Guillain-Barré Syndrome and Posterior Reversible Encephalopathy Syndrome following Spinal Surgery

Abstract

Guillain-Barré syndrome (GBS) typically occurs after gastroenteritis and respiratory tract infection, but surgery has also been considered one of the triggers. Posterior reversible encephalopathy syndrome (PRES) is a rare complication of GBS. A normotensive female in her 70s presented ascending paralysis and frontal-parieto-occipital subcortical lesions with intermittent hypertension after spinal surgery. Nerve conduction studies revealed demyelinating polyneuropathy. The patient’s brain lesions disappeared with amelioration of hypertension. She was diagnosed with the demyelinating form of GBS and PRES caused by intermittent hypertension. Intravenous immunoglobulin G (IVIG) improved her symptoms without exacerbation of the PRES. Surgery can be a trigger of GBS, and GBS can cause PRES by hypertension and present as central nervous lesions. It is important to treat hypertension before using IVIG when PRES is suspected as a complication of GBS, since the encephalopathy can be exacerbated by IVIG. There may be more undiagnosed cases of the coexistence of GBS and PRES after surgery because surgery itself can also cause PRES. Proper control of blood pressure and confirmation of negative central nervous lesions are required to treat GBS patients with IVIG safely.

Development of Acute Inflammatory Demyelinating Polyneuropathy 11 Days after Spinal Surgery: A Case Report and Literature Review

“…Seven (38.9%) patients had sensory deficits at the nadir in the lower limbs only [ 11 , 16 , 17 , 20 , 22 – 24 ], five (27.8%) in the upper and lower limbs [ 12 , 13 , 15 , 17 , 19 ], and one (11.1%) in the upper limbs only [ 14 ]. Eleven (61.1%) patients showed areflexia or hyporeflexia [ 11 – 17 , 20 – 23 ]. Three (16.7%) patients reported pain [ 17 , 22 , 24 ].…”

“…Three (16.7%) patients reported pain [ 17 , 22 , 24 ]. Nine (50.0%) patients had cranial nerve symptoms [ 13 , 14 , 16 , 18 , 19 , 23 , 24 ], which included facial paralysis, dysphagia, decreased gag reflex, and impaired vocalization. Five (27.8%) patients had autonomic nerve symptoms [ 13 – 15 , 19 , 23 ], which included fever, tachycardia, atrial fibrillation, urinary retention, abdominal pain, diarrhea, and constipation.…”

“…Nine (50.0%) patients had cranial nerve symptoms [ 13 , 14 , 16 , 18 , 19 , 23 , 24 ], which included facial paralysis, dysphagia, decreased gag reflex, and impaired vocalization. Five (27.8%) patients had autonomic nerve symptoms [ 13 – 15 , 19 , 23 ], which included fever, tachycardia, atrial fibrillation, urinary retention, abdominal pain, diarrhea, and constipation. Nine (50.0%) patients needed mechanical ventilator support by intubation [ 11 , 13 , 14 , 17 – 20 ], one patient could not be weaned [ 18 ], and the rest received temporary support.…”

“…Seven (38.9%) patients needed a reoperation to determine the cause of postoperative complications [ 14 , 15 , 17 , 18 ]. CSF examinations were performed in 10 (55.6%) patients, 6 of 12 (50.0%) patients who underwent lumbar surgery [ 12 , 16 , 17 , 21 , 23 ], and 4 of 5 (80.0%) patients who underwent nonlumbar surgery [ 13 , 15 , 18 ]). Fifteen (88.2%) patients underwent an NCS [ 11 – 20 , 22 – 24 ].…”

“…Antiganglioside antibodies were detected in two patients [ 15 , 17 ], but the prior infection status was unknown. Seventeen patients underwent intravenous immunoglobulin (IVIg) therapy [ 12 – 24 ], three patients received concomitant plasma exchange (PE) therapy [ 12 , 17 ], and two patients received concomitant high-dose corticosteroids [ 12 , 23 ]. One patient received high-dose corticosteroids only [ 11 ].…”