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Title: Guillain-Barré syndrome following thrombolysis with rtPA in acute [Síndrome de Guillain-Barré despúes de troḿbolisis de un infarto cerebral con rtPA]
Author: Parada-Garza, J.D.
Ruiz-Herrera, V.V.
Chiquete, E.
Luquin, S.
Ruiz-Sandoval, J.L.
Issue Date: 2014
Abstract: INTRODUCTION: Guillain-Barré syndrome (GBS) has been associated with various conditions, infectious agents, lymphoproliferative disorders, trauma, recent surgery, acute myocardial infarction and application of immunological drugs. Its association with the use of tissue plasminogen activator (rtPA) is extremely rare. CASE REPORT: A 53-year-old man was admitted to the emergency room for a stroke in the territory of the right middle cerebral artery, with 2 hours of evolution and NIHSS of 7 points. After discarding intraparenchymal hemorrhage by head CT, the pattient received thrombolysis with rtPA. At 24 hours a control head CT showed an infarct with hemorrhagic transformation, without neurological repercussion. The patient was discharged after 96 hours with NIHSS of 5 points. On the ninth day after discharge the patient returned to the emergency room with generalized weakness, dysphagia, and progressive respiratory distress of 24 hours of evolution, requiring invasive mechanical ventilation upon arrival. At 48 hours it was documenteda right VI nerve paresis, bilateral VII nerve palsy, quadriplegia and areflexia. An MRI showed a right temporo-parietal subacute ischemic stroke with hemorrhagic transformation without evidence of brain stem infarction. Nerve conduction studies were abnormal, showing motor axonal and demyelinating polyneuropathy. The patient underwent 5 sessions of plasmapheresis without improvement. CONCLUSION: This case could point to an association between thrombolytic use and GBS. However, it is necessary to wait for many other reports before this association is considered epidemiologically sound. The rare risk of GBS after thrombolysis should not be an impediment to timely reperfusion of a patient with a stroke through the use of rtPA.
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