Bilateral Ptosis with Hypoglossal Nerve Palsy in Guillain-Barre Syndrome: A Rare Presentation

Abstract

Cranial nerve involvement in Gullian-barre syndrome (GBS) is common and a well-known fact, however there are few studies only focusing on cranial nerve involvement in GBS. We here describe a 12 yrs old boy presented with flaccid quadruparesis and respiratory distress. There was inability to elevate both the upper eyelids, deviation of tongue to the right and deviation of angle of mouth to the left. The patient was treated with IVIG (2 mg/kg) and was ventilated in volume control mode for 10 days and then tracheostomy tube was inserted, which was removed after 2 wks. Patient achieved complete recovery of all 4 limbs with no residual neurodeficit. Though cranial nerves are involved frequently in GBS but bilateral 3rd nerve involvement manifesting as bilateral ptosis and 12th nerve involvement are very rare till date and if managed early with IVIG the recovery is remarkable in pediatric age group.