Panautonomic Dysfunction and Guillain-Barré Syndrome-Reply

In Reply.— The report by Levy contains several statements that require clarification. Autonomic dysfunction in Guillain-Barré syndrome is extremely common and plays a significant role in producing mortality. The outcome in any individual case still remains unpredictable and, therefore, there is no substitute for careful clinical observation and monitoring. Since spontaneous fluctuations in blood pressure, heart rate, and sweating have been observed to occur within minutes in the same patient, it is apparent that carefully monitored patients tend to have a better prognosis for survival. One author noted that the mortality from the disease could be reduced from 25% to less than 5% with competent respiratory and cardiac support care units.¹ Sudden vasomotor collapse in the bedridden Guillain-Barré patient poses a diagnostic dilemma to the physician who must consider an acute, massive myocardial infarction, pulmonary embolism, or autonomic collapse. The rationale for considering the use of the Swan-Ganz catheter,