195 Management of optic disc swelling in atypical inflammatory neuropathy

Abstract

An 18-year-old female presented with rapidly progressive ascending flaccid paralysis, respiratory failure and bilateral VI and VII cranial nerve palsies. She was diagnosed with Guillain-Barré syndrome (GBS) and, following intravenous immunoglobulin (IVIG) and plasma exchange (PLEX), made steady improvement. Seventy-four days after presentation and despite continued clear improvement in her other symptoms, she developed headaches, bilateral optic disc swelling and a dilated, tonic left pupil with light-near dissocia- tion. Her cerebrospinal fluid (CSF) protein was markedly elevated. She was managed with serial lumbar punctures and steroids and had an excellent response. Optic disc swelling is an unusual but described complication of GBS and may be caused by raised intracranial pressure, disorders of CSF protein (or its resorption) or direct inflammation of the optic nerve itself. Prompt recognition and appropriate manage- ment are essential to avoid permanent visual loss. We discuss differential diagnosis and management of this challenging clinical entity of delayed onset of optic disc swelling and very elevated CSF protein in the context of acute inflammatory neuropathy.