title: One thing leads to another: GBS complicated by PRES and Takotsubo cardiomyopathy.
abstract: 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.
authors.affiliation: Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. fugate.jennifer@mayo.edu
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Fugate
authors.forename: Eelco F
authors.initials: EF
authors.lastname: Wijdicks
authors.forename: Gautam
authors.initials: G
authors.lastname: Kumar
authors.forename: Alejandro A
authors.initials: AA
authors.lastname: Rabinstein
mesh_terms: 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