Kobayashi Haruka, Hoshina Yoji, Higa Hidemasa, Watari Takashi
Department of General Internal Medicine, Nakagami Hospital, Okinawa, Japan.
Department of Neurology, University of Utah, Salt Lake City, Utah, USA.
Eur J Case Rep Intern Med. 2023 Aug 16;10(10):003949. doi: 10.12890/2023_003949. eCollection 2023.
Guillain-Barré syndrome is an immune-mediated inflammatory polyneuritis characterised by rapidly progressive flaccid paralysis. Guillain-Barré syndrome may present with posterior reversible encephalopathy syndrome or reversible cerebral vasoconstriction syndrome in rare cases.
A woman in her 60s with a history of follicular lymphoma presented with a one-week history of difficulty walking and thunderclap headaches. The patient was diagnosed with Guillain-Barré syndrome based on neurological examination, cerebrospinal fluid analysis and nerve conduction findings. Further diagnosis of posterior reversible encephalopathy and reversible cerebral vasoconstriction syndromes was based on imaging findings and headache history. The patient was treated with intravenous immunoglobulin and amlodipine, and symptoms improved.
We reviewed the literature on Guillain-Barré syndrome associated with posterior reversible encephalopathy and/or reversible cerebral vasoconstriction syndrome. The underlying pathophysiology may involve dysautonomia resulting in unstable blood pressure, and hyponatraemia causing endothelial dysfunction. The SNOOP mnemonic highlights the 'red flags'. This SNOOP mnemonic suggests the possibility of secondary headaches that require imaging studies. In this case, the patient exhibited three SNOOP symptoms: S (history of malignancy: follicular lymphoma), O (sudden-onset headache) and O (over 50 years old).
This case highlights the importance of considering coexisting central neurological disorders in patients with Guillain-Barré syndrome.
Guillain-Barré syndrome (GBS) alone rarely causes headaches; therefore, when GBS patients complain of severe headaches, especially when the headache is associated with 'red flags', other complications and differential diagnosis should be considered.Posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction syndrome (RCVS) can be triggered by GBS.Hyponatraemia, age over 50 years and female gender may be risk factors for developing PRES and RCVS in GBS patients.
吉兰 - 巴雷综合征是一种免疫介导的炎症性多发性神经炎，其特征为快速进展的弛缓性麻痹。在罕见情况下，吉兰 - 巴雷综合征可能伴有后部可逆性脑病综合征或可逆性脑血管收缩综合征。
一名60多岁有滤泡性淋巴瘤病史的女性，出现了为期一周的行走困难和霹雳样头痛症状。基于神经学检查、脑脊液分析和神经传导检查结果，该患者被诊断为吉兰 - 巴雷综合征。基于影像学检查结果和头痛病史，进一步诊断为后部可逆性脑病和可逆性脑血管收缩综合征。该患者接受了静脉注射免疫球蛋白和氨氯地平治疗，症状有所改善。
我们回顾了有关吉兰 - 巴雷综合征合并后部可逆性脑病和/或可逆性脑血管收缩综合征的文献。潜在的病理生理学机制可能涉及自主神经功能障碍导致血压不稳定，以及低钠血症引起内皮功能障碍。SNOOP记忆法突出了“危险信号”。这种SNOOP记忆法提示了需要进行影像学检查的继发性头痛的可能性。在本病例中，患者表现出三种SNOOP症状：S（恶性肿瘤病史：滤泡性淋巴瘤）、O（突发头痛）和O（年龄超过50岁）。
本病例突出了在吉兰 - 巴雷综合征患者中考虑并存的中枢神经系统疾病的重要性。
单独的吉兰 - 巴雷综合征（GBS）很少引起头痛；因此，当GBS患者主诉严重头痛时，尤其是当头痛伴有“危险信号”时，应考虑其他并发症和鉴别诊断。吉兰 - 巴雷综合征可引发后部可逆性脑病综合征（PRES）和可逆性脑血管收缩综合征（RCVS）。低钠血症、年龄超过50岁和女性性别可能是GBS患者发生PRES和RCVS的危险因素。
