Guillain–Barré syndrome presenting with an ‘angina’ mimic and posterior reversible encephalopathy syndrome

Abstract

A 56-year-old woman presented with severe headache, blurring of vision, hypertensive emergency and severe crushing central chest pain. Extensive evaluation was undertaken to rule out sinister myocardial, pulmonary and mediastinal pathology. Pain relief required intravenous opiates. One week later, persistent complaints of numbness of hands and legs led to a suspicion of dysautonomic inflammatory neuropathy. Nerve conduction studies confirmed a demyelinating Guillain-Barré syndrome. Intravenous immunoglobulin treatment led to rapid resolution of pain, dysautonomia and neuropathic symptoms.

Transient Hypnic Headache-like Phenomenon in Guillain-Barre Syndrome: Lessons from a First Case Report

“…Most reports of headache as a prominent feature in GBS are based on the development of posterior reversible encephalopathy syndrome (PRES) or reversible cerebral vasoconstriction syndrome (RCVS) or raised intracranial pressure. (3)(4)(5)(6)(7)(8)(9) Headache in GBS may also be associated with the use of intravenous immunoglobulins (IVIg). IVIg may precipitate aseptic meningitis, (10) and rarely, a hypercoagulable state, leading to cerebral venous sinus thrombosis (CVST).…”