Guillain-Barre Syndrome is an acute inflammatory process which can lead to progressive muscle weakness and sensory disturbances. According to Zaeem et al, approximately, 2/3 of patients also present with dysautonomic symptoms, however there is no consensus about screening autonomic nervous system neuropathy in these patients.
A 64-year-old Caucasian male with recent laminectomy who presented to our hospital after being sent by his orthopedist for complaints of bilateral muscle weakness in his extremities for the past 5 days. He reported that his muscle weakness started distally and traveled proximally up his extremities. His symptoms were associated with shortness of breath, difficulty swallowing, and profuse sweating. He was vaccinated against SARS-COV2 earlier this year and denies recent vaccinations. Denies any similar symptoms in the past. At the time of admission, his airway was patent with an oxygen saturation of 93% on 5 L of nasal cannula and an elevated blood pressure of 188/68. His pulse was 54. He was having hypophonia. His HEENT exam demonstrated dilated pupils. Neurological exam showed no signs of facial weakness or opthalmoplegia. He had hyporeflexia. His motor examination revealed hypotonia along with muscle weakness with the proximal weaker than the distal muscles in all extremities. His sensation was impaired in a distal symmetrical graded fashion. His spinal examination showed tenderness to lumbar spine paraspinally. CBC showed a WBC of 12.0. His SARS COV2 – PCR was negative. Head CT was negative. Lumbar spine MRI showed fluid-filled mass at the laminectomy site. Orthopedics examined patient and concluded the mass was a fluid filled seroma with minimal cord compression. Subsequently, neurology was consulted and patient was started on IV Immune Globulin for post-surgical Guillain-Barre Syndrome. He was transferred to a tertiary care center in order to receive plasmapheresis as his oxygen requirements were increasing, which required subsequent intubation. He recovered and was discharged to acute rehab. He was seen in the outpatient setting and was doing well.
This case displays significant autonomic which demonstrates the importance of early identification of dysautonomia in the diagnosis of Guillain-Barre Syndrome as dysautonomia is associated with worsening morbidity and mortality.