A 56-year-old man with a history of well-controlled hypertension in monotherapy began with loss of strength in his right hand and difficulty in differentiating changes in the temperature of the tap water.
In a few hours the motor deficit progressed to a mild right phago-brachio-crural paresis, which did not prevent him from continuing his usual activities.
The next day headache, dizziness, dysarthria and general malaise were added.
From the third day on, the patient complained of muscle weakness in both arms, which progressively and upwards, affecting her four limbs and preventing her walking on the day of evolution.
During this first week he checked his blood pressure daily, documenting figures at 200/100 mmHg.
She presented quantitative compromise of consciousness and a versive epileptic seizure in her local hospital.
Due to this clinical worsening, he was referred to our institution with respiratory failure.
On admission to the Intensive Care Unit and connected to mechanical ventilation, blood pressure 220/90 mmHg, heart rate 80 x min, axillary temperature 37°C and capillary glucose 110 mg/dl were recorded. The general physical examination showed no pathological findings.
Neurological examination revealed tetraparesis, osteotendinous global areflexia, plantar flexor reflexes, symmetrical pain response and reflexes.
The plasma biochemistry showed a total creatine kinase (CKt) of 677, with renal function, liver function and plasma electrolytes in normal ranges.
Brain MRI in FLAIR sequence showed bilateral hyperintense lesions on parieto-occipital and frontal regions, suggesting vasogenic edema.
Cerebrospinal fluid (CSF) analysis showed high proteins in 169 mg/dl, with normal cytology and glucose.
Subsequently, the four-extremity neuroconduction (NC) showed absence of F waves and severe dementia with low amplitude, compound motor potentials and very low velocities, with some elements of nerve conductive blockade.
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GBS was treated with IVIG at a dose of 0.4 g/kg/day for 5 days.
Intravenous labetalol was used as antihypertensive therapy in continuous infusion in order to achieve values lower than 140/90 mmHg, in a paulatin decrease not greater than 20% daily, a goal achieved at the end of the week.
During the acute stage of the disease, its global evolution was satisfactory, being discharged after 40 days of hospitalization.
The neurological examination at that time showed tetraparesis of distal predominance, with plegic feet and hands.
After 12 months of outpatient rehabilitation, her motor deficit improved satisfactorily, achieving total independence in her activities of daily living.
The neurological examination showed only mild paresis of the external flexure of orthoses and feet, with mild right brachiocrural osteotendinous hyperreflexia.
Control brain MRI showed complete regression of the lesions mentioned above.
Moreover, it again maintains good control of hypertension with its usual drug.
