Bilateral Tonic Pupils and Guillain-Barre Syndrome in a 6-Year-Old Boy

Abstract

Corresponding author: Jin-Hwa Moon, MD Division of Pediatric Neurology, Department of Pediatrics, Hanyang University Guri Hospital, Hanyang University College of Medicine, 153 Gyeongchun-ro, Guri 11923, Korea Tel: +82-31-560-2258 Fax: +82-31-552-9493 E-mail: [email protected] Bilateral tonic pupils can be a rare manifestation of Guillain-Barré syndrome (GBS). Here we report our experience of bilateral tonic pupils in a child with GBS, who diagnosed by pharmacological pupil test with diluted 0.125% pilocarpine and nerve conduction velocity (NCV) study. A 6-year-old boy was transferred to our hospital due to altered mental status after respiratory resuscitation. One day before the transfer, he had gastrointestinal symptoms and weakness for dehydration. Few hours before the transfer, he abruptly started vomiting and developed difficulty in breathing. Upon arrival at the emergency room, he was intubated and mental status was stupor (Glasgow coma scale E2V2M5, temperature 37.7°C, blood pressure 110/65 mm Hg, respiration rate 25/min). Both pupils were dilated > 5 mm and light reflexes were hardly detected bilaterally. He was flaccid and deep tendon reflexes were decreased. He was born at full term by uncomplicated delivery (birth weight 4,000 g). Before admission, he had been healthy and neurodevelopment was normal. Medical and family histories were unremarkable. He had not been vaccinated recently. The initial laboratory results for blood, stool, and cerebrospinal fluid (CSF) were unremarkable, except for a mild hyponatremia (Table 1). Chest Letter to the editor