Guillain-Barré syndrome following intracranial hemorrhage: a systematic review of case reports.

Introduction: Guillain-Barré syndrome (GBS) is an autoimmune polyradiculopathy linked to various triggers. Recently, several case reports described GBS development following intracranial hemorrhage (ICH), posing diagnostic and therapeutic challenges. Methods: PubMed and EMBASE were searched from inception till February 2023 for case reports. Two reviewers independently screened the articles and extracted data using a standardized form. The extracted data were then analyzed narratively. Quality was assessed with the JBI Checklist for Case Reports. Results: Twenty-three cases from 11 countries were identified (14 males, mean age of 60.1 years). Onset of GBS occurred after a median of 9 days (range 2-24) post-ICH, with intracerebral hemorrhage being the most common antecedent (39.1%), followed by subarachnoid (26.1%) and subdural hemorrhage (21.7%). Electrophysiology showed predominantly axonal variants, while CSF consistently demonstrated albuminocytologic dissociation with positive antiganglioside antibodies in five cases. The clinical course was severe, marked by rapid progression to nadir (median 2.5 days), profound functional impairment (average Hughes Functional Grading Scale: 4.57 ± 0.66), and a high rate of respiratory failure requiring mechanical ventilation (78.3%). Axonal variants were associated with higher rates of mechanical ventilation and poorer outcomes than demyelinating forms. Among the 21 patients who received immunomodulatory treatment, 3 (14.3%) showed complete recovery, 13 (61.9%) had partial recovery, 3 (14.3%) had a poor recovery, and 2(9.5%) died at last follow up. Conclusion: GBS may complicate recovery after ICH and appears to present with an aggressive course, particularly in axonal variants. Clinicians should consider GBS when patients with ICH develop progressive, symmetrical weakness unexplained by the initial brain injury, as prompt initiation of immunotherapy may improve outcomes.