Delalande S, De Sèze J, Hurtevent J-P, Stojkovic T, Hurtevent J-F, Vermersch P
Service de Neurologie D, Hôpital R. Salengro, Lille.
Rev Neurol (Paris). 2005 Apr;161(4):465-7. doi: 10.1016/s0035-3787(05)85078-7.
We report a case of a Guillain-Barre syndrome (GBS) with subarachnoid hemorrhage and regressive occipital white matter lesions.
A 62-year-old woman developed ascendant progressive paresthesia and weakness of arms and legs, 48 hours after enteritis infection. Neurological examination showed tetraparesia with loss of deep tendon reflexes and alteration of proprioception tests. Nerve conduction studies revealed polyradiculoneuritis. Then she presented an acute blindness and hypertension. Brain magnetic resonance imaging showed bilateral occipital lesions and subarachnoid hemorrhage. Cerebrospinal fluid analysis revealed an elevated protein level (1.54 g/l) and red blood cells without meningitis. Brain arteriography was normal. Intravenous immunoglobulins improved neurological symptoms.
Posterior localisation of reversible white matter lesions evoked a reversible posterior leukoencephalopathy. The implication of arterial hypertension caused by dysautonomia during GBS could be suspected.
我们报告一例伴有蛛网膜下腔出血和枕叶白质病变退行性变的吉兰-巴雷综合征（GBS）病例。
一名62岁女性在肠炎感染48小时后出现上肢和下肢进行性上升性感觉异常和无力。神经系统检查显示四肢轻瘫，深腱反射消失，本体感觉测试异常。神经传导研究显示多发性神经根神经炎。随后她出现急性失明和高血压。脑部磁共振成像显示双侧枕叶病变和蛛网膜下腔出血。脑脊液分析显示蛋白水平升高（1.54 g/l）且有红细胞，但无脑膜炎表现。脑动脉造影正常。静脉注射免疫球蛋白改善了神经症状。
可逆性白质病变的枕叶定位引发了可逆性后部白质脑病。可怀疑GBS期间自主神经功能障碍引起的动脉高血压的影响。
