# The Differential Diagnosis of Coma in the ICU: Hyperacute Postoperative Guillain‐Barré Syndrome—A Case Report

## TL;DR

This case report describes a rare instance of Guillain-Barré syndrome (GBS) in a post-surgery ICU patient, highlighting the diagnostic challenges and atypical presentation of the condition.

## Contribution

The report emphasizes the importance of considering GBS in postoperative ICU patients with coma and flaccid paralysis, even without typical triggers.

## Key findings

- GBS can present atypically in postoperative patients, mimicking other conditions like hypoxic brain injury.
- A 56-year-old man developed coma and flaccid quadriplegia after surgery, with a delayed diagnosis of GBS.
- Treatment with intravenous immunoglobulin showed partial improvement, underscoring the need for early suspicion of GBS in similar cases.

## Abstract

Guillain‐Barré syndrome (GBS) is a rare, immune‐mediated neurological disorder that can be challenging to diagnose in postoperative patients due to atypical manifestations and overlapping conditions. This case report highlights the diagnostic and therapeutic challenges of GBS following vascular surgery. We present the case of a 56‐year‐old man scheduled for elective femoro‐popliteal bypass surgery. The initial neurological development of the patient's GBS was masked by delirium requiring sedation and culminated with cardio‐respiratory arrest in the 72 h following admission in the post‐operative care unit for surveillance. The patient subsequently developed a profound coma with flaccid quadriplegia. A search for the etiology of these symptoms was initiated, with a belated diagnosis of GBS, but with a positive, albeit partial, response to treatment by intravenous immunoglobulin administration. As in this case report, GBS in a post‐surgical setting should not be expected in its classical form, frequently characterized by a more severe clinical presentation regarding the onset of symptoms, associated dysautonomia and atypical, yet possible encephalopathy.

Guillain‐Barré syndrome should be considered in postoperative ICU patients presenting with coma, flaccid paralysis, or severe dysautonomia—even in the absence of typical infectious triggers—since hyperacute forms can mimic hypoxic brain injury and delay diagnosis.