Posterior reversible encephalopathy syndrome as the initial manifestation of Guillain‐Barré syndrome: case report and review of the literature

Abstract

We report a 63-year-old female patient with Guillain-Barré syndrome revealed after posterior reversible encephalopathy syndrome. The onset was characterized by hypertension, headache, and cortical blindness, followed a few days later by progressive limb and facial paresis, dysautonomia, and respiratory failure. Treatment with plasmapheresis led to a rapid improvement of the clinical picture and the disappearance of magnetic resonance abnormalities. This report reviews the literature on this unusual association and discusses possible pathophysiological mechanisms.

Headache and Pain in Guillain-Barré Syndrome

“…These also included cases where headache was a salient clinical feature, similar with PRES in its more typical presentation [12,[20][21][22]. There are currently 15 adult cases of PRES and GBS reported in the literature, the majority (87 %) being both female and over the age of 55 [23••, 24, 25].…”

Posterior reversible encephalopathy syndrome after intrathecal methotrexate infusion: a case report and literature update

“…Immunological processing seems to be further involved in the genesis of PRES. Cytokine production in the early phase of Guillain-Barré Syndrome could play a role in altering capillary permeability and cause breakdown of the blood brain barrier (28).…”

Posterior reversible encephalopathy syndrome as an initial neurological manifestation of primary Sjögren’s syndrome

“…The mechanisms underlying autonomic hyperactivity are poorly understood and vary according to the underlying cause [2]. Examples of peripheral neuropathy associated with autonomic hyperactivity include GBS, porphyria, and familial dysautonomia [4,5,8]. It has been stated that baroreflex failure is a possible mechanism of PRES in patients with GBS.…”

“…PRES has been reported in many diseases and in cases of acute neuropathy syndromes with autonomic instability, such as Guillain-Barré syndrome (GBS) [8].…”