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Abstract Details

Dr. Jekyll and Mr. Hyde: A Case Report of Guillain-Barre Syndrome and the Treatment that Revealed Unexpected Disease Complications
Cerebrovascular Disease and Interventional Neurology
P11 - Poster Session 11 (5:30 PM-6:30 PM)
5-027

Guillain-Barre Syndrome (GBS) has been well reported in literature and is recognized as a severe acute paralytic neuropathy, affecting many worldwide. The accepted treatment includes IVIG or PLEX alongside supportive care. However, treatment does not always come without complications, with rare case reports of vascular complications following administration of IVIG. We present such a case, and discuss treatment strategies and hospital outcomes. 

To highlight the adverse effects of IVIG. 
N/A

62-year-old female with medical history of cervicothoracic subdural hematoma, hypertension, and significant arteriosclerotic disease who was transferred for evaluation of subacute lower extremity weakness and back pain. Upon examination, we noted lower extremity areflexia and reduced lower extremity strength, with significant vital sign dysautonomia. Studies completed included a lumbar puncture, which showed albuminocytologic dissociation, and MRI of the neuro-axis. MRI of the brain noted findings concerning for PRES (likely a product of vital sign dysautonomia). MRI of the spine noted thoracic cord adhesions as well as ventral nerve root enhancement. Given these findings, patient was diagnosed with GBS and IVIG was initiated with resultant improvement in lower extremity strength over time. However, during her hospital stay vision and mentation declined, with vessel imaging showing evidence of vasospasm and resultant ischemia. Verapamil was started with some improvement, and eventually, patient was discharged for further recovery. Since discharge she has followed in clinic, with continued improvement in strength and MRI resolution of vasospasm/stenosis.

GBS is a life-threatening disease marked by progressive weakness. It is prudent to start standard treatment with IVIG or PLEX as soon as possible, prior to patients developing irreversible nerve damage. Despite its proven benefits on clinical outcomes, IVIG is associated with rare side effects.  In this case report, we discuss how standard therapy for GBS with IVIG led to the development of cerebral vasospasm and ischemia.   

Authors/Disclosures
Sarah E. Lam, MD
PRESENTER
Dr. Lam has nothing to disclose.
Elizabeth Anderson, MD (Barrow Neurological Institute) Dr. Anderson has nothing to disclose.
Supreet Kaur, MD Dr. Kaur has nothing to disclose.
Shafeeq Ladha, MD (Barrow Neurological Institute) Dr. Ladha has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biogen. Dr. Ladha has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Sanofi. Dr. Ladha has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amylyx. Dr. Ladha has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Genentech. Dr. Ladha has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Annexon. Dr. Ladha has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amicus. Dr. Ladha has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Neurosense. Dr. Ladha has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Rapa Therapeutics. Dr. Ladha has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Biogen. Dr. Ladha has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Sanofi. Dr. Ladha has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for Genentech. The institution of Dr. Ladha has received research support from Biogen. The institution of Dr. Ladha has received research support from Sanofi.