Blood pressure fluctuations in the dysautonomia of Guillain-Barre syndrome
A. H. Ropper and E. F. Wijdicks
Neurological/Neurosurgical Intensive Care Unit, Massachusetts General Hospital, Boston 02114.
A 76-year-old man with severe Guillain-Barre syndrome had extremes of
hypotension alternating with hypertension. His blood pressure paralleled
both systemic vascular resistance and cardiac output. Heart rate, rather
than stroke volume, was the major determinant of cardiac output over a wide
range of blood pressures. It was at times invariant for several hours and
was unresponsive to carotid massage or respiratory cycles, but slowed
slightly with each episode of hypotension. Trend monitoring indicated that
hypotension preceded reductions in pulmonary artery diastolic pressure.
These findings suggest that hypotension resulted from a vasodepressor
response with a vagotomized heart and that hypertension was the result of
increased sympathetic activity. Both extremes were caused by parallel
changes in vascular resistance and heart rate. Dysfunction of baroreflex
buffering may have accounted for the rapid swings in pressure.
