Neurocritical care
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Dysautonomia is a characteristic finding in Guillain-Barré syndrome (GBS). Sinus tachycardia, blood pressure instability, sustained hypertension or hypotension, cardiac arrhythmias, sweating abnormalities, gastrointestinal or urogenital symptoms, and neurogenic stunned myocardium have been previously described in patients with GBS. To our knowledge, increased intrapulmonary shunts in association with GBS have not yet been reported. ⋯ Intrapulmonary shunts in GBS may relate to sympathetic overactivation and should be anticipated in GBS patients with unexplained respiratory deterioration.
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Subarachnoid hemorrhage (SAH) can trigger immune activation sufficient to induce the systemic inflammatory response syndrome (SIRS). This may promote both extra-cerebral organ dysfunction and delayed cerebral ischemia, contributing to worse outcome. We ascertained the frequency and predictors of SIRS after spontaneous SAH, and determined whether degree of early systemic inflammation predicted the occurrence of vasospasm and clinical outcome. ⋯ Systemic inflammatory activation is common after SAH even in the absence of infection; it is more frequent in those with more severe hemorrhage and in those who undergo surgical clipping. Higher burden of SIRS in the initial four days independently predicts symptomatic vasospasm and is associated with worse outcome.