Guillain-Barré syndrome and cytomegalovirus infection during pregnancy

An atypical presentation of pre-eclampsia (PET) in a patient diagnosed with Guillain-Barré syndrome: A case report

Guillain-Barré syndrome (GBS) is an autoimmune neurological disorder with unknown aetiology. Given the incidence of GBS is between 1.2 and 1.9 cases per 100,000 people annually [1], it is extremely rare in pregnancy. We report a case with a challenging diagnosis of pre-eclampsia (PET) in a 34-year-old diabetic primigravida who was diagnosed with GBS at 30 weeks of gestation. At her initial presentation, she complained of progressive weakness of her limbs and facial muscles. This was associated with difficulty swallowing. The diagnosis of GBS was made based on electromyography (EMG) and clinical findings. She was managed conservatively with supportive management and was delivered by lower segment caesarean section at 34 weeks of gestation due to rapidly deteriorating liver function tests (LFTs) in the likely setting of PET.

Neuromuscular disorders in pregnancy

Many neuromuscular disorders preexist or occur during pregnancy. In some cases, pregnancy unmasks a latent hereditary disorder. Most available information is based on case reports or series or retrospective clinical experience or patient surveys. Of special interest are pregnancy-induced changes in disease course or severity and likelihood for baseline recovery of function postpartum. Labor and delivery present special challenges in many conditions that affect skeletal but not smooth (uterine) muscle; so labor complications must be anticipated. Anesthesia for cesarean section surgery requires special precautions in many disorders. The types of conditions reviewed are broad and include examples of autoimmune, hereditary, and compressive/mechanical processes. Disorders include carpal tunnel syndrome and other focal neuropathies, Bell palsy, myasthenia gravis, and other neuromuscular junction disorders, acute and chronic inflammatory neuropathy, hereditary and acquired muscle diseases, spinal muscular atrophy, amyotrophic lateral sclerosis, channelopathies, autonomic neuropathy, and dysautonomia. Many commonly used therapies have fetal animal but no proven human toxicity concerns, complicating treatment and risk decisions. Weaning off effective therapeutic agents or preemptive aggressive treatment or surgery prior to planned pregnancy is an option in some conditions.

Guillain-Barré syndrome in pregnancy: A case report

Guillain-Barré syndrome is a rare condition in pregnancy which is characterised by symmetrical progressive ascending polyneuropathy. A case of a 16-year-old nulliparous woman who presented with rapidly progressive limb paralysis following an upper respiratory tract infection a week prior to presentation is discussed. She was intubated as she had developed respiratory failure and managed in the intensive care unit by a multidisciplinary team. Plasma exchange and intravenous immunoglobulin were not readily available so she was managed conservatively. The management of Guillain-Barré syndrome, maternal and foetal outcomes have been discussed.