Fulminant Guillain-Barre syndrome mimicking cerebral death: case report and literature review

A 45-year-old woman was admitted to the intensive care unit (ICU) for respi ratory arrest. One day prior to admission, she had been nauseated and in a state of total exhaustion. On the night of admission she was unresponsive a nd developed gasping respiration. The patient was comatose with absent brai nstem reflexes and appeared brain dead. Blood chemistry findings and brain magnetic resonance imaging were normal. Electroencephalogram revealed an al pha rhythmical activity unresponsive to painful or visual stimuli. The cere brospinal fluid showed an albuminocytological dissociation. Guillain-Barre syndrome (GBS) was suspected. The electrophysiological evaluation revealed an inexcitability of all nerves. The pathological findings of the sural ner ve biopsy indicated an axonal degeneration secondary to severe demyelinatio n. GBS can very rarely present with coma and absent brainstem reflexes. Thi s case illustrates the importance of electrophysiological tests and laborat ory and imaging studies in patients with suspected brain death where a caus e is not clearly determined.