The Differential Diagnosis of Coma in the ICU: Hyperacute Postoperative Guillain-Barré Syndrome-A Case Report.

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.