Re: Relationship between SLE & Guillain-Barre?

Posted By ccf neuro M.D. on May 15, 1997 at 15:47:22:

In Reply to: Relationship between SLE & Guillain-Barre? posted by Jean H on May 09, 1997 at 12:56:01:







: I have systemic lupus and have recently begun to have nervous system involvment--blurred vision, eyelid twitching, etc.
A few years ago, I had bilateral facial weakness to the point of not being able to close my eyes or speak very well.
At that time, I was told I had Guillain-Barre syndrome, and my prednisone was increased for about 6 weeks.
My question is--is there a relationship between SLE and GBS? Or, is it likely that the facial weakness was just a
different manifistation of my lupus? An MRI showed an ischemic area on my brainstem when I had the GBS.



        


Bilateral facial nerve weakness may be seen in up to one third of cases of Guillian-Barre syndrome, but this is almost always in the context of generalized weakness that starts most often in the legs, works its way up to the arms, and then, if at all, lastly to the face. Isolated bilateral facial weakness is more characteristic of chronic meningitis like that seen in sarcoidosis, certain fungal and tubercular infections, and in some inflammatory conditions, including on rare occasions lupus. There is an old medical addage that "lupus is always in the diffrential diagnosis" (of ANY problem), which reflects the diseases well known ability to affect practically literally every organ in the body if it wants to. The blurred vision and twitching are nonspecific symptoms. If the blurred vision is constant, or in association with headache or eye pain, or if has lasted longer than a few days, I would get evaluated immediately. Chronic meningitis can infiltrate the optic nerves and cause something called pappiledema,  which can make you go blind if the underlying cause goes undiagnosed and untreated. If you have temporary LOSS of vision, this is especially ominous and you should go straight to the nearest emergency room. Spinal taps and MRI scans can both be used to diagnose chronic meningitis, as well as other problems lupus can cause in the brain like VASCULITIS, an inflammation of blood vessels in the brain that can cause strokes, like the one it sounds like you had in your brainstem from your description of your MRI. I would NOT delat seeking treatment, however, as central nervous system complications of lupus can be extremely dangerous. If you are near the Cleveland area and are interested in being evaluated at the Cleveland Clinic, the dept. of neurology appointment number is 216-444-5559 or 1-800-223-2273 extension 45559. I hope you find this information useful.