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Abstract Details

Guillain-Barre Syndrome with Dysautonomia Presenting as Posterior Reversible Leukoencephalopathy Syndrome
Neuromuscular and Clinical Neurophysiology (EMG)
P2 - Poster Session 2 (8:00 AM-9:00 AM)
1-007
To report a case of Guillain-Barre Syndrome initially presenting as posterior reversible leukoencephalopathy syndrome secondary to dysautonomia 
Guillain Barre Syndrome (GBS) is an acute inflammatory demyelinating polyradiculoneuropathy which typically presents with weakness, areflexia, and dysautonomia. Posterior reversible leukoencephalopathy syndrome (PRES) is a clinicoradiographic diagnosis, typically presenting with symptoms of headache, seizures, and altered mental status. PRES can be caused by a number of inciting factors, the most common being hypertension. There is growing evidence in the literature that links PRES to GBS with dysautonomia. 
A 62 year old woman presented with seizures in the setting of hypertension. Magnetic resonance imaging (MRI) of the brain showed bilateral occipital lobe and convexity cortical Fluid attenuated inversion recovery (FLAIR) hyperintensity with increased diffusivity, most consistent with PRES. By day 12 of admission, she subsequently developed weakness, areflexia, and sensory deficits, and was ultimately found to have GBS, confirmed by albuminocytologic dissociation in the cerebrospinal fluid. She improved with a course of intravenous immunoglobulin. 
NA

We describe an uncommon presentation wherein the patient’s first indication of GBS was dysautonomia leading to PRES, which preceded the more classic presentation of GBS by multiple days. This case illustrates the important relationship between GBS and PRES, and highlights the need for providers to recognize the variable ways in which GBS can present in order to avoid delay in diagnosis and treatment.

Authors/Disclosures
Emilia Raimondo, DO (Rhode Island Hospital)
PRESENTER 		Dr. Raimondo has nothing to disclose.
Mayra Montalvo Perero, MD (University of Florida) Dr. Montalvo Perero has received personal compensation in the range of $500-$4,999 for serving as a Consultant for TG THERAPEUTICS. Dr. Montalvo Perero has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for AMGEN.
Kara Stavros, MD, FÂ鶹´«Ã½Ó³»­ Dr. Stavros has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Springer Healthcare LLC. Dr. Stavros has received personal compensation in the range of $500-$4,999 for serving as an officer or member of the Board of Directors for Rhode Island Medical Society.