Guillain‐Barré syndrome (GBS) with bilateral optic neuritis and central white matter disease

Abstract

A patient with acute Guillain-Barré syndrome (GBS), recovering following plasmapheresis, developed bilateral optic neuritis with extensive CNS white matter lesions on MRI. This illness was associated with Mycoplasma pneumoniae infection. The rare association of GBS with CNS disease raises a possibility of a shared pathogenic CNS and PNS epitope in these cases.

High-Dose Intravenous Immunoglobulin Treatment and Cerebral Vasospasm: A Possible Mechanism of Ischemic Encephalopathy?

“…Although no angiographic or TCD studies were performed on these patients, these findings may suggest a vasculopathic process which could be reponsible for increased cerebral blood flow velocities. The time course however of the onset of symptoms is very different in the case reported by Nadkarni and Lisak [15]than the one observed in our 2 patients and it is therefore difficult to postulate the same underlying mechanism.…”

“…We therefore believe that cerebral vasospasm is a possible mechanism explaining the rare episodes of stroke or encephalopathy occurring after IVIg treatment. A vasculopathic process related to the GBS may also be responsible for high blood flow velocities; however, in the case reported by Nadkarni and Lisak [15], CNS symptoms occurred later in the course of the illness and responded to a treatment with steroids. These facts render this second hypothesis less likely in our 2 patients.…”

“…CNS complications have been described in several cases of GBS [14, 15, 16, 17, 18]. Nadkarni and Lisak [15]reported 1 case with bilateral optic neuritis and central white-matter disease. The central symptoms appeared in the third week when the patient was already in the recovery phase of GBS and diagnosis of an acute disseminated encephalomyelitis, responding to steroid treatment, was established.…”

Guillain-Barre Syndrome with Optic Neuritis and a Focal Lesion in the Central White Matter Following Epstein-Barr Virus Infection

“…In most of the reported cases of GBS with ON, the temporal profile of GBS differed from that of ON (1,13). This biphasic illness profile suggests that an autoantigen was liberated from the nervous system during the first attack and subsequently sensitized the host to cause the second insult (13) …”

Bilateral third-nerve palsy with aberrant regeneration in Guillain–Barré syndrome

“…7,8 Optic nerve involvement may be a result of either optic neuritis or papilloedema. 9,10 The latter occurs in 4-6% of patients with Guillain-Barré syndrome and is believed to be caused by either impairment of CSF reabsorption secondary to high protein level or by cerebral oedema. 9 Visual loss at presentation can be very severe, but most patients usually have good recovery.…”