Abstract
Objectives Recurrent GBS is rare with a reported incidence of 5%, usually of a demyelinating polyneuropathy subtype. Dysautonomia in GBS occurs in 70% of patients however development of PRES is rare. Case reports revealed a female predominance with an antecedent infection. It has been shown that PRES can precede the onset of flaccid paralysis for up to twelve days. Therefore, it is important to recognise that these two diseases may precede each other. Unique to our case is the recurrence of GBS, with PRES as the initial manifestation in both episodes.
Case We report a 42-year-old female who presented after resolved diarrheal illness with headache, visual blurriness, and seizures. She was hypertensive and had a left homonymous hemianopia. Her cerebral magnetic resonance imaging (MRI) showed cortical and subcortical fluid attenuated inversion recovery (FLAIR) hyperintensities in the parietal and occipital lobes suggestive of PRES. Eight days later, she had flaccid tetraplegia with areflexia and progressed into respiratory failure. A diagnosis of acute inflammatory demyelinating polyradiculopathy variant of GBS was made. This was supported by an albumin-cytological dissociation (protein 0.92 [normal value <0.45g/L]) and nerve conduction study (NCS) revealed acute demyelinating sensorimotor polyneuropathy. Antiganglioside antibody was negative. A repeat MRI brain revealed resolution of intracranial FLAIR hyperintensities. Intravenous immunoglobulin was commenced. Within days, she was extubated. After 6 weeks of rehabilitation, she returned to independent living. Eight weeks later, repeat NCS showed normalisation. She had previous GBS in 2019 in which she had PRES seven days before the onset of flaccid paralysis.
