Guillain Barre Syndrome: A Rare Presentation Mimicking Acute Stroke.

Guillain Barre Syndrome (GBS) is an acute neuromuscular weakness and paralysis associated with areflexia and often spontaneous recovery, but carries the potential risk of respiratory depression owing to muscle weakness. Worldwide, 1 to 3 cases/100,000 are reported. The syndrome is most commonly reported as symmetrical ascending weakness in arms and legs accompanied by hyporeflexia or areflexia. Sensory disturbances are not required for diagnosis, but may or may not be present. Acute inflammatory demyelinating poly-radiculoneuropathy (AIDP) is the most common variant, but acute motor and sensory axonal neuropathy (ASMAN) is more severe and usually leads to partial or slow recovery. We present a case of GBS presenting with asymmetric weakness and sensory disturbance in a patient with bloody diarrhea of unknown etiology. This patient had asymmetrical paralysis mimicking stroke, but the physical findings, laboratory studies, normal CT and MRI of the brain, Electromyogram (EMG) and the patient’s improvement with Intravenous Immunoglobulin (IVIG) support the diagnosis of GBS. People with inflammatory bowel disease are at increased risk of developing GBS. Persons with antecedent Campylobacter jejuni infections are 77 percent more likely to contract GBS compared to the general population, and Cytomegalovirus (CMV) and Epstein Barr virus (EBV) are also implicated risk factors.

Simultaneous Occurrence of Spontaneous Coronary Artery Dissection and Embolic Stroke.

Acute coronary syndrome (ACS) due to spontaneous coronary artery dissection (SCAD) is rare. Further, concurrent ACS with a cerebrovascular accident is improbable, but possible. We report a case of a young man, with a history of Hodgkin’s lymphoma treated with a combination of chemotherapy and radiotherapy ten years ago, presented with acute coronary syndrome caused by an extensive dissection of the right coronary artery, together with acute ischemic stroke. Survivors of Hodgkin’s lymphoma are at increased risk for cardiovascular complications due to radiation, which can expedite atherosclerosis and can, eventually, give rise to dissection and cerebrovascular disease, as exemplified in our case. This case report and review outlines the incidence, epidemiology, causes, pathophysiology, diagnosis and treatment of spontaneous coronary artery dissection. Our case report is a remainder to clinicians to be mindful of concomitant occurrence of these two conditions and highlights the significant impact the treatment of each has on the other, especially when the literature does not have clear recommendations about simultaneous management. Spontaneous coronary artery dissection with concomitant ischemic cerebrovascular stroke poses a therapeutic dilemma and requires a multi-disciplinary team to appropriately manage the patient.

HIV Infection Itself may be a Cause of Hypokalemic Distal Renal Tubular Acidosis without Hypergammaglobulinemia.

Distal renal tubular acidosis (dRTA) is seen in the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) population in the setting of hypergammaglobulinemia and antiretroviral agents, whereas isolated HIV infection is rarely reported to be associated with dRTA. We report a case of a young woman with a history of untreated HIV/AIDS who presented with profound generalized weakness and refractory hypokalemia along with non-anion gap metabolic acidosis and inappropriately high urine pH. Her serum gamma-globulin level was not significantly elevated and she was not on highly active antiretroviral therapy (HAART). No other cause of dRTA was evident. Subsequently, a diagnosis of dRTA secondary to isolated HIV/AIDS was made. Distal RTA can be acquired or inherited and is caused by defects in proton pumps or pH pressure gradients. In dRTA, the potassium level can be low, normal, or even high depending upon the pathophysiologic abnormality. Early recognition and prompt treatment is imperative to avoid the serious consequences of severe electrolyte and metabolic disturbances. Our case report is a reminder to clinicians to be mindful of this rare condition when evaluating unexplained dRTA and to include HIV/AIDS as part of the differential diagnosis of dRTA even in the absence of significant hypergammaglobulinemic (IgG level was slightly elevated) state or antiretroviral agents. We believe this is the second such case to be documented.