title: Intrapulmonary right-left shunts in Guillain-Barré syndrome with severe dysautonomia.
abstract: BACKGROUND
  Dysautonomia is a characteristic finding in Guillain-Barré syndrome (GBS). Sinus tachycardia, blood pressure instability, sustained hypertension or hypotension, cardiac arrhythmias, sweating abnormalities, gastrointestinal or urogenital symptoms, and neurogenic stunned myocardium have been previously described in patients with GBS. To our knowledge, increased intrapulmonary shunts in association with GBS have not yet been reported.
  
  
  METHODS
  We present a case of GBS with severe dysautonomia associated with clinical relevant intrapulmonary shunts. Autonomic functions were tested using baroreflex sensitivity and heart rate variability measures. Intrapulmonary shunts were calculated according to the Berggren formula.
  
  
  RESULTS
  Autonomic functions showed excessive sympathetic activation. Intrapulmonary shunts were increased up to six times compared to the norm. Other causes of increased intrapulmonary shunts, such as sepsis, pulmonal or cardiac complications, were excluded during hospitalization.
  
  
  CONCLUSIONS
  Intrapulmonary shunts in GBS may relate to sympathetic overactivation and should be anticipated in GBS patients with unexplained respiratory deterioration.
authors.affiliation: Department of Neurology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. marek.sykora@med.uni-heidelberg.de
authors.forename: Marek
authors.initials: M
authors.lastname: Sykora
authors.forename: Jennifer
authors.initials: J
authors.lastname: Diedler
authors.forename: Werner
authors.initials: W
authors.lastname: Hacke
authors.forename: Roland
authors.initials: R
authors.lastname: Veltkamp
mesh_terms: D000328:Adult; D001164:Arteriovenous Fistula / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D020275:Guillain-Barre Syndrome / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D008171:Lung Diseases / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D008297:Male; D054969:Primary Dysautonomias / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D016156:Respiratory Tract Fistula / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy