Abdominal Pain Followed by Altered Mental Status: A Rare Presentation of Guillain Barré Syndrome

Abstract

Guillain Barré syndrome (GBS) is an acute inflammatory polyneuropathy with several variants; it usually presents as acute symmetrical muscle weakness with or without bulbar involvement, making it a neurological emergency. In this report, we describe the case of a 39-year-old male who presented with abdominal pain for three days and whose illness became progressively drowsy on the fifth day. Based on clinical assessment, nerve conduction studies, and biochemical, microbiological, and radiological investigations, other causes were ruled out and it was concluded that the patient had hyponatremia secondary to syndrome of inappropriate diuretic hormone secretion (SIADH) due to GBS.Although sensory symptoms like pain or dysaesthesias occurring in the back or extremities are common and may precede motor weakness, abdominal pain remains a very rare presentation of GBS. GBS is usually understood as a "pure" peripheral nervous system disorder but central nervous system (CNS) dysfunction may occur due to metabolic abnormalities (like hyponatremia and CO 2 narcosis) or autonomic dysfunction in GBS, its treatment, or due to GBS itself (Anti-GQ1b disease variant).

Guillain-Barre syndrome with hyponatremia, more than a simple finding

“…Due to this, some study groups state that the patient with GBS and hyponatremia should be considered as having a marker or predictor of the course of the disease. This may yield interesting results to determine need for ICU, discharge planning, and follow-up 20,21 . The patient with a history of hyponatremia due to systemic or neurological disease is more likely to have hyponatremia after the onset of GBS, since a small trigger may be enough to develop a new autonomic dysfunction even after a long time and lead to a worse prognosis in their next illness 22 .…”