Acute Facial Dyplegia and Rhabdomyolisis: Case Report and Review of Literature

Abstract

In 1916, Guillain, Barre and Strohl reported on two cases of acute flaccid paralysis with high cerebrospinal fluid protein levels and normal cell counts-novel findings that identified the disease we now know as Guillain–Barre syndrome (GBS). 100 years on, we have made great progress with the clinical and pathological characterization of GBS. GBS is an acute/subacute-onset polyradiculoneuropathy typically presenting with sensory symptoms and weakness over several days, often leading to quadriparesis. Approximately 70% of patients report a recent preceding upper or lower respiratory tract infection or gastrointestinal illness. The interplay between the microbial and host factors that dictate whether and how the immune response shifts towards autoreactivity is still unclear, and nothing is known about the genetic and environmental factors that affect an individual's susceptibility to the disease. Facial Diplegia with Paresthesias is a rare localized variant of GBS in which patient presents with simultaneous facial diplegia, distal limb paresthesias and minimal or no motor weakness. Treatment with intravenous immunoglobulin or plasma exchange is the optimal management approach, alongside supportive care. A common misconception is that the Guillain–Barre syndrome has a good prognosis-but up to 20% of patients remain severely disabled and approximately 5% die, despite immunotherapy. We report the case of a woman with acute facial dyplegia and rhabdomyolisis improved after immunoglobulin treatment.