Case Report Fulminant Guillain–Barré Syndrome Post Hemorrhagic Stroke: Two Case Reports Sameeh Abdulmana 1 , Naif Al-Zahrani 1 , Yahya Sharahely 2 , Shahid Bashir 1 and Talal M. Al-Harbi 1, *   Citation: Abdulmana, S.; Al-Zahrani, N.; Sharahely, Y.; Bashir, S.; M. Al-Harbi, T. Fulminant Guillain–Barré Syndrome Post Hemorrhagic Stroke: Two Case Reports. Neurol. Int. 2021, 13, 190–194. https://doi.org/10.3390/ neurolint13020019 Academic Editor: Takehiko Yanagihara Received: 8 January 2021 Accepted: 31 March 2021 Published: 6 May 2021 Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affil- iations. Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). 1 Neuroscience Centre, Neurology Department, King Fahad Specialist Hospital-Dammam, Dammam 31444, Saudi Arabia; Sameeh.Omar@kfsh.med.sa (S.A.); Naif.Zahrani@kfsh.med.sa (N.A.-Z.); sbashir10@gmail.com (S.B.) 2 Neurology Division, Medical Department, Dammam Medical Complex, Dammam 31444, Saudi Arabia; Ysharahely@moh.gov.sa * Correspondence: talal563@yahoo.com; Tel.: +96-6138442222 (ext. 2270/2278); Fax: +96-6138150315 Abstract: Guillain–Barré syndrome (GBS) is an acute, immune-mediated inflammatory peripheral polyneuropathy characterized by ascending paralysis. Most GBS cases follow gastrointestinal or chest infections. Some patients have been reported either following or concomitant with head trauma, neurosurgical procedures, and rarely hemorrhagic stroke. The exact pathogenesis is not entirely understood. However, blood–brain barrier damage may play an essential role in triggering the autoimmune activation that leads to post-stroke GBS. Here, we present two cases of fulminant GBS following hemorrhagic stroke to remind clinicians to be aware of this rare treatable complication if a stroke patient develops unexplainable flaccid paralysis with or without respiratory distress. Keywords: Guillain–Barré syndrome; Guillain–Barré following stroke; intracranial hemorrhage; hemorrhagic stroke complicated by radiculopathy 1. Introduction Guillain, Barré, and Strohl first reported Guillain–Barré syndrome (GBS), or acute inflammatory demyelinating polyradiculoneuropathy, in 1916 [1]. It is characterized by acute ascending progressive weakness, areflexia, and dysautonomia [2]. Clinically, the incidence of GBS is rare, at 0.8–1.9/100,000 people/year [1]. Several subtypes of GBS are well recognized, including acute inflammatory demyelinating polyradiculoneuropathy (AIDP), acute motor axonal neuropathy (AMAN), acute motor-sensory axonal neuropathy (AMSAN), and Miller Fisher syndrome (MFS). GBS is thought to result from an immune response that leads to acute polyneuropathy. It is often triggered by an antecedent infection. Two-thirds of patients report symptoms suggesting an initial respiratory or gastrointestinal disease [3]. A minority of patients develop GBS following a vaccine, bone marrow transplant, neurosurgery, or head trauma. However, in the last few years, growing reports about the concurrence of GBS with unusual events like intracerebral hemorrhage (ICH) have increased with unfavorable prognosis due to cardiovascular autonomic instability [4]. Here, we report two cases of patients who were diagnosed with GBS following hem- orrhagic stroke. The first patient developed GBS after endovascular mechanical thrombec- tomy for acute ischemic stroke complicated by a hemorrhagic transformation. In compari- son, the second patient developed GBS after hematoma evacuation. 2. Case Presentation 2.1. Case 1 The patient was a 74-year-old right-handed woman. She was known to have type 2 diabetes (DM), hypertension (HTN), and dyslipidemia. She presented to the emergency department (ED) after six hours of left-sided weakness and dysarthria in February 2019. Neurol. Int. 2021, 13, 190–194. https://doi.org/10.3390/neurolint13020019 https://www.mdpi.com/journal/neurolint