radio diagnosis

Guillain-Barré syndrome (GBS) is an autoimmune disease mainly affecting the peripheral nervous system. Therefore It may present with autonomic dysfunction (hypotension, hypertension, sinus tachycardia, paroxysmal tachyarrhythmias or bradyarrhythmias, and electro cardiographic ECG changes). Because Manifestations of GBS vary from monoparesis to life-threatening paralysis of the respiratory muscles.

Electro cardiographic ECG changes

Cardiovascular abnormalities in GBS are attribute to autonomic neuropathy and are see variably in two-thirds of affect patients. Therefore There have been few case reports associating GBS and ECG abnormalities or left ventricular dysfunction. Hence Usually explained by temporary alterations in cardiac innervations or catecholamine cardiotoxicity, ECG abnormalities are often regressive.

The pathophysiology remains unclear, but the role of catecholamine-mediated myocardial stunning may be predominant. The association of GBS with stress cardiomyopathy is not well understand. Dysregulation of autonomic tone with excessive sympathetic activation in GBS with elevated catecholamine levels has been report. The dysregulation of the parasympathetic and sympathetic systems is responsible for alterations in peripheral vascular resistance, most often causing transient or permanent hypotension.

Mediated myocardial stunning

Rare cases of sudden cardiac death or cardiovascular collapse might be attributed to lethal arrhythmias or acute heart failure episodes, which could be prevented by transthoracic echocardiographic (TTE) examination and hemodynamic continuous monitoring. They present a case of a 65 year-old Greek woman who presented to the neurology ward of our hospital with a 1-week history of symmetrical weakness of her lower limbs, numbness and paresthesia of her upper limbs, and dysarthria. Her medical, family, and psychosocial histories were unremarkable.

She was not receiving any medication at the time of her presentation, and she had no allergies. She only reported an upper respiratory viral infection 2 weeks ago. But On neurological examination, the patient’s motor strength was 4/5 in her upper extremities and 1/5 in her lower extremities. The tendon reflexes were absent, and there was no cranial nerve involvement.

Associated cardiac symptoms

Initially, there were no associated cardiac symptoms, no neuromuscular respiratory weakness (vital capacity [VC] > 20 ml//kg and maximal inspiratory pressure [MIP] > 30 cm H2O), and no hypercapnia (partial pressure of carbon dioxide [PCO2] = 38 mmHg) in arterial blood gas analysis. The patient was afebrile (36.8 °C), had normal ECG findings (sinus rhythm ~ 80 beats/min), and was hemodynamically stable (mean arterial pressure [MAP] = 70 mmHg).

Initial cerebral magnetic resonance imaging (MRI) findings were normal. Both neurophysiological and cerebrospinal fluid (CSF) examinations were consistent with the diagnosis of GBS. Thus, CSF examination showed elevated protein level (450 mg/L) with normal cells (2/mm3), and electrodiagnostic testing showed temporal dispersion, significantly slow conduction velocities, prolonged distal and F-wave latencies, and abnormal upper extremity sensory nerve conduction. The patient’s laboratory test results upon admission were normal.