PRESenting a Challenge: Posterior Reversible Encephalopathy Syndrome in Pediatric Patients With Guillain-Barré Syndrome: A Case Series and Review of Literature

• Published in: Pediatric neurology Vol. 156; pp. 162 - 169
• Main Authors: Surve, Rohini M., Sharma, Kunal K., Sharma, Prachi, Nisal, Roshan, Pendharkar, Hima S., Kulkarni, Girish B.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-07-2024
• Subjects: Adolescent; Child; Child, Preschool; Dysautonomia; Guillain-Barre Syndrome - complications; Guillain-Barre Syndrome - physiopathology; Guillain-Barre Syndrome - therapy; Guillain-Barré syndrome; Humans; Hypertension; Intensive care; Male; Pediatric; Posterior Leukoencephalopathy Syndrome - diagnostic imaging; Posterior Leukoencephalopathy Syndrome - etiology; Posterior Leukoencephalopathy Syndrome - physiopathology; Posterior Leukoencephalopathy Syndrome - therapy; Posterior reversible encephalopathy syndrome; Hypertension; Intensive care; Dysautonomia; Posterior reversible encephalopathy syndrome; Pediatric; Guillain-Barré syndrome
• ISSN: 0887-8994; 1873-5150; 1873-5150
• DOI: 10.1016/j.pediatrneurol.2024.04.018

Guillain-Barré syndrome (GBS) is an autoimmune disorder characterized by demyelination of peripheral nerves. GBS-associated posterior reversible encephalopathy syndrome (PRES) is a rare and potentially life-threatening complication in the pediatric population. We aimed to report and analyze the clinical features, management, and outcomes of three cases of GBS-associated PRES in our setting in the light of the existing literature.
Medical records of 75 pediatric patients with GBS were reviewed for autonomic changes and GBS-associated PRES. Thirty-one developed dysautonomia while three were identified to have PRES. Clinical, radiological, laboratory, and treatment data were collected and analyzed.
All three patients were male and presented with symptoms of acute flaccid paralysis and respiratory distress requiring mechanical ventilation. All three patients experienced various complications, including hypertension, seizures, and hyponatremia, and were subsequently diagnosed with PRES. Multimodal intensive care resulted in patient improvement and discharge in an ambulatory state after an average of 104 days of care.
GBS-associated PRES is a rare and potentially life-threatening complication that can occur in pediatric patients with GBS. Our findings suggest that early recognition, prompt intervention, and multimodal intensive care can improve patient outcomes. Further studies are needed to determine optimal treatment strategies for GBS-associated PRES.