Objawy sugerujące śmierć pnia mózgu w zespole Guillain-Barre – opis przypadku

*Waldemar Iwańczuk

Summary
Background.The classic Guillain-Barre syndrome is characterized by acute ascending and progressive neuropathy associated with muscle weakness and hyporeflexia. Cranial nerves are involved in approximately 50% of cases. A special form of the syndrome is the Miller-Fisher syndrome in which signs of the cranial nerve deficit dominate in the first phase of the disease. The diagnosis of Guillain-Barre syndrome is based on clinical features and albumin cytological dissociation present in the spinal fluid. In rare cases, acute quadriparesis may develop leading to coma and the absence of brainstem reflexes. In the case described, a patient presents with Guillain-Barre syndrome mimicking brain death.
Case report. A 52-yr-old woman was admitted to hospital due to acute progressive ophthalmoplegia and unilateral facial nerve paresis. A CT-scan showed mild cerebral oedema. The cerebrospinal fluid analysis revealed an albumin cytological dissociation (pleocytosis 14, albumin concentration 11.38g l^-1). Guillain-Barre syndrome was suspected, and the patient was transferred to the ITU. Five days later, she became comatose with absent brainstem reflexes, with fixed and dilated pupils that did not react to light. No respiratory movements were observed during the apnoeic test. An EEG test performed at this time showed however, the presence of bilateral alpha and theta activity. After a further 20 h, she arrested and died. Autopsy revealed a small necrotic focus in the brainstem.
Conclusion. We conclude that before the declaration of brain death and withdrawal of life support systems, the exact aetiology must be identified.

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