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- Guillain–Barré syndrome (GBS)
- syndrome of inappropriate antidiuretic hormone secretion (SIADH)
- autonomic dysfunction
Guillain–Barré syndrome (GBS) typically presents with progressive ascending paralysis and sensory loss.1 2 Both the syndrome of inappropriate antidiuretic hormone secretion (SIADH) and dysautonomia separately have a recognised association with GBS but usually occur after the evolution of weakness.2–4 We report a patient with a rare clinical presentation of severe SIADH and dysautonomia which significantly preceded the onset of weakness and areflexia, leading to a delay in diagnosis.
An 82-year-old previously active and independent woman presented with 5 days of back pain and glove and stocking paraesthesia. Her medical history included obstructive sleep apnoea, mitral regurgitation, hypercholesterolaemia, osteoporosis, gastro-oesophageal reflux disease and multinodular goitre. She had a respiratory tract infection 3 weeks earlier. She had no recent vaccinations or travel history.
Her initial blood pressure was 190/90. She had one syncopal event with a corresponding drop in her systolic blood pressure to 70 mm Hg. Neurological examination demonstrated no motor or sensory deficit, and intact reflexes. Other examination and laboratory parameters were unremarkable. Given her back pain and hypertension, a CT scan was performed and excluded an aortic aneurysm or dissection. She was admitted for analgesia and observation. She had ongoing fluctuations in systolic blood pressure ranging from 60 mm Hg …