A 58-year-old male smoker, obese, hypertensive and treated with losartan 50 mg daily.
He suffered paresthesia of the hands and feet of one week of evolution and progressive weakness of the four limbs that prevented him from walking.
Upon admission he was conscious and oriented, with tetraparesis of proximal predominance, generalized areflexia and right facial paresis.
Blood pressure (BP) 177/62 mmHg
Blood count, creatinine, urea nitrogen, plasma electrolytes, blood gases and liver tests were normal.
Immunoglobulins A, G and M in normal ranges.
With the diagnosis of Guillain-Iglobulin Syndrome, intravenous administration of 0.4 g/kg body weight was initiated (intravenous immunoglobulin G UNC, Argentina).
Two hours after the first infusion, the patient developed consciousness compromise and psychomotor agitation, which resolved to sedation.
His BP was 181/90 mmHg and there was motor worsening, paresis of both third pairs and bulbar pairs, requiring orotracheal intubation and mechanical ventilation.
Computed tomography (CT) of the brain showed blurring of sulci and mild ventricular collapse, suggesting cerebral edema.
Lumbar puncture yielded clear cerebrospinal fluid.
Their study revealed 0.60 g/l of proteins, glucose 0.75 g/l and 1.6 leukocytes per mm3.
The electromyography defined an acute demyelinating polyneuropathy.
Igev was suspended and plasmapheresis was started that same day.
She committed consciousness for four days.
On the fifth day he was extubated due to remarkable motor recovery, which included oculomotility, although mild adduction paresis and left eye elevation persisted.
Brain CT performed on the seventh day showed regression of cerebral edema and EEG performed that day was normal.
He completed 5 sessions of plasmapheresis achieving standing on the tenth day.
