title: A Case of Acute Motor Axonal Neuropathy Mimicking Brain Death and Review of the Literature.
abstract: We describe a case report of fulminant Guillain-Barré syndrome (GBS) mimicking brain death. A previously healthy 60-year-old male was admitted to the neurointensive care unit after developing rapidly progressive weakness and respiratory failure. On presentation, the patient was found to have absent brainstem and spinal cord reflexes resembling that of brain death. Acute motor axonal neuropathy, a subtype of GBS, was diagnosed by cerebrospinal fluid and nerve conduction velocity testing. An electroencephalogram showed that the patient had normal, appropriately reactive brain function. Transcranial Doppler (TCD) ultrasound showed appropriate blood flow to the brain. GBS rarely presents with weakness so severe as to mimic brain death. This article provides a review of similar literature. This case demonstrates the importance of performing a proper brain death examination, which includes evaluation for irreversible cerebral injury, exclusion of any confounding conditions, and performance of tests such as electroencephalography and TCDs when uncertainty exists about the reliability of the clinical exam.
authors.affiliation: Department of Neurology, University of Southern California , Los Angeles, CA , USA.
authors.forename: Sandhya
authors.initials: S
authors.lastname: Ravikumar
authors.affiliation: Department of Neurology, University of Southern California , Los Angeles, CA , USA.
authors.forename: Poysophon
authors.initials: P
authors.lastname: Poysophon
authors.affiliation: Department of Neurology, University of Southern California , Los Angeles, CA , USA.
authors.forename: Roy
authors.initials: R
authors.lastname: Poblete
authors.affiliation: Department of Neurology, University of Southern California , Los Angeles, CA , USA.
authors.forename: May
authors.initials: M
authors.lastname: Kim-Tenser
keywords: Guillain–Barré syndrome; acute motor axonal neuropathy; brain death