Shah Preet Mukesh, Dhakre Vijay Waman, Veerasuri Ramya, Bhabhor Anand
Department of Critical Care, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India.
Department of HPB Surgery, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India.
BMJ Case Rep. 2019 Apr 15;12(4):e226925. doi: 10.1136/bcr-2018-226925.
A 56-year-old woman with a medical history of hypertension presented to our hospital with back pain, abdominal pain, vomiting and elevated blood pressure. The laboratory parameters including evaluation for secondary hypertension were within normal ranges at the time of presentation. During her hospitalisation, fluctuations in her blood pressure and pulse were observed which were attributed to autonomic disturbances, the cause of which was unknown. On the seventh day after presentation to the hospital, the patient developed focal seizures and slurred speech which was believed to be secondary to hyponatraemia detected at that time. Hyponatraemia improved with hypertonic saline and she experienced no further seizures. On the eighth day of her admission, she developed acute flaccid paralysis of all her limbs and respiratory distress. We concluded this to be secondary to Guillain-Barre syndrome (GBS). She responded to plasmapheresis.The presence of dysautonomia and hyponatraemia before the onset of paralysis makes this a rare presentation of GBS.
一名有高血压病史的56岁女性因背痛、腹痛、呕吐和血压升高入住我院。就诊时包括继发性高血压评估在内的实验室参数均在正常范围内。住院期间，观察到她的血压和脉搏波动，归因于自主神经紊乱，但其原因不明。入院第七天，患者出现局灶性癫痫发作和言语不清，据信这是当时检测到的低钠血症所致。高渗盐水治疗后低钠血症有所改善，她未再出现癫痫发作。入院第八天，她出现四肢急性弛缓性麻痹和呼吸窘迫。我们认为这是吉兰-巴雷综合征（GBS）的继发表现。她对血浆置换治疗有反应。瘫痪发作前存在自主神经功能障碍和低钠血症，使得这成为GBS的一种罕见表现。
