Abstract
We report a case of fulminant Guillain–Barre syndrome (GBS), mimicking brain death. A previously healthy 52-year-old male was admitted to hospital for rapidly progressive limb weakness. A GBS was diagnosed, based on the clinical picture and cerebrospinal fluid albumin-cytological dissociation; nerve conduction studies were scheduled for the following day and treatment with intravenous immunoglobulins was immediately started. The patient quickly developed respiratory failure and was admitted to Intensive Care Unit, requiring mechanical ventilation and deep sedation. The nerve conduction studies demonstrated motor and sensory responses unexcitable in upper and lower extremities. A week later, when the pharmacological sedation was withdrawn, the patient was found to have a coma with absent brainstem reflexes, resembling a state of brain death. An electroencephalogram showed quite a normal brain function, the brain MRI was unremarkable. On the following days, while the flaccid quadriplegia persisted, the ocular movements first reappeared, with signs of recovered consciousness, resembling a locked-in syndrome. Then, after six weeks, small amplitude and long duration motor response were detectable at upper limbs. The outcome was favorable, after long Intensive Care Unit and through rehabilitation program. Severe GBS may mimic brain death, probably by a de-afferentation/de-efferentation mechanism.
Published Version
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