Guillain-Barre Syndrome (GBS) has been well reported in literature and is recognized as a severe acute paralytic neuropathy, affecting many worldwide. The accepted treatment includes IVIG or PLEX alongside supportive care. However, treatment does not always come without complications, with rare case reports of vascular complications following administration of IVIG. We present such a case, and discuss treatment strategies and hospital outcomes. 

62-year-old female with medical history of cervicothoracic subdural hematoma, hypertension, and significant arteriosclerotic disease who was transferred for evaluation of subacute lower extremity weakness and back pain. Upon examination, we noted lower extremity areflexia and reduced lower extremity strength, with significant vital sign dysautonomia. Studies completed included a lumbar puncture, which showed albuminocytologic dissociation, and MRI of the neuro-axis. MRI of the brain noted findings concerning for PRES (likely a product of vital sign dysautonomia). MRI of the spine noted thoracic cord adhesions as well as ventral nerve root enhancement. Given these findings, patient was diagnosed with GBS and IVIG was initiated with resultant improvement in lower extremity strength over time. However, during her hospital stay vision and mentation declined, with vessel imaging showing evidence of vasospasm and resultant ischemia. Verapamil was started with some improvement, and eventually, patient was discharged for further recovery. Since discharge she has followed in clinic, with continued improvement in strength and MRI resolution of vasospasm/stenosis.

GBS is a life-threatening disease marked by progressive weakness. It is prudent to start standard treatment with IVIG or PLEX as soon as possible, prior to patients developing irreversible nerve damage. Despite its proven benefits on clinical outcomes, IVIG is associated with rare side effects.  In this case report, we discuss how standard therapy for GBS with IVIG led to the development of cerebral vasospasm and ischemia.