To the Editor.—
In response to the letter from Michael I. Weintraub, MD (242:513, 1979), autonomic dysfunction is a well-documented complication of Guillain-Barré syndrome. In his review of 28 patients, Lichtenfeld1 found that the disease took the form of either excessive or insufficient sympathetic or parasympathetic activity, or both. Hypertension was seen in 61% of the patients, postural hypotension in 43%, abnormal sweating and flushing in 15% to 25%, and ECG abnormalities in 64%. Dr Weintraub makes a provocative suggestion, that early Swan-Ganz monitoring be used to predict incipient autonomic dysfunction in those patients with Guillain-Barré syndrome. However, as the following case illustrates, there are simpler, less invasive methods of making the diagnosis and, in fact, because of the rapid fluctuations in autonomic activity, the Swan-Ganz measurements are of limited therapeutic value in those patients.
Report of a Case.—
A 39-year-old man came to a Veterans Administration Hospital with