Atypical Clinical Features of Guillain Barré syndrome

Abstract

Guillain-Barré syndrome (GBS) is a heterogeneous group of acute immune-mediated polyradiculoneuropathy. The cardinal clinical features of GBS include progressive and symmetric muscle weakness accompanied by the absence of deep tendon reflexes as well as acute tetraplegia and respiratory failure. In addition, more benign or atypical forms might also occur. Atypical GBS is a heterogeneous disorder with various clinical presentations. We reported a case of a 29-year-old woman presenting with a complaint of sudden weakness in all four extremities during the last 10 days, preceded by a history of upper respiratory tract infection 3 weeks prior. She experienced paresthesia in all palms and feet. The patient also had difficulty urinating and experienced constipation for 1 week. On physical examination, peripheral tetraparesis and segmental ecteroceptive sensory disturbances were found at the 5th level of myelo-cervical segment and below. Neurological exam showed reduced deep tendon reflexes in lower extremities. In addition, urinary retention and constipation were found. She was suspected of having myelitis based on clinical symptoms. Serial EMG examination showed demyelinating polyradiculoneuropathy. Cerebrospinal fluid examination revealed cytoalbumin dissociation suggesting GBS. Cervicothoracic MRI imaging showed no abnormalities. The patient was diagnosed with GBS that clinically improved without receiving any IVIG or plasmapheresis therapy.