One thing leads to another: GBS complicated by PRES and takotsubo cardiomyopathy

Jennifer E. Fugate, Eelco F. Wijdicks, Gautam Kumar, Alejandro A. Rabinstein

Research output: Contribution to journalArticlepeer-review

32 Scopus citations


Background: To describe a patient with Guillane-Barré syndrome (GBS), posterior reversible encephalopathy syndrome (PRES) and takotsubo cardiomyopathy, and in doing so, to postulate a new mechanism for hypotension in the setting of dysautonomia in GBS. Methods: Case report. Results: We report an 82-year-old woman who presented with bilateral lower extremity weakness and back pain following an upper respiratory viral illness. Within 4 days she became markedly hypertensive and developed status epilepticus. Brain MRI revealed patchy bilateral occipital lesions with T2 signal hyperintensity consistent with PRES. Her clinical exam, CSF, and electrophysiologic findings were consistent with GBS. She became relatively hypotensive and transthoracic echocardiogram showed severe apical akinesis. The patient clinically improved, and echocardiogram and MRI abnormalities resolved within 2 weeks. Conclusions: The autonomic effects of GBS may cause a variety of reversible clinical syndromes associated with sympathetic dysfunction including PRES and takotsubo cardiomyopathy; both of which are self-limited. Relative hypotension in GBS may be caused in part by neurogenic stunned myocardium.

Original languageEnglish (US)
Pages (from-to)395-397
Number of pages3
JournalNeurocritical care
Issue number3
StatePublished - Jan 1 2009


  • Apical ballooning syndrome
  • Autonomic disorders
  • Demyelinating disease
  • Guillain-Barré syndrome
  • Posterior reversible encephalopathy syndrome
  • Reversible posterior leukoencephalopathy syndrome
  • Takotsubo cardiomyopathy

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine


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