Guillain-Barre syndrome presenting with an 'angina' mimic and posterior reversible encephalopathy syndrome

A 56-year-old woman presented with severe headache, blurring of vision, hypertensive emergency and severe crushing central chest pain. Extensive evaluation was undertaken to rule out sinister myocardial, pulmonary and mediastinal pathology. Pain relief required intravenous opiates. One week later, persistent complaints of numbness of hands and legs led to a suspicion of dysautonomic inflammatory neuropathy. Nerve conduction studies confirmed a demyelinating Guillain-Barre syndrome. Intravenous immunoglobulin treatment led to rapid resolution of pain, dysautonomia and neuropathic symptoms.