Atypical presentation of Guillain-Barre syndrome with acute hydrocephalus

A 32-year-old man was treated with a ventriculo-peritoneal shunt for acute panventricular hydrocephalus. On the third postoperative day, an ascending tetraparesis and subsequent respiratory failure developed. Based on the clinical findings, cerebrospinal fluid study and electrophysiological results, a diagnosis of Guillain-Barre syndrome (GBS) was made. Despite plasmaphoresis and immunoglobulin infusion, the patient was ventilator dependent and bed-bound for 4 months. One year later, he was able to walk without assistance and had only slightly wasting of the intrinsic hand muscles. This is the first report of acute hydrocephalus preceding the symptoms of GBS.