Dinesh Sangroula1, Richard Durrance2, Shirshak Bhattarai3, Thambirajah Nandakumar4. 1. Jamaica Hospital Medical Center, Department of Psychiatry, NY, United States. Electronic address: dsangrou@jhmc.org. 2. Jamaica Hospital Medical Center, Department of Medicine, NY, United States. Electronic address: jessedurrance@gmail.com. 3. University of Louisville, Department of Medicine, KY, United States. 4. Jamaica Hospital Medical Center, Department of Medicine, NY, United States.
Abstract
INTRODUCTION: Guillain Barré Syndrome (GBS) is an acute immune-mediated polyneuropathy most frequently presenting two to four weeks after an acute mild-moderately severe infection as progressive muscular weakness of the lower limbs extending proximally with dysreflexia and autonomic dysfunction. While GBS is typically believed to be isolated to the Peripheral Nervous System, Central Nervous System (CNS) and psychiatric manifestations as a sequela of the disease have been described in different imaging and clinical studies. Many variants of presentation of GBS have been recognized, however a case presenting with primarily psychiatric and autonomic dysfunction preceding muscle weakness has not been cited in the literatures to date. CASE PRESENTATION: We describe a 24-year-old previously healthy male presenting with behavioral symptoms including depression, anxiety, and amnesia, and autonomic dysfunction which preceded muscle weakness by two weeks. CNS imaging and blood work results were unremarkable. GBS was confirmed upon cerebral spinal fluid analysis remarkable for an important cytoalbuminologic dissociation and markedly elevated protein concentration. The patient responded well to five cycles of inpatient plasmapheresis and short-term selective serotonin reuptake inhibitor treatment with complete recovery of both neurological and behavioral symptoms. CONCLUSION: Though GBS is typically considered a peripheral neuropathy, evidence for CNS involvement exists; GBS should be considered within the differential diagnosis, and neurological features should be monitored, in a patient with new onset unclear psychiatric and CNS symptoms.
INTRODUCTION: Guillain Barré Syndrome (GBS) is an acute immune-mediated polyneuropathy most frequently presenting two to four weeks after an acute mild-moderately severe infection as progressive muscular weakness of the lower limbs extending proximally with dysreflexia and autonomic dysfunction. While GBS is typically believed to be isolated to the Peripheral Nervous System, Central Nervous System (CNS) and psychiatric manifestations as a sequela of the disease have been described in different imaging and clinical studies. Many variants of presentation of GBS have been recognized, however a case presenting with primarily psychiatric and autonomic dysfunction preceding muscle weakness has not been cited in the literatures to date. CASE PRESENTATION: We describe a 24-year-old previously healthy male presenting with behavioral symptoms including depression, anxiety, and amnesia, and autonomic dysfunction which preceded muscle weakness by two weeks. CNS imaging and blood work results were unremarkable. GBS was confirmed upon cerebral spinal fluid analysis remarkable for an important cytoalbuminologic dissociation and markedly elevated protein concentration. The patient responded well to five cycles of inpatient plasmapheresis and short-term selective serotonin reuptake inhibitor treatment with complete recovery of both neurological and behavioral symptoms. CONCLUSION: Though GBS is typically considered a peripheral neuropathy, evidence for CNS involvement exists; GBS should be considered within the differential diagnosis, and neurological features should be monitored, in a patient with new onset unclear psychiatric and CNS symptoms.
Authors: Aditi Vian Varma-Doyle; Kristen Garvie; Seema Walvekar; Mae Igi; Radha Mayuri Garikepati Journal: J Investig Med High Impact Case Rep Date: 2020 Jan-Dec
Authors: Yavor Yalachkov; Valerie Uhlmann; Johannes Bergmann; Dilara Soydaş; Stefan Frisch; Marion Behrens; Christian Foerch; Johannes Gehrig Journal: PLoS One Date: 2020-02-04 Impact factor: 3.240