Mielopathy’s Like Symptom in Guillain Barre Syndrome: Case Report

Abstract

Background: Guillain-Barré syndrome (GBS) is a peripheral nervous system inflammatory disease that is the most prevalent cause of acute flaccid paralysis, with an annual global incidence of 1-2 per 100,000 person-years. GBS typically appears with acute ascending flaccid paralysis and sensory abnormalities in anesthetic glove stockings; paralysis may extend to cranial muscles. Although the disease’s clinical presentation is diverse and there are multiple discrete clinical forms, myelopathy as a sign of GBS is a relatively unusual condition. Case presentation: GBS is diagnosed in a 29-year-old woman with myelopathy symptoms such as tetraparesis, hypoesthesia below the level of second thoracal myelum, aberrant proprioceptive in lower extremities, retention of urine and anhidrosis. We perform a lumbar puncture, and a cerebrospinal fluid (CSF) examination reveals albumin-cytological dissociation. Cervico-thoracic magnetic resonance imaging (MRI) revealed no abnormalities. Demyelinating polyradiculopathy was discovered using electromyography (EMG) and nerve conduction studies (NCS). Discussion: The classical presentation of GBS is progressive (ascending) limb weakness with decreased or absent physiological reflexes. Pharyngeal–cervical–brachial variation and face diplegia with paraesthesia are rare variations of GBS. Our patient presented with ascending limb weakness accompanied by a disturbance in the central nervous system but had similiar serological biomarker, which may be another rare variant of GBS. Conclusion: Diagnosis of GBS is quite challenging. GBS has a wide range of clinical symptoms. EMG-NCV and lumbar puncture are still required in myelopathic individuals with normal MRI, and unusual GBS symptoms should be explored. As a result, the choice of therapy and management becomes more appropriate.