J Clin Neurol.  2007 Jun;3(2):105-107. 10.3988/jcn.2007.3.2.105.

Fulminant Guillain-Barre Syndrome Mimicking Cerebral Death Following Acute Viral Hepatitis A

• Kang BH
• Kim KK

• KMID: 1851022
• DOI: http://doi.org/10.3988/jcn.2007.3.2.105

Abstract

A 32-year-old man was transferred to an intensive care unit due to respiratory difficulties with a 4-day history of progressive areflexic quadriparesis following acute hepatitis A. A nerve-conduction study revealed inexcitability of most nerves. The cerebrospinal fluid showed albuminocytologic dissociation, suggesting Guillain-Barre syndrome (GBS). The patient appeared brain dead on day 4, showing absent brainstem reflexes, respiratory failure, and fully dilated and fixed pupils. This case is an example of how GBS can evolve and simulate a brain-dead state from fulminant deafferentation following acute hepatitis A.

Keyword

Fulminant Guillain-Barre syndrome; Acute hepatitis A; Brain death

MeSH Terms

Adult
Brain Death
Brain Stem
Cerebrospinal Fluid
Guillain-Barre Syndrome*
Hepatitis A*
Hepatitis*
Humans
Intensive Care Units
Pupil Disorders
Quadriplegia
Reflex
Respiratory Insufficiency

Reference

1. Mares-Segura R, Sola-Lamoglia R, Soler-Singla L, Pou-Serradell A. Guillain-Barré syndrome associated with hepatitis A. Ann Neurol. 1986. 19:100.

2. Ono S, Chida K, Takasu T. Guillain-Barré syndrome following fulminant viral hepatitis A. Intern Med. 1994. 33:799–801.

3. Triggs WJ, Cros D, Gominak SC, Zuniga G, Beric A, Shahani BT, et al. Motor nerve inexcitability in Guillain-Barré syndrome. The spectrum of distal conduction block and axonal degeneration. Brain. 1992. 115:1291–1302.

4. Vargas F, Hilbert G, Gruson D, Valentino R, Gbikpi-Benissan G, Cardinaud JP. Fulminant Guillain-Barré syndrome mimicking cerebral death: case report and literature review. Intensive Care Med. 2000. 26:623–627.

5. Samantray SK, Johnson SC, Mathai KV, Pulimood BM. Landry-Guillain-Barré-Strohl syndrome. A study of 302 cases. Med J Aust. 1977. 2:84–91.

6. Dowling PC, Bosch VV, Cook SD. Possible beneficial effect of high-dose intravenous steroid therapy in acute demyelinating disease and transverse myelitis. Neurology. 1980. 3033–3036.

7. Mori E, Yoshida T, Ohsumi Y, Tabuchi M, Yamadori A. Beneficial effects of plasma exchange in acute Guillain-Barré syndrome: comparision with methylprednisolone pulse therapy. Clin Neurol. 1988. 28:196–203.

8. Ropper AH, Wijdicks EF, Truax BT. Guillain-Barré syndrome. 1991. Philadelphia: F.A. Davis;232–234. Contemporary Neurology Series.

9. Winer JB, Hughes RA, Greenwood RJ, Perkin GD, Healy MJ. Prognosis in Guillain-Barré syndrome. Lancet. 1985. 1:1202–1203.