Posterior reversible encephalopathy syndrome as the initial manifestation of Guillain-Barre Syndrome

Background: Guillain-Barre Syndrome (GBS) frequently affects autonomic nerves with subsequent fluctuations in blood pressure. Posterior reversible encephalopathy syndrome (PRES) is a descriptive radiological term for hypertensive encephalopathy. This article describes a unique case in which autonomic neuropathy led to marked elevations in blood pressure with subsequent PRES prior to the significant motor weakness and diagnosis of GBS. Methods: To describe a patient who presented with PRES and GBS. Results: A 58-year-old female presented to the local emergency room with complaints of acute sharp thoracolumbar back pain. Within the following 2 days, her blood pressure showed marked elevation with sudden episodic falls. She subsequently became encephalopathic and had a tonic-clonic seizure. Brain MRI was consistent with PRES. By day 5 of her initial presentation, she had developed weakness and areflexia with the electrophysiological findings of GBS. Her sensorium recovered, and MRI changes reversed with control of blood pressure. She was treated with intravenous immunoglobulin with full recovery back to baseline over the next 4 to 5 months. Conclusion: The autonomic effects of GBS may cause hypertensive encephalopathy or PRES prior to the motor manifestations.