Guillain-Barré syndrome complicated by posterior reversible encephalopathy syndrome and reversible cerebral vasoconstriction syndrome
  • Haruka Kobayashi
    Department of General Internal Medicine, Nakagami Hospital, Okinawa, Japan
  • Yoji Hoshina
    Department of Neurology, University of Utah, Salt Lake City, Utah, USA
  • Hidemasa Higa
    Chibana Clinic Neurology, Nakagami Hospital, Okinawa, Japan
  • Takashi Watari
    General Medicine Center, Shimane University Hospital, Shimane, Japan; Department of Medicine, University of Michigan Medical School, Michigan, USA


Guillain-Barré syndrome, posterior reversible encephalopathy syndrome, reversible cerebral vasoconstriction syndrome, hyponatremia


Introduction: Guillain-Barré syndrome is an immune-mediated inflammatory polyneuritis characterised by rapidly progressive flaccid paralysis. Guillain-Barré syndrome may present with posterior reversible encephalopathy syndrome or reversible cerebral vasoconstriction syndrome in rare cases.
Case description: A woman in her 60s with a history of follicular lymphoma presented with a one-week history of difficulty walking and thunderclap headaches. The patient was diagnosed with Guillain-Barré syndrome based on neurological examination, cerebrospinal fluid analysis and nerve conduction findings. Further diagnosis of posterior reversible encephalopathy and reversible cerebral vasoconstriction syndromes was based on imaging findings and headache history. The patient was treated with intravenous immunoglobulin and amlodipine, and symptoms improved.
Discussion: We reviewed the literature on Guillain-Barré syndrome associated with posterior reversible encephalopathy and/or reversible cerebral vasoconstriction syndrome. The underlying pathophysiology may involve dysautonomia resulting in unstable blood pressure, and hyponatraemia causing endothelial dysfunction. The SNOOP mnemonic highlights the ‘red flags’. This SNOOP mnemonic suggests the possibility of secondary headaches that require imaging studies. In this case, the patient exhibited three SNOOP symptoms: S (history of malignancy: follicular lymphoma), O (sudden-onset headache) and O (over 50 years old).
Conclusion: This case highlights the importance of considering coexisting central neurological disorders in patients with Guillain-Barré syndrome.



  • Dimachkie MM, Barohn RJ. Guillain-Barré syndrome and variants. Neurol Clin 2013;31:491–510.
  • Belgrado E, Del Negro I, Bagatto D, Lorenzut S, Merlino G, Gigli GL, et al. Posterior reversible encephalopathy syndrome in Guillain-Barré syndrome: just a problem of immunoglobulins? controversy from two atypical case reports. Front Neurol 2022;13:817295.
  • Alrohimi A, Jassal R. Headache in Guillain-Barré Syndrome: diagnostic and management implications. Can J Neurol Sci 2018;45:240–242.
  • Storti B, Vedovello M, Riva R, Agazzi E, Censori B, Manara O, et al. Posterior reversible encephalopathy and Guillain-Barré syndrome: which came first, the chicken or the egg? A review of literature. Neurol Sci 2020;41:3663–3666.
  • Drye C, Bose S, Pathireddy S, Aeddula NR. Guillain-Barre syndrome with concurrent posterior reversible encephalopathy syndrome and hyponatraemia: mere coincidence or rare coexistence. BMJ Case Rep 2019;12:e229749.
  • Wei DY, Kao J, Wu TY, Pereira JA, Anderson NE, Alan Barber P. Reversible cerebral vasoconstriction in Guillain-Barré syndrome. J Clin Neurosci 2015;22:1201–1202.
  • Jeanneret V, Jillella DV, Rangaraju S, Groover O, Peterson R, Koneru S, et al. PRES and RCVS: Two Distinct Entities or a Spectrum of the Same Disease? J Stroke Cerebrovasc Dis 2022;31:106472.
  • Ducros A. Reversible cerebral vasoconstriction syndrome. Lancet Neurol 2012;11:906–917.
  • Jeon JS, Park SP, Seo JG. Posterior reversible encephalopathy syndrome due to hyponatremia. J Epilepsy Res 2014;4:31–33.
  • Wang Y, Liu J. Hyponatremia is a predictor for poor outcome in Guillain-Barré syndrome. Neurol Res 2015;37:347-351.
  • Tada M. Reversible cerebral vasoconstriction syndrome (RCVS) and posterior reversible encephalopathy syndrome (PRES). No Shinkei Geka 2021;49:342–348.
  • Nahas SJ. Diagnosis of acute headache. Curr Pain Headache Rep 2011;15:94–97.
  • Views: 441
    HTML downloads: 94
    PDF downloads: 417

    Published: 2023-08-17
    Issue: 2023: Vol 10 No 10 (view)

    How to cite:
    Kobayashi H, Hoshina Y, Higa H, Watari T. Guillain-Barré syndrome complicated by posterior reversible encephalopathy syndrome and reversible cerebral vasoconstriction syndrome. EJCRIM 2023;10 doi:10.12890/2023_003949.