One thing leads to another: GBS complicated by PRES and Takotsubo cardiomyopathy.
BACKGROUND
To describe a patient with Guillane-Barré syndrome (GBS), posterior reversible encephalopathy syndrome (PRES) and takotsubo cardiomyopathy, and in doing so, to postulate a new mechanism for hypotension in the setting of dysautonomia in GBS.


METHODS
Case report.


RESULTS
We report an 82-year-old woman who presented with bilateral lower extremity weakness and back pain following an upper respiratory viral illness. Within 4 days she became markedly hypertensive and developed status epilepticus. Brain MRI revealed patchy bilateral occipital lesions with T2 signal hyperintensity consistent with PRES. Her clinical exam, CSF, and electrophysiologic findings were consistent with GBS. She became relatively hypotensive and transthoracic echocardiogram showed severe apical akinesis. The patient clinically improved, and echocardiogram and MRI abnormalities resolved within 2 weeks.


CONCLUSIONS
The autonomic effects of GBS may cause a variety of reversible clinical syndromes associated with sympathetic dysfunction including PRES and takotsubo cardiomyopathy; both of which are self-limited. Relative hypotension in GBS may be caused in part by neurogenic stunned myocardium.
Fugate
Jennifer E
JE
Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. fugate.jennifer@mayo.edu
Wijdicks
Eelco F
EF
Kumar
Gautam
G
Rabinstein
Alejandro A
AA
D000369:Aged, 80 and over; D005260:Female; D020275:Guillain-Barre Syndrome / Q000150:complications* / Q000473:pathology; D006801:Humans; D006973:Hypertension / Q000209:etiology; D007022:Hypotension / Q000209:etiology; D054038:Posterior Leukoencephalopathy Syndrome / Q000150:complications* / Q000473:pathology; D054549:Takotsubo Cardiomyopathy / Q000150:complications* / Q000000981:diagnostic imaging; D014463:Ultrasonography