Case reportNeuropsychiatric debut as a presentation of Guillain-Barré Syndrome: An atypical clinical case and literature review

- Guillain Barre Syndrome has multiple variations of presentation.
- Neuropsychiatric and autonomic symptoms preceding weakness has not been described.
- Reviews reveal that autonomic dysfunction and psychiatric sequelae are common.
- We present a case of GBS where autonomic/psychiatric symptoms preceded weakness.
- Though GBS is considered primarily a PNS neuropathy, evidence affecting CNS exists.
- GBS should be considered in new onset psychiatric/CNS symptoms of unclear origin.

IntroductionGuillain Barré Syndrome (GBS) is an acute immune-mediated polyneuropathy most frequently presenting two to four weeks after an acute mild-moderately severe infection as progressive muscular weakness of the lower limbs extending proximally with dysreflexia and autonomic dysfunction. While GBS is typically believed to be isolated to the Peripheral Nervous System, Central Nervous System (CNS) and psychiatric manifestations as a sequela of the disease have been described in different imaging and clinical studies. Many variants of presentation of GBS have been recognized, however a case presenting with primarily psychiatric and autonomic dysfunction preceding muscle weakness has not been cited in the literatures to date.Case presentationWe describe a 24-year-old previously healthy male presenting with behavioral symptoms including depression, anxiety, and amnesia, and autonomic dysfunction which preceded muscle weakness by two weeks. CNS imaging and blood work results were unremarkable. GBS was confirmed upon cerebral spinal fluid analysis remarkable for an important cytoalbuminologic dissociation and markedly elevated protein concentration. The patient responded well to five cycles of inpatient plasmapheresis and short-term selective serotonin reuptake inhibitor treatment with complete recovery of both neurological and behavioral symptoms.ConclusionThough GBS is typically considered a peripheral neuropathy, evidence for CNS involvement exists; GBS should be considered within the differential diagnosis, and neurological features should be monitored, in a patient with new onset unclear psychiatric and CNS symptoms.