Neurology India Medknow Publications on behalf of the Neurological Society of India ISSN: 0028-3886 EISSN: 1998-4022 Vol. 51, Num. 1, 2003, pp. 135

Neurology India, Vol. 51, No. 1, Jan-Mar, 2003, pp. 135

Letter to Editor

Visual loss with papilloedema in Guillian-Barrei- Syndrome

R. K. Garg

Department of Neurology, Chhatrapati Shahuji Maharaj Medical University, Lucknow-226003. E-mail: garg50@yahoo.com

Accepted on 12.03.2003.

Code Number: ni03052

Sir,

I read with great interest the case report of Guillian-Barre syndrome; the patient also had papilloedema and vision loss.¹ In this report the authors have not mentioned about pupil and light reflex, which I think, was of great diagnostic importance in this patient. Suppose, if pupillary response to light was normal, it suggested a cortical type of vision loss making diagnosis of Guillian-Barre-syndrome very unlikely. In the presence of normal pupillary response porphyria presenting as malignant hypertension (papilloedema) and posterior leukoencephalopathy presenting as cortical blindness was a better likely possibility. In case pupillary abnormality was present along with impaired light reflex, it suggested optic nerve involvement and optic disk swelling was more likely to be because of papillitis rather than because of papilloedema.

I think that in a lady presenting with headache, bilateral vision loss and bilateral 6^th nerve involvement, in the presence of inconclusive electrophysiology and normal cerebrospinal fluid examination, the diagnosis of Guillian-Barre syndrome becomes very unlikely. In this patient an inherently multifocal disease affecting the optic nerve and peripheral nervous system like vasculitis was more probable. Several diagnostic possibilities, which should have been considered, include polyarteritis nodosa, Churg-Strauss syndrome, Wegener's granulomatosis, a cryoglobulin-mediated neuropathy, rheumatoid arthritis, systemic lupus erythematosus, sarcoidosis, spirochetal diseases (e.g. borrelliosis), Sjogren's syndrome, or a non-systemic vasculitic neuropathy.² Though authors have performed a few investigations which are relevant for the diseases just mentioned, several other diseases have not been comprehensively excluded.

R. K. Garg

Department of Neurology, Chhatrapati Shahuji Maharaj Medical University, Lucknow-226003. E-mail: garg50@yahoo.com

Reference

1. Kharbanda PS, Prabhakar S, Lal V, Das CP. Visual loss with papilloedema in Gullian-Barre- Syndrome. Neurol India 2002;50:528-9.
2. Case records of the Massachusetts General Hospital. Case 3-1999- a 41-year-old woman with muscle weakness, painful paresthesias and visual problems. N Engl J Med 1999;340:300-7.

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