To the Editor.—
Idiopathic polyneuritis (Guillain-Barré syndrome) is a distinctive disorder characterized by ascending paralysis, areflexia, and elevated CSF protein. Sudden death is seen, and although there are numerous possibilities in these bedridden patients (eg, myocardial infarction and pulmonary embolism), it has been assumed that the bulk of the fatalities are secondary to respiratory impairment. Evidence is accumulating that autonomic dysfunction is a more critical factor predisposing to sudden death. Using the Swan-Ganz flow-directed balloon-tipped cardiac catheter in a patient with Guillain-Barré syndrome and sudden pulmonary collapse, clinical and physiological observations were made that provided a unique opportunity to determine the role of the autonomic nervous system.
Report of a Case.—
The patient, a previously healthy 67-year-old woman, had severe, rapid-onset Guillain-Barré syndrome that required tracheostomy and respiratory support. Her condition stabilized, and while she was in the intensive care unit, an episode of unresponsiveness with absent blood pressure developed.