Abstract
Background
To describe a patient with Guillane–Barré syndrome (GBS), posterior reversible encephalopathy syndrome (PRES) and takotsubo cardiomyopathy, and in doing so, to postulate a new mechanism for hypotension in the setting of dysautonomia in GBS.
Methods
Case report.
Results
We report an 82-year-old woman who presented with bilateral lower extremity weakness and back pain following an upper respiratory viral illness. Within 4 days she became markedly hypertensive and developed status epilepticus. Brain MRI revealed patchy bilateral occipital lesions with T2 signal hyperintensity consistent with PRES. Her clinical exam, CSF, and electrophysiologic findings were consistent with GBS. She became relatively hypotensive and transthoracic echocardiogram showed severe apical akinesis. The patient clinically improved, and echocardiogram and MRI abnormalities resolved within 2 weeks.
Conclusions
The autonomic effects of GBS may cause a variety of reversible clinical syndromes associated with sympathetic dysfunction including PRES and takotsubo cardiomyopathy; both of which are self-limited. Relative hypotension in GBS may be caused in part by neurogenic stunned myocardium.
References
Zochodne DW. Autonomic involvement in Guillain–Barre syndrome: a review. Muscle Nerve. 1994;17:1145–55.
Flachenecker P. Autonomic dysfunction in Guillain–Barre syndrome and multiple sclerosis. J Neurol. 2007;254(Suppl 2):II96–101.
Hinchey J, Chaves C, Appignani B, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med. 1996;334:494–500.
Schwartz RB, Jones KM, Kalina P, et al. Hypertensive encephalopathy: findings on CT, MR imaging, and SPECT imaging in 14 cases. AJR Am J Roentgenol. 1992;159:379–83.
Bybee KA, Kara T, Prasad A, et al. Systematic review: transient left ventricular apical ballooning: a syndrome that mimics ST-segment elevation myocardial infarction. Ann Intern Med. 2004;141:858–65.
Lyon AR, Rees PS, Prasad S, Poole-Wilson PA, Harding SE. Stress (Takotsubo) cardiomyopathy—a novel pathophysiological hypothesis to explain catecholamine-induced acute myocardial stunning. Nat Clin Pract Cardiovasc Med. 2008;5:22–9.
Wittstein IS, Thiemann DR, Lima JA, et al. Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med. 2005;352:539–48.
Akashi YJ, Musha H, Nakazawa K, Miyake F. Plasma brain natriuretic peptide in takotsubo cardiomyopathy. QJM. 2004;97:599–607.
Banuelos PA, Temes R, Lee VH. Neurogenic stunned myocardium associated with reversible posterior leukoencephalopathy syndrome. Neurocrit Care. 2008;9:108–11.
Palazzuoli A, Lenzi C, Iovine F, Carrera A, Nuti R. A case of acute heart failure associated with Guillain–Barre syndrome. Neurol Sci. 2006;26:447–50.
Elahi A, Kelkar P, St Louis EK. Posterior reversible encephalopathy syndrome as the initial manifestation of Guillain–Barre Syndrome. Neurocrit Care. 2004;1:465–8.
Van Diest D, Van Goethem JW, Vercruyssen A, Jadoul C, Cras P. Posterior reversible encephalopathy and Guillain–Barre syndrome in a single patient: coincidence or causative relation? Clin Neurol Neurosurg. 2007;109:58–62.
Koichihara R, Hamano S, Yamashita S, Tanaka M. Posterior reversible encephalopathy syndrome associated with IVIG in a patient with Guillain–Barre syndrome. Pediatr Neurol. 2008;39:123–5.
Bartynski WS. Posterior reversible encephalopathy syndrome, part 2: controversies surrounding pathophysiology of vasogenic edema. AJNR Am J Neuroradiol. 2008;29:1043–9.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Fugate, J.E., Wijdicks, E.F., Kumar, G. et al. One Thing Leads to Another: GBS Complicated by PRES and Takotsubo Cardiomyopathy. Neurocrit Care 11, 395–397 (2009). https://doi.org/10.1007/s12028-009-9279-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12028-009-9279-8