GBS is an acute immune-mediated polyradiculoneuropathy associated with various infectious and non-infectious triggers. Recently, several case reports have described the development of GBS following ICH, a rare association that poses significant diagnostic and therapeutic challenges. However, comprehensive data regarding the clinical features, diagnosis, and management of this rare association are lacking.

We systematically searched PubMed and EMBASE from inception till February 2025 for case reports of GBS following ICH. Two reviewers independently screened articles, extracted data, and assessed methodological quality using the JBI Critical Appraisal Checklist for Case Reports. We then synthesized the data narratively.

Twenty-three cases from 11 countries were identified (14 males, mean age of 60.1 years). Onset of GBS occurred after a median of 9 days (range 2-24) post-ICH, with intracerebral hemorrhage being the most common antecedent (39.1%), followed by subarachnoid (26.1%) and subdural hemorrhage (21.7%). Electrophysiology revealed a predominance of axonal variants (47.8%), while CSF consistently demonstrated albuminocytologic dissociation with positive antiganglioside antibodies in five cases. The clinical course was severe, marked by rapid progression to nadir (median 2.5 days), profound functional impairment (mean Hughes Functional Grading Scale: 4.78 ± 0.90), and a high rate of respiratory failure requiring mechanical ventilation (47.8%). Among the 21 patients who received immunomodulatory treatment, 4 (19.0%) showed complete recovery, 13 (61.9%) had partial recovery, and 2 (9.5%) had a poor recovery. Overall, four patients (17.4%) died, including the two who did not receive immunomodulatory treatment.

GBS may complicate recovery after ICH and appears to present with an aggressive course characterized by rapid progression and high rates of respiratory failure. Clinicians should consider GBS when patients with ICH develop progressive, symmetrical weakness unexplained by the initial brain injury, as prompt initiation of immunotherapy may improve outcomes.