Coexistence of Guillain-Barré Syndrome and an Impending Rupture of a Pancreaticoduodenal Artery Aneurysm Associated With Celiac Artery Stenosis.

Guillain-Barré syndrome (GBS) after medical procedures has been reported, although the association is not clear. Since the use of sedatives for the procedures may complicate neurological evaluation and delay the initiation of treatment, all physicians should be familiar with its clinical features. Celiac artery stenosis can increase collateral blood flow through the pancreaticoduodenal arcades and contribute to the formation of arterial aneurysms. The relationship between a pancreaticoduodenal artery aneurysm associated with celiac artery stenosis and GBS is unclear. Multiple life-threatening disorders may coexist by chance; therefore, clinicians should consider an additional underlying condition when a single disorder cannot explain the entire clinical picture. A 34-year-old woman was transferred to our hospital for the evaluation of progressive muscle weakness in all four limbs and respiratory failure. She had developed flu-like symptoms 10 days before transfer. Two days later, she noticed numbness involving all four extremities and back pain. The following day, her back pain worsened, and she was diagnosed with an impending rupture of a pancreaticoduodenal artery aneurysm associated with celiac artery stenosis. Urgent transcatheter arterial coil embolization resulted in improvement of her back pain, but the numbness persisted. She subsequently reported muscle weakness in all four limbs, which was attributed to the residual effects of sedative medications used during the procedure. The following day, she developed respiratory failure requiring intubation and mechanical ventilation, which prompted her transfer for further management. Based on rapidly progressive muscle weakness with absent reflexes and a positive anti-GM1 antibody test, a diagnosis of GBS was made. Following two courses of intravenous immunoglobulin therapy, she was weaned from mechanical ventilation and eventually was able to walk with a walker. We learned the following lessons from this case. First, since GBS is difficult to recognize in patients undergoing medical procedures requiring sedative agents, physicians should be familiar with its clinical presentation and maintain a high index of suspicion. Second, as Hickam's dictum suggests, patients may experience multiple distinct conditions simultaneously. When a single diagnosis cannot explain the entire clinical course, clinicians should consider the possibility of a coexisting pathology.