Hallucinations in Guillain-Barré Syndrome

Mr. A, a 76-year-old man, was admitted to the hospital with rapidly decreasing motor strength and was subsequently diagnosed with Guillain-Barré syndrome. During the first few days of hospitalization, he reported seeing cats in a large cage and people coming into his room to give lumber to his doctor. His weakness rapidly progressed, necessitating intubation and a 6-week stay in the intensive care unit. At extubation, he reported having been raped by a staff member. His description of the act of sodomy was highly implausible and did not stand up to investigation.

Over the next 6 months, the lack of return of his motor strength was disappointing. He regained only slight movement in his proximal upper and lower extremities. He continued to describe unusual experiences. These included seeing pictures floating in his room and the recurrent sensation that “plastic worms” were writhing in his hands. A particularly disturbing and recurrent sensation that occurred on awakening was that of being suspended over an open chasm. This would abruptly disappear when nursing staff spoke to him. The sensation bore a striking resemblance to sleep paralysis, differing primarily in its length (lasting many minutes). Mr. A, in retrospect, admitted that these unusual experiences must have been “fantasies.” He displayed no evidence of ongoing delusions, delirium, or any psychotic symptoms other than the experiences described. The addition of a low dose of trazodone (50 mg/day) and haloperidol (0.5 mg at bedtime) had no significant effect on his symptoms. Over time his physical sensations lessened only slightly, but the fantasies associated with them faded to a greater extent.