Guillain –Barre syndrome AND central nervous system involvement: Two case reports

Abstract

Although Guillain Barre Syndrome (GBS) is generally considered as a peripheral neuropathy, there is evidence of central impairment explaining the observed atypies. We report the case of two patients who had a GBS with hyperreflexia and a Babinski sign. Two patients (23 and 70 years old) had simultaneous 4-limb weakness in less than 6 hours (aged patient) and 6-day ascending motor deficit (young). The examination revealed a tetraplegia with hyperreflexia in both patients with a Babinski sign (young patient ). Facing tetraplegia associated with an albumino-cytological dissociation in the cerebrospinal fluid (young), the normality of the spinal imaging as well as the electrophysiological results in favor of an acute motor axonal polyradiculoneuropathy, the diagnosis of pure motor GBS (AMAN) was retained.Immunoglobulins were introduced with a favorable evolution (young). The elderly patient developed on the first day a respiratory distress requiring ventilatory support despite the early treatment. Our patients had a GBS with hyperreflexia and a Babinski sign requiring spinal imaging to eliminate a central lesion that could mimic these symptoms. In fact, in the pure motor forms (AMAN) and pharyngo-cervico-brachial syndrome (variant of GBS), the osteotendinous reflexes can be present even increased with clonus suggesting an associated central nervous system involvement. The clinical atypia of the GBS are more and more described. Their lack of knowledge could delay the early management.