Guillain-Barré syndrome （GBS） often involves the autonomic nervous system and may present with extensive panautonomic dysfunction or localized autonomic dysfunction. Some patients may have autonomic impairment as the only symptom， which can lead to missed diagnosis or misdiagnosis. A male patient， aged 49 years， who had fever 1 week before disease onset was admitted to the Department of Neurology， People's Hospital of Suzhou Gaoxin District. The patient suddenly developed dizziness， vomiting， and unsteady gait two days before admission and had difficulty in urination one day before admission， and on the day of admission， he was admitted to the Department of Urology due to inability to urinate. He was transferred to the Department of Neurology on day 4 after admission. Physical examination showed postural hypotension and active tendon reflex. Lumbar puncture on day 4 after admission showed a slight increase in white blood cell count in cerebrospinal fluid， while albuminocytologic dissociation was not observed， and laboratory examination showed positive anti-GM1 IgG antibodies in serum. The patient was treated with gamma-globulin at a dose of 0.4 g/kg daily for 5 days， and the symptoms disappeared. Some patients with GBS only have localized autonomic dysfunction， and the patient in this study only had inability to urinate and postural hypotension. Therefore， the possibility of GBS should be considered for patients with acute urinary retention. Gamma-globulin is effective for the treatment of GBS. ［Journal of International Neurology and Neurosurgery, 2023, 50(3): 47-50］