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LETTER
Year : 2017  |  Volume : 12  |  Issue : 1  |  Page : 124-125

Vision loss in guillain-barre syndrome; a complication or a coincidence


Department of Pediatrics, Al-Kindy College of Medicine, Baghdad University, Baghdad, Iraq

Date of Submission14-Aug-2016
Date of Acceptance09-Dec-2016
Date of Web Publication15-Feb-2017

Correspondence Address:
Mahmood Dhahir Al-Mendalawi
Department of Pediatrics, Al-Kindy College of Medicine, Baghdad University, Baghdad Post Office 55302
Iraq
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2008-322X.200160

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How to cite this article:
Al-Mendalawi MD. Vision loss in guillain-barre syndrome; a complication or a coincidence. J Ophthalmic Vis Res 2017;12:124-5

How to cite this URL:
Al-Mendalawi MD. Vision loss in guillain-barre syndrome; a complication or a coincidence. J Ophthalmic Vis Res [serial online] 2017 [cited 2017 Mar 22];12:124-5. Available from: http://www.jovr.org/text.asp?2017/12/1/124/200160

Dear Editor,

In their interesting case report, Ramakrishan et al described a patient with Guillain-Barre syndrome (GBS) who developed vision loss during the course of the illness and proved later to have posterior reversible encephalopathy syndrome (PRES).[1] Herein, the following two comments regarding that case report can be made.

First, PRES is a clinical condition characterized by sudden systemic hypertension associated with headache, seizure, visual disturbance, and altered mental state. The authors mentioned that GBS with dysautonomia can be considered as an independent risk factor for the development of various clinical manifestations of PRES (such as visual disturbance) through which an acute increase in blood pressure results in the release of pro-inflammatory cytokines to break the blood-brain barrier and cause vasogenic edema.[1] Such explanation cannot be applied to the current case as the patient had no documented persistent hypertension. Actually, the association of PRES without arterial hypertension with autoimmune-mediated inflammatory neuropathies such as GBS is a rare and poorly understood phenomenon. There might be another mechanism contributing to the development of PRES in this GBS patient. The authors mentioned that the patient received intravenous immunoglobulin (IVIG) 20 g/day for 5 days. On day 14 after admission, the patient had two attacks of generalized seizures to be associated later with severe vision loss in both eyes.[1] To date, various reports have described PRES as an adverse event subsequent to immunomodulatory treatment with IVIG in cases of axonal and demyelinating GBS.[2],[3],[4] The exact mechanism is not fully understood. Hence, in severe GBS cases, immunoadsorption has been advocated as the first-line therapy instead of IVIG for rapid removal of IgG to hasten recovery, improve functional outcome, and minimize serious aftermaths.[4]

Second, the authors stated that PRES can occur concurrently with weakness or during the course of GBS.[1] It should be noted that PRES preceding the development of GBS has previously been reported.[5]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Ramakrishnan S, Kannan B, Kannan A, Venkatesan EP. Vision loss in Guillain-Barre syndrome: Is it a complication of Guillain-Barre syndrome or just a coincidence? J Ophthalmic Vis Res 2016;11:340-341.  Back to cited text no. 1
    
2.
Doss-Esper CE, Singhal AB, Smith MS, Henderson GV. Reversible posterior leukoencephalopathy, cerebral vasoconstriction, and strokes after intravenous immune globulin therapy in guillain-barre syndrome. J Neuroimaging 2005;15:188-192.  Back to cited text no. 2
    
3.
Koichihara R, Hamano S, Yamashita S, Tanaka M. Posterior reversible encephalopathy syndrome associated with IVIG in a patient with Guillain-Barré syndrome. Pediatr Neurol 2008;39:123-125.  Back to cited text no. 3
    
4.
Stetefeld HR, Lehmann HC, Fink GR, Burghaus L. Posterior reversible encephalopathy syndrome and stroke after intravenous immunoglobulin treatment in Miller-Fisher syndrome/Bickerstaff brain stem encephalitis overlap syndrome. J Stroke Cerebrovasc Dis 2014;23:e423-e425.  Back to cited text no. 4
    
5.
Rigamonti A, Basso F, Scaccabarozzi C, Lauria G. Posterior reversible encephalopathy syndrome as the initial manifestation of Guillain-Barré syndrome: Case report and review of the literature. J Peripher Nerv Syst 2012;17:356-360.  Back to cited text no. 5
    




 

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