Abstract
We describe a case report of fulminant Guillain–Barré syndrome (GBS) mimicking brain death. A previously healthy 60-year-old male was admitted to the neurointensive care unit after developing rapidly progressive weakness and respiratory failure. On presentation, the patient was found to have absent brainstem and spinal cord reflexes resembling that of brain death. Acute motor axonal neuropathy, a subtype of GBS, was diagnosed by cerebrospinal fluid and nerve conduction velocity testing. An electroencephalogram showed that the patient had normal, appropriately reactive brain function. Transcranial Doppler (TCD) ultrasound showed appropriate blood flow to the brain. GBS rarely presents with weakness so severe as to mimic brain death. This article provides a review of similar literature. This case demonstrates the importance of performing a proper brain death examination, which includes evaluation for irreversible cerebral injury, exclusion of any confounding conditions, and performance of tests such as electroencephalography and TCDs when uncertainty exists about the reliability of the clinical exam.
Highlights
A 60-year-old male with diabetes mellitus, hypertension, and chronic obstructive pulmonary disease presented to a local community hospital with worsening shortness of breath
We describe a patient with fulminant acute motor axonal neuropathy (AMAN) whose clinical presentation mimicked brain death beginning 7 days after the onset of symptoms, and lasting for 7 days before return of central nervous system function on clinical examination
Six months after his initial admission, the patient remained in a long-term acute care facility with high ventilator requirements, he regained proximal arm and leg strength. He was able to sit up in a chair and mouth words to communicate. This case report describes a patient with fulminant AMAN with progressive loss of appendicular strength and deep tendon reflexes leading to areflexic quadriplegia, respiratory muscle weakness progressing to respiratory failure, and loss of brainstem reflexes
Summary
Guillain–Barré syndrome (GBS) is a term used to describe a group of acute, immune-mediated polyneuropathies that are clinically characterized by rapidly progressive, symmetrical, ascending weakness, and hyporeflexia. The degree of muscle weakness in GBS is variable but can be severe with 25% of patients requiring mechanical ventilation from respiratory failure [1, 10,11,12,13,14,15]. In this case report, we describe a patient with fulminant AMAN whose clinical presentation mimicked brain death beginning 7 days after the onset of symptoms, and lasting for 7 days before return of central nervous system function on clinical examination
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