title: Long-term impact after fulminant Guillain-Barré syndrome, case report and literature review.
abstract: A 47-year-old man was admitted to the intensive care unit a few hours after presenting to emergency department with acute diplopia and dysphonia. Swallowing disorders and respiratory muscular weakness quickly required invasive ventilation. On day 3, the patient was in a "brain-death"-like state with deep coma and absent brainstem reflexes. Electroencephalogram ruled out brain death diagnosis as a paradoxical sleep trace was recorded. Cerebrospinal fluid analysis, electrophysiologic studies, and a recent history of diarrhea led to the diagnosis ofCampylobacter jejuni-related fulminant Guillain-Barré syndrome (GBS) mimicking brain death. The outcome was favorable after long Intensive Care Unit and inpatient rehabilitation stays, despite persistent disability at 9 years follow-up. This case and the associated literature review of 34 previously reported fulminant GBS patients emphasize the importance of electrophysiological investigations during clinical brain-death states with no definite cause. Fulminant GBS has a worse outcome than "standard" GBS with higher rates of severe disability (about 50%). Long-term physiotherapy and specific rehabilitation programs appear essential to improve recovery.
authors.affiliation: Medical Intensive Care Unit, Hôpital Central, University Hospital of Nancy, Nancy, France; INSERM UMRS-1116, Faculty of Medicine, University of Lorraine, Nancy, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Rougé
authors.affiliation: Medical Intensive Care Unit, Hôpital Central, University Hospital of Nancy, Nancy, France; INSERM UMRS-1116, Faculty of Medicine, University of Lorraine, Nancy, France.
authors.forename: Jérémie
authors.initials: J
authors.lastname: Lemarié
authors.affiliation: Medical Intensive Care Unit, Hôpital Central, University Hospital of Nancy, Nancy, France; INSERM UMRS-1116, Faculty of Medicine, University of Lorraine, Nancy, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Gibot
authors.affiliation: Medical Intensive Care Unit, Hôpital Central, University Hospital of Nancy, Nancy, France; INSERM UMRS-1116, Faculty of Medicine, University of Lorraine, Nancy, France.
authors.forename: Pierre Edouard
authors.initials: PE
authors.lastname: Bollaert
keywords: C. jejuni; brain death; electroencephalogram; fulminant Guillain-Barré syndrome; long-term follow