Unique Clinical and Psychiatric Challenges in Elderly Patients With Guillain-Barré Syndrome: A Case Series

Guillain-Barré syndrome (GBS) is an immune-mediated peripheral neuropathy characterized by rapid-onset bilateral flaccid paralysis and areflexia, often triggered by an antecedent illness. Here, we report three elderly male patients, aged 67, 78, and 81, who developed severe GBS requiring mechanical ventilation. Each patient presented with rapid neurological deterioration following antecedent illnesses, such as respiratory and gastrointestinal infections. Cranial nerve involvement, particularly ocular movement deficits, was prominent. Nerve conduction studies revealed motor and sensory axonopathy and cerebrospinal fluid analysis showed albuminocytologic dissociation. Despite initial treatment with intravenous immunoglobulin and plasmapheresis, all patients developed akinesia in the chronic phase. One patient was diagnosed with progressive supranuclear palsy, while MRI in the other two patients revealed cerebral ischemic lesions and temporal lobe atrophy. Elderly GBS patients tend to have rapid progression, severe neurological deficits, and prolonged recovery. In addition, the disease severity and protracted recovery can lead to stress reactions and consequent psychiatric symptoms in GBS patients. Long-term management strategies, both neurological and psychiatric, are essential for elderly GBS patients.