Joshi Stuti, Prentice David, van Heerden Jolandi, Chemmanam Thomas
Neurology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
Internal Medicine, St John of God Hospital, Midland, Western Australia, Australia.
BMJ Case Rep. 2020 Apr 20;13(4):e234184. doi: 10.1136/bcr-2019-234184.
A 69-year-old woman presented with headaches and visual disturbance in the context of marked hypertension secondary to non-compliance with antihypertensive medications. She developed seizures and hyperreflexia, and MRI brain showed changes consistent with posterior reversible encephalopathy syndrome (PRES). She was treated with antihypertensives with the resolution of symptoms. Over the following week, she developed progressive distal sensory loss, weakness and areflexia. The cerebrospinal fluid examination demonstrated albuminocytologic dissociation, and electrophysiological findings were in keeping with a diagnosis of Guillain-Barré syndrome (GBS). She was treated with intravenous immunoglobulin with gradual recovery. The co-occurrence of PRES and GBS has only been described in a handful of cases. In the majority of these, the dysautonomia of GBS leads to profound hypertension and subsequently PRES. This is a rare case of PRES preceding and possibly even triggering the onset of GBS. In this report, we review the literature and discuss the potential pathogenic mechanisms for this unusual association.
一名69岁女性，因未遵医嘱服用降压药导致严重高血压，出现头痛和视觉障碍。她出现癫痫发作和反射亢进，脑部MRI显示符合后部可逆性脑病综合征（PRES）的改变。她接受了降压治疗，症状得以缓解。在接下来的一周里，她逐渐出现进行性远端感觉丧失、无力和反射消失。脑脊液检查显示蛋白细胞分离，电生理检查结果符合吉兰-巴雷综合征（GBS）的诊断。她接受了静脉注射免疫球蛋白治疗，逐渐康复。PRES和GBS同时出现的情况仅在少数病例中被描述过。在大多数此类病例中，GBS的自主神经功能障碍导致严重高血压，进而引发PRES。这是一例罕见的PRES先于GBS出现甚至可能触发GBS发病的病例。在本报告中，我们回顾了相关文献并讨论了这种不寻常关联的潜在致病机制。
