Posterior reversible encephalopathy and Guillain–Barré syndrome: which came first, the chicken or the egg? A review of literature

Storti, Benedetta; Vedovello, Marcella; Riva, Riccardo; Agazzi, Emanuela; Censori, Bruno; Manara, Ornella; Sessa, Maria; Rottoli, M. R.

doi:10.1007/s10072-020-04496-1

Cited by 7 publications

(2 citation statements)

References 18 publications

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“…Although rare, the association between GBS and PRES has been previously described in the literature, with PRES preceding or following GBS diagnosis ( 5 ). Autonomic dysfunction with pressure changes, altered permeability of the blood-brain barrier in the central nervous system, and increased risk of encephalopathy after IVIg treatment are believed to be involved in the pathogenesis of PRES associated with GBS ( 6 ).…”

Section: Discussionmentioning

confidence: 99%

Posterior Reversible Encephalopathy Syndrome in Guillain-Barré Syndrome: Just a Problem of Immunoglobulins? Controversy From Two Atypical Case Reports

et al. 2022

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BackgroundPosterior reversible encephalopathy syndrome (PRES), reversible cerebral vasoconstriction syndrome (RCVS), or the coexistence of these two entities shares similar risk factors and clinical features. For these conditions, a common origin has been supposed. Even if the majority of patients show a favorable course and a good prognosis, a small percentage of cases develop neurological complications. Up to date, only about 30 cases of PRES associated with Guillain-Barré syndrome (GBS) have been reported in the literature.CasesHere, we present two cases of a particularly aggressive PRES/RCVS overlap syndrome, associated with acute motor axonal neuropathy (AMAN) and acute inflammatory demyelinating polyneuropathy (AIDP) variants of GBS, respectively, presenting with similar initial clinical aspects and developing both an atypical and unfavorable outcome. On MRI examination, the first patient showed typical aspects of PRES, while, in the second case, radiological features were atypical and characterized by diffusion restriction on the apparent diffusion coefficient (ADC) map. The first patient demonstrated rapid worsening of clinical conditions until death; the second one manifested and maintained neurological deficits with a permanent disability.ConclusionsWe suggest that PRES may conceal RCVS aspects, especially in most severe cases or when associated with a dysimmune syndrome in which autoimmune system and endothelial dysfunction probably play a prominent role in the pathogenesis. Although the role of IVIg treatment in the pathogenesis of PRES has been proposed, we suggest that GBS itself should be considered an independent risk factor in developing PRES.

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Section: Discussionmentioning

confidence: 99%

Posterior Reversible Encephalopathy Syndrome in Guillain-Barré Syndrome: Just a Problem of Immunoglobulins? Controversy From Two Atypical Case Reports

et al. 2022

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“…Guillain-Barré syndrome (GBS) is an immune-mediated inflammatory polyneuritis, a disease clinically characterised by rapidly progressive flaccid paralysis and various sensory disturbances [1] . Although rare, GBS is an independent risk factor for posterior reversible encephalopathy syndrome (PRES) [2][3][4][5] . Reversible cerebral vasoconstriction syndrome (RCVS) has also been reported in patients with GBS [6] .…”

Section: Introductionmentioning

confidence: 99%

Guillain-Barré syndrome complicated by posterior reversible encephalopathy syndrome and reversible cerebral vasoconstriction syndrome

Kobayashi,

Hoshina,

Higa

et al. 2023

European Journal of Case Reports in Internal Medicine

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Introduction: Guillain-Barré syndrome is an immune-mediated inflammatory polyneuritis characterised by rapidly progressive flaccid paralysis. Guillain-Barré syndrome may present with posterior reversible encephalopathy syndrome or reversible cerebral vasoconstriction syndrome in rare cases. Case description: A woman in her 60s with a history of follicular lymphoma presented with a one-week history of difficulty walking and thunderclap headaches. The patient was diagnosed with Guillain-Barré syndrome based on neurological examination, cerebrospinal fluid analysis and nerve conduction findings. Further diagnosis of posterior reversible encephalopathy and reversible cerebral vasoconstriction syndromes was based on imaging findings and headache history. The patient was treated with intravenous immunoglobulin and amlodipine, and symptoms improved. Discussion: We reviewed the literature on Guillain-Barré syndrome associated with posterior reversible encephalopathy and/or reversible cerebral vasoconstriction syndrome. The underlying pathophysiology may involve dysautonomia resulting in unstable blood pressure, and hyponatraemia causing endothelial dysfunction. The SNOOP mnemonic highlights the ‘red flags’. This SNOOP mnemonic suggests the possibility of secondary headaches that require imaging studies. In this case, the patient exhibited three SNOOP symptoms: S (history of malignancy: follicular lymphoma), O (sudden-onset headache) and O (over 50 years old). Conclusion: This case highlights the importance of considering coexisting central neurological disorders in patients with Guillain-Barré syndrome.

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Seltene Formen der entzündlichen Erkrankungen des Zentralnervensystems

Bachhuber

2022

Radiologe

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Posterior reversible encephalopathy and Guillain–Barré syndrome: which came first, the chicken or the egg? A review of literature

Cited by 7 publications

References 18 publications

Posterior Reversible Encephalopathy Syndrome in Guillain-Barré Syndrome: Just a Problem of Immunoglobulins? Controversy From Two Atypical Case Reports

Posterior Reversible Encephalopathy Syndrome in Guillain-Barré Syndrome: Just a Problem of Immunoglobulins? Controversy From Two Atypical Case Reports

Guillain-Barré syndrome complicated by posterior reversible encephalopathy syndrome and reversible cerebral vasoconstriction syndrome

Seltene Formen der entzündlichen Erkrankungen des Zentralnervensystems

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