Fulminant Guillain–Barré syndrome after closed head injury: a potentially reversible cause of an ominous examination

Case report

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✓ Fulminant Guillain–Barré syndrome (GBS) is a rapidly progressive form of polyneuropathy in which patients demonstrate eventual flaccid quadriplegia and an absence of brainstem function. Most patients present after a mild upper respiratory or gastrointestinal illness and have nondiagnostic cerebral imaging studies. The authors present a case of fulminant GBS that developed in a 55-year-old alcoholic man 1 week after admission for a closed head injury. The details of this case and a discussion of GBS will be presented. This case provides evidence for combined central and peripheral nervous system involvement in severe cases of GBS. Recognition of fulminant GBS is important to prevent inappropriate declaration of brain death or withdrawal of support in the face of a potentially reversible process.

Abbreviations used in this paper: CN = cranial nerve; CT = computed tomography; GBS = Guillain–Barré Syndrome; MR = magnetic resonance.

Article Information

Address correspondence to: Kimberly Harbaugh, M.D., Department of Neurosurgery, Penn State Hershey Medical Center, Hershey, Pennsylvania 17033. email: kharbaugh@psu.edu.

© AANS, except where prohibited by US copyright law.

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Figures

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    Axial CT bone density (left) and brain (right) scans demonstrating the right parietal skull fracture (arrow) and left posterior subdural hematoma.

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    Axial T1-weighted images without (A and B) and with (C and D) contrast enhancement, obtained 2 weeks after the onset of coma. Midbrain and CN enhancement are shown (arrows).

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    Axial T2-weighted images obtained 2 weeks after coma onset, demonstrating patchy, asymmetrically increased signal intensity within the brainstem.

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