Guillain–Barré syndrome variant with prominent facial diplegia, limb paresthesia, and brisk reflexes

Abstract

Dear Sirs, Guillain-Barresyndrome (GBS) is an acute monophasic neuropathic disorder of autoimmune origin. Rare GBS variants have been described, including Fisher's syndrome (2) and subtypes that present predominantly with lower cranial nerve involvement or pure brachio-pharyngeal weakness (10). Another condition that has been suggested to be part of the GBS spectrum is characterized by prom- inent facial diplegia and limb paresthesia with no or only mild motor deficits. This condition was first outlined by Ropper on the basis of four cases (7) and characterized in more detail by Susuki and colleagues in a recent issue of this journal (9). We report here a patient who presented initially with unilateral Bell's palsy, brisk tendon reflexes, and normal CSF examination, who subsequently developed the full clinical picture of the syndrome described by Ropper and Susuki including bilateral facial paresis, limb paresthesia, and albuminocytologic dissociation. Notably, our patient did not respond to corticosteroid treatment but symptoms resolved rapidly upon treatment with IVIg. A 33-year-old man presented with facial muscle weak- ness on the right side. Symptoms had started 3 days earlier with unilateral right neck pain and were accompanied by slight paresthesia in the limbs. The pain resolved, but the other symptoms progressed over the next 72 h. Anteceding gastrointestinal or airway infection were denied.