Neurocritical Care

, 11:395

One Thing Leads to Another: GBS Complicated by PRES and Takotsubo Cardiomyopathy


    • Department of NeurologyMayo Clinic
  • Eelco F. Wijdicks
    • Department of NeurologyMayo Clinic
  • Gautam Kumar
    • Department of Cardiovascular DiseasesMayo Clinic
  • Alejandro A. Rabinstein
    • Department of NeurologyMayo Clinic
Practical Pearl

DOI: 10.1007/s12028-009-9279-8

Cite this article as:
Fugate, J.E., Wijdicks, E.F., Kumar, G. et al. Neurocrit Care (2009) 11: 395. doi:10.1007/s12028-009-9279-8



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.


Case report.


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.


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.


Posterior reversible encephalopathy syndromeReversible posterior leukoencephalopathy syndromeApical ballooning syndromeTakotsubo cardiomyopathyGuillain–Barré syndromeAutonomic disordersDemyelinating disease

Copyright information

© Humana Press Inc. 2009