Critical illness polyneuropathy or axonal Guillain-Barré syndrome triggered by subarachnoid haemorrhage?

Abstract

Abstract Introduction This article reports a case of the difficulty to differentiate between critical illness polyneuropathy and axonal Guillain–Barre syndrome when triggered by subarachnoid haemorrhage. Case report An 81-year-old man was admitted comatose (Glasgow coma scale score 4/15) after a subarachnoid haemorrhage. His neurological condition gradually improved with as best motor response (M4) withdrawal from pain at the four limbs. The patient developed early complications such as septicaemia and acute renal injury. After 3 weeks, a marked decrease of motor response (M1) was noted in the lower, and, to lesser extent, upper limbs. Deep tendon reflexes were abolished. The cerebrospinal fluid examination showed elevated protein level. After electrophysiological examination, the diagnosis of acute motor axonal neuropathy, a variant of Guillain–Barre syndrome, was discussed versus critical illness polyneuropathy. Specific therapy for Guillain–Barre syndrome could not be administered. No significant motor recovery was observed after 7 months. Conclusion The distinction between critical illness polyneuropathy and Guillain– Barre syndrome remains difficult in critically ill patients. It is not known if subarachnoid haemorrhage could be considered as a possible triggering factor for Guillain–Barre syndrome.