Acute Neuropathy Mimicking Guillain-Barr� Syndrome after Diabetic Ketoacidosis: A casereport

Abstract

A 42 year-old woman was admitted in a comatose state after exhibiting polydipsia and progressive body weight loss of 4-week duration. Diabetic ketoacidosis was diagnosed due to an increased blood glucose level (956 mg/dl), metabolic acidosis, and positive urinary ketone bodies. On the fourth hospital day, despite recovery from the critical state of ketoacidosis, the patient suffered from progressively ascending paresthesia and weakness in the lower limbs. On the basis of clinical and electrophysiological findings, axonal Guillain-Barre syndrome presenting as a paraparesis variant, a very unusual neuropathy related to diabetic ketoacidosis, was diagnosed. The patient reached satisfactory functional outcome after eight weeks of outpatient rehabilitation program. This article discusses the differential diagnoses of acute onset of weakness in critically ill patients. Correlation of pathogenesis between Guillain-Barre syndrome and diabetes mellitus is briefly described. Management policies of Guillain-Barre syndrome, including rehabilitative treatment, are also delineated.