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Autonomic neuropathy — an uncommon variant of Guillain–Barré syndrome

Robert D Henderson, Jeyaraj D Pandian, Kaye M Dalton and John M Bradfield
Med J Aust 2010; 192 (4): 232.
Published online: 15 February 2010

A 29-year-old woman presented with a 19-day history of blurred vision and intolerance to bright light after a presumed viral illness (a sore throat and fever resolved 4 days before the onset of other symptoms). At presentation, she reported a dry mouth, mild constipation, abdominal bloating and hesitancy of micturition. Results of a clinical examination were normal apart from dilated, slightly asymmetric pupils (Figure, A), non-reactive to light and accommodation. The patient’s condition gradually improved over the subsequent 6 months.

Tests of heart rate and blood pressure showed normal cardiovascular autonomic function. Thermoregulatory sweat testing was undertaken by applying a starch and iodine paste to the skin; this changes colour to purple in the presence of sweat. Results showed an absence of sweating in the patient’s arms and legs (Figure, B and C) compared with an age-matched control volunteer (Figure, D and E).

These findings support a diagnosis of a subacute cholinergic neuropathy causing parasympathetic failure, which, in the clinical context, is likely to represent an uncommon variant of Guillain–Barré syndrome.1

Figure

  • Robert D Henderson1
  • Jeyaraj D Pandian2
  • Kaye M Dalton1
  • John M Bradfield1

  • 1 Department of Neurology, Royal Brisbane and Women’s Hospital, Brisbane, QLD.
  • 2 Betty Cowan Research and Innovation Center, Christian Medical College, Ludhiana, India.


  • 1. Low PA, McLeod JG. Autonomic neuropathies. In: Low PA, editor. Clinical autonomic disorders. 2nd ed. Philadelphia: Lippincott-Raven, 1997: 463-486.

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