Can Subdural Hematoma Be a Trigger for Guillain–Barré Syndrome?

Abstract

Guillain-Barré syndrome (GBS) is an acute inflammatory polyneuropathy which follows a precipitating event in approximately two thirds of cases. Although its pathogenesis is unclear, it is likely to be a consequence of an immune-mediated process. In the literature there are three case reports of GBS following subarachnoid hemorrhage, subdural hematoma, and facial bone fracture after head trauma.The unique feature of our case with GBS after subdural hematoma is the presence of cerebellar symptoms. We believe that GBS results from an aberrant immune response following trauma that somehow mistakenly attacks the nerve tissue of its host, and we discuss the effects of the trauma of head injury on cellular and humoral immunities and the absence of antiganglioside antibody (anti-GD1b IgG, which is accused of ataxia and cerebellar symptoms) in this case report.

Critical illness polyneuropathy or axonal Guillain�Barr� syndrome triggered by subarachnoid haemorrhage?

“…There are in the literature very few cases of GBS following either spontaneous or post-traumatic brain haemorrhage and the causal relationship between remains speculative [1][2][3][4] . A 29-year-old man developed a flaccid tetraparesia and respiratory failure 13 days following post-traumatic SAH 5 .…”

“…The discrepancy between a progressive recovery of consciousness manifested as spontaneous eye opening or response to verbal command in the oro-facial territories and a persisting quadriplegia or quadriparesia should prompt further investigations to rule out peripheral injury. Numerous conditions have been associated with critical illness polyneuropathy (CIP) and myopathy and Guillain-Barré syndrome (GBS), including head trauma or intracerebral haemorrhage [1][2][3][4] . The potential role of subarachnoid bleeding is speculative, but the following observation illustrates the difficulties of the differential diagnosis between CIP and GBS when consciousness is impaired.…”

Guillain-Barre Syndrome Following Spinal Fusion for Thoracic Vertebral Fracture

“…The presence of antibodies to myelin basic protein has been identified in trauma patients and in surgical patients 2) . The connection of GBS and surgery and trauma also has been postulated as the result of alternations in T-cell function and major stress during surgery and trauma 2,4,7,12) . In our patients, the only clearly identified precipitating event was the thoracic vertebral fracture and spinal fusion operation, which we consider to be the antecedent event for the development of GBS.…”

“…It is a symmetric, rapidly progressive polyneuropathy of unknown cause that has been described most frequently after non-specific viral infection 4,5) . GBS has rarely been reported following trauma and operation 2,6,7,12) . In addition, only three cases in the literature have been reported after spine surgery [8][9][10] .…”

Guillain-Barré Syndrome and Cerebral Hemorrhage: Two Cases and Literature Review

“…Autonomic dysfunction, especially cardiovascular instability, is a frequent accompaniment and has been attributed to subsequent hemorrhagic stroke in GBS patients [10,11,13] . Conversely, head trauma [2][3][4] , neurosurgery [1,9] or other intracerebral hemorrhagic injury [6] also result in GBS. According to previous literature reports, GBS and cerebral hemorrhage could occur successively.…”