Takotsubo Cardiomyopathy as a Manifestation of Dysautonomia in Guillain-Barré Syndrome: A Case Series and Review of the Literature

Abstract

Guillain-Barré syndrome (GBS) is an inflammatory polyneuropathy that classically presents with low back pain, sensory paresthesias, and rapidly progressive weakness. Patients with GBS can develop dysautonomia, and Takotsubo cardiomyopathy (TCM) is a rare potential manifestation of this dysautonomia. This association has been reported only 12 times in the literature so far, which we review here. We present two cases of GBS associated with TCM, to increase awareness with regard to this comorbid relationship, which would encourage prompt initiation of proper supportive care to avoid morbidity and mortality.We report the case of two patients -a 58-year-old man and a 79-year-old woman -who developed TCM in the setting of axonal variants of GBS. Electrodiagnostic results, cerebrospinal fluid profiles, and echocardiogram findings were consistent with these diagnoses. Both patients were treated with intravenous immunoglobulin (IVIG) in an intensive care unit (ICU) setting. Echocardiogram findings were reversible.TCM should be recognized as a potential complication of GBS in patients with dysautonomia. This case series adds to the sparse body of literature describing the association between these two conditions. It is not clear if patients with axonal variants of GBS are more predisposed to developing TCM; further, larger case series in the future may help identify the risk factors associated with it. We hope to shed more light on this possible association to expedite the diagnosis and management of this condition.

Takotsubo Cardiomyopathy and Autoimmune Disorders: A Systematic Scoping Review of Published Cases

“…Despite few published cases of concurrent TCM and MS, the presence of medulla oblongata lesions was a common finding, suggesting a potential role for catecholamines [ 145 ]. One review study supports TCM as a probable complication of GBS, especially for those with dysautonomia [ 146 ]. TCM may also present as a manifestation of thyrotoxicosis, especially Grave's disease [ 7 , 147 ].…”

Isolated right ventricular Takotsubo cardiomyopathy in Guillain–Barré syndrome

“…In addition, autonomic nerve involvement is a common feature of GBS. Autonomic dysfunction in GBS is typically accompanied with elevated plasma norepinephrine, plasma epinephrine, and 24-h urine Vanillylmandelic acid levels, as well as deranged neurotransmitter metabolism in the CSF [ 3 ]. It is now well documented that myocardial dysfunction in GBS can be linked to TC by means of a transient hyperadrenergic state [ 4 ].…”