{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T03:53:16Z","timestamp":1777693996404,"version":"3.51.4"},"reference-count":29,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Reports"],"abstract":"<jats:p>Background and Clinical Significance: Guillain\u2013Barr\u00e9 syndrome (GBS) can rarely progress to fulminant paralysis with loss of brainstem reflexes, mimicking coma or brain death despite preserved cortical function. Case Presentation: A 38-year-old man developed rapidly progressive weakness following a diarrheal illness, culminating in quadriplegia, areflexia, respiratory failure, and complete loss of brainstem reflexes within 72 h. Neuroimaging was unrevealing. EEG demonstrated preserved cerebral activity with an alpha coma pattern. Despite initial intravenous immunoglobulin therapy, neurological deterioration continued, prompting escalation to plasma exchange. Gradual recovery of brainstem reflexes and motor function ensued, followed by substantial functional improvement over nine months. This case highlights the diagnostic and prognostic challenges of fulminant GBS at the interface of peripheral and brainstem dysfunction. Neurophysiologic assessment and disciplined exclusion of central etiologies are essential. Timely immunotherapy and supportive care can lead to meaningful recovery even in extreme presentations. Conclusions: Fulminant GBS should be recognized as a potentially reversible cause of apparent coma, underscoring the importance of early diagnosis and aggressive treatment.<\/jats:p>","DOI":"10.3390\/reports9020138","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T07:43:51Z","timestamp":1777448631000},"page":"138","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Lessons from a Severe Case of Fulminant Guillain\u2013Barr\u00e9 Syndrome: A Case Report"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-4477-8914","authenticated-orcid":false,"given":"Jacob Allen","family":"Saunders","sequence":"first","affiliation":[{"name":"Department of Neurology, The University of Arizona College of Medicine\u2014Phoenix, Phoenix, AZ 85004, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8960-0655","authenticated-orcid":false,"given":"Sadiq Shakir","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Neurology, The University of Arizona College of Medicine\u2014Phoenix, Phoenix, AZ 85004, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3586-2909","authenticated-orcid":false,"given":"Thomas Chandy","family":"Varkey","sequence":"additional","affiliation":[{"name":"Department of Neurology, The University of Arizona College of Medicine\u2014Phoenix, Phoenix, AZ 85004, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4897-6800","authenticated-orcid":false,"given":"Sara","family":"Shaikh","sequence":"additional","affiliation":[{"name":"Department of Neurology, The University of Arizona College of Medicine\u2014Phoenix, Phoenix, AZ 85004, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony","family":"Conforti","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, The University of Arizona College of Medicine\u2014Phoenix, Phoenix, AZ 85004, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ganesh","family":"Murthy","sequence":"additional","affiliation":[{"name":"Department of Neurology, The University of Arizona College of Medicine\u2014Phoenix, Phoenix, AZ 85004, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3646","DOI":"10.1111\/ene.16073","article-title":"European Academy of Neurology\/Peripheral Nerve Society Guideline on diagnosis and treatment of Guillain-Barr\u00e9 syndrome","volume":"30","author":"Hadden","year":"2023","journal-title":"Eur. J. Neurol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1214","DOI":"10.1016\/S0140-6736(21)00517-1","article-title":"Guillain-Barr\u00e9 syndrome","volume":"397","author":"Shahrizaila","year":"2021","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1038\/s41572-024-00580-4","article-title":"Guillain-Barr\u00e9 syndrome","volume":"10","author":"Leonhard","year":"2024","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e16365","DOI":"10.1111\/ene.16365","article-title":"Guillain-Barr\u00e9 syndrome: A comprehensive review","volume":"31","author":"Bellanti","year":"2024","journal-title":"Eur. J. Neurol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1177\/14782715241244839","article-title":"Guillain Barre syndrome mimicking brain death","volume":"54","author":"Sarna","year":"2024","journal-title":"J. R. Coll. Physicians Edinb."},{"key":"ref_6","first-page":"600","article-title":"Guillain-Barr\u00e9 syndrome mimicking brain death pattern: A poorly reversible condition","volume":"112","author":"Bernard","year":"2010","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.cnp.2020.11.004","article-title":"Electroencephalographic findings in Bickerstaff\u2019s brainstem encephalitis: A possible reflection of the dysfunction of the ascending reticular activating system","volume":"6","author":"Yoshimura","year":"2020","journal-title":"Clin. Neurophysiol. Pract."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e517","DOI":"10.1002\/ams2.517","article-title":"Diagnosis and prediction of prognosis for Bickerstaff\u2019s brainstem encephalitis using auditory brainstem response: A case report","volume":"7","author":"Kurihara","year":"2020","journal-title":"Acute Med. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"74","DOI":"10.2478\/jccm-2020-0008","article-title":"Guillain-Barr\u00e9 and Acute Transverse Myelitis Overlap Syndrome Following Obstetric Surgery","volume":"6","author":"Stoian","year":"2020","journal-title":"J. Crit. Care Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1212\/WNL.41.1.131","article-title":"\u201cPseudospasticity\u201d in Guillain-Barr\u00e9 syndrome","volume":"41","author":"Preston","year":"1991","journal-title":"Neurology"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1215","DOI":"10.1002\/mus.28271","article-title":"Timing of intravenous immunoglobulin treatment and outcome in Guillain\u2013Barr\u00e9 syndrome: Is time nerve?","volume":"70","author":"Min","year":"2024","journal-title":"Muscle Nerve"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"100468","DOI":"10.1016\/j.ensci.2023.100468","article-title":"Plasma exchange versus intravenous immunoglobulin for the treatment of Guillain-Barr\u00e9 syndrome in patients with severe symptoms: A systematic review and meta-analysis","volume":"31","author":"Zaki","year":"2023","journal-title":"eNeurologicalSci"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Plasma Exchange\/Sandoglobulin Guillain-Barr\u00e9 Syndrome Trial Group (1997). Randomised trial of plasma exchange, intravenous immunoglobulin, and combined treatments in Guillain-Barr\u00e9 syndrome. Lancet, 349, 225\u2013230.","DOI":"10.1016\/S0140-6736(96)09095-2"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1016\/S1474-4422(20)30494-4","article-title":"Second intravenous immunoglobulin dose in patients with Guillain-Barr\u00e9 syndrome with poor prognosis (SID-GBS): A double-blind, randomized, placebo-controlled trial","volume":"20","author":"Walgaard","year":"2021","journal-title":"Lancet Neurol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1111\/jns.12646","article-title":"Efficacy and safety of eculizumab in Guillain-Barr\u00e9 syndrome: A phase 3, multicenter, double-blind, randomized, placebo-controlled clinical trial","volume":"29","author":"Kuwabara","year":"2024","journal-title":"J. Peripher. Nerv. Syst."},{"key":"ref_16","unstructured":"Rocha Cabrero, F., and Morrison, E.H. (2023). Miller Fisher Syndrome. StatPearls, StatPearls Publishing."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Noioso, C.M., Bevilacqua, L., Acerra, G.M., Della Valle, P., Serio, M., Vinciguerra, C., Piscosquito, G., Toriello, A., Barone, P., and Iovino, A. (2023). Miller Fisher syndrome: An updated narrative review. Front. Neurol., 14.","DOI":"10.3389\/fneur.2023.1250774"},{"key":"ref_18","first-page":"645","article-title":"MR imaging findings of spinal posterior column involvement in a case of Miller Fisher syndrome","volume":"25","author":"Inoue","year":"2004","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_19","first-page":"e18788","article-title":"Pharyngeal-Cervical-Brachial Variant of Guillain-Barr\u00e9 Syndrome","volume":"13","year":"2021","journal-title":"Cureus"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1136\/jnnp-2013-305397","article-title":"Pharyngeal-cervical-brachial variant of Guillain-Barre syndrome","volume":"85","author":"Wakerley","year":"2013","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.cca.2015.02.039","article-title":"Autoimmune peripheral neuropathies","volume":"449","author":"Bourque","year":"2015","journal-title":"Clin. Chim. Acta"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1212\/WNL.0000000000013220","article-title":"Pearls & Oy-sters: Delayed Diagnosis of Acute Motor Axonal Neuropathy With Cardiac Arrest","volume":"98","author":"Marzoughi","year":"2022","journal-title":"Neurology"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"838","DOI":"10.1007\/s13311-019-00716-5","article-title":"Differentiation Between Guillain-Barr\u00e9 Syndrome and Acute-Onset Chronic Inflammatory Demyelinating Polyradiculoneuritis-a Prospective Follow-up Study Using Ultrasound and Neurophysiological Measurements","volume":"16","author":"Grimm","year":"2019","journal-title":"Neurotherapeutics"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1016\/j.rcl.2018.10.005","article-title":"Spinal Manifestations of Systemic Disease","volume":"57","author":"Dodson","year":"2019","journal-title":"Radiol. Clin. N. Am."},{"key":"ref_25","first-page":"e70787","article-title":"Postpartum Guillain-Barr\u00e9 Syndrome Presenting as Acute Motor Axonal Neuropathy in a Young Female: A Report of a Rare Case","volume":"16","author":"Maqbool","year":"2024","journal-title":"Cureus"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1016\/S0887-8994(96)00293-7","article-title":"Acute Motor Axonal Neuropathy in Childhood: Clinical and MRI findings","volume":"16","author":"Phillips","year":"1997","journal-title":"Pediatr. Neurol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1111","DOI":"10.1007\/s00415-011-6309-1","article-title":"Magnetic resonance imaging of lower limb musculature in acute motor axonal neuropathy","volume":"259","author":"Berciano","year":"2011","journal-title":"J. Neurol."},{"key":"ref_28","first-page":"6462","article-title":"Classification of Guillain-Barr\u00e9 syndrome based on electrophysiological features","volume":"6","author":"Zafar","year":"2022","journal-title":"Int. J. Health Sci."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Geng, N., Wang, P., and Zhang, Y. (2023). Acute Motor-Sensory Axonal Polyneuropathy Variant of Guillain-Barr\u00e9 Syndrome with a Thalamic Lesion and COVID-19: A Case Report and Discussion on Mechanism. Front. Neurol., 14.","DOI":"10.3389\/fneur.2023.1227505"}],"container-title":["Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2571-841X\/9\/2\/138\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T09:14:12Z","timestamp":1777454052000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2571-841X\/9\/2\/138"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,29]]},"references-count":29,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["reports9020138"],"URL":"https:\/\/doi.org\/10.3390\/reports9020138","relation":{},"ISSN":["2571-841X"],"issn-type":[{"value":"2571-841X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,29]]}}}