient 2 presented with headache, leg pain, seizures, and significant hypertension. Brain MRI was normal but spine MRI revealed enhancement of the cauda equina ventral nerve roots. She was areflexic with lower limb weakness a few days after intensive care unit admission and made a significant improvement after treatment with intravenous immunoglobulin. In children presenting with posterior reversible encephalopathy syndrome in the absent of other causes of primary hypertension, Guillain-Barré syndrome variants are an important differential etiology, presenting with autonomic dysfunction, even before signs of motor weakness become evident.

Clinico-electrophysiological findings and prognosis of Guillain-Barré syndrome - 10 years’ experience

2011 ◽  
Vol 123 (3) ◽  
pp. 181-186 ◽  
Author(s):  
A. Soysal ◽  
F. Aysal ◽  
B. Calıskan ◽  
P. Dogan Ak ◽  
B. Mutluay ◽  
...  
Keyword(s):  
Guillain Barre Syndrome ◽  
Guillain Barré Syndrome ◽  
Electrophysiological Findings ◽  
Guillain Barré

scholarly journals Posterior Reversible Encephalopathy Syndrome with Bilateral Independent Epileptic Foci Precipitated By Guillain-Barrè Syndrome

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Rosario Rossi ◽  
Maria Valeria Saddi ◽  
Alessandro Mela ◽  
Anna Ticca
Keyword(s):  
Posterior Reversible Encephalopathy Syndrome ◽  
Seizure Activity ◽  
Guillain Barre Syndrome ◽  
Cerebral Lesions ◽  
Posterior Reversible Encephalopathy ◽  
Guillain Barré Syndrome ◽  
Guillain Barré ◽  
Reversible Encephalopathy ◽  
Occipital Lobes ◽  
Parenchymal Abnormalities

We report the case of a 56-year-old woman who developed status epilepticus (SE) related to independent occipital foci as clinical manifestation of posterior reversible encephalopathy syndrome (PRES) in the background of Guillain-Barrè syndrome (GBS). SE resulted from a series of focal seizures clinically characterized by left- and rightward deviations of the head and consequent oculoclonic movements. Electroencephalography recorded independent seizure activity in both occipital regions with alternate involvement of the two cerebral hemispheres. The epileptic foci corresponded topographically to parenchymal abnormalities of PRES in the occipital lobes. The manifestation of bilateral, independent occipital seizures with alternate deviations of the head and oculoclonic movements, previously not reported in patients with PRES, highlights the acute epileptogenicity of the cerebral lesions in this syndrome. Despite the variable clinical expression of seizures due to occipital damage in PRES, the development of independent seizure activity in both occipital lobes might represent a distinctive epileptic phenomenon of this encephalopathy.

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